Follow up care for Neuroblastoma

Summary

Once primary treatment for NBL has been completed, survivors usually visit a doctor or cancer care provider for regular check-ups and consultations. The follow up regime for the NBL patients may differ among patients with low risk, intermediate risk and high risk NBL.

Introduction

Once primary treatment for NBL has been completed, survivors usually visit a doctor or cancer care provider for regular check-ups and consultations. This is called follow-up. How often cancer survivors should contact the doctors or care providers depends on many factors.

Monitoring for recurrence after treatment should be individualized and risk-based. Follow-up treatment in low- and moderate-risk patients typically involves imaging and measurement of urine and serum markers 1 to 2 months after completion of treatment and every 6 months for 5 years thereafter​1​. High-risk patients should be monitored monthly, as only a third can survive more than three to five years.

Late relapse of cancer is usually observed. In patients with relapse at age 5 (i.e., predominantly low-risk patients), the risk of recurrence 10 years after initial diagnosis is 3.4% and the overall survival rate for such population is 94%. In a multivariate analysis of patients with relapse at 5 years, age more than 1 year at diagnosis and stage IV disease were associated with a relative risk of failure of 4.2 and 10.5, respectively. Failure of organs among patients with stage IV disease surviving more than 5 years often include bones, bone marrow, and lymph nodes​2​.

Follow-up intervals for survivors >5 years should also be adjusted for risk factors such as age at diagnosis, N-myc amplification, Shimada histopathology, and serum markers. Follow-up periods longer than 5 years have yet to be determined, highlighting the need for risk-benefit and cost-benefit studies. Annual detection of urinary markers and ultrasonography is an appropriate approach for low-risk patients, and biannual follow-up are recommended for high-risk patients​3​.

The recommended follow-up for patients with neuroblastoma is summarised below:

Low risk

  • Imaging with urinary and serum markers 1 to 2 months after therapy.
  • Imaging and markers every 6 months for the first 5 years.
  • Imaging and markers every year after 5 years.

Intermediate risk

  • Imaging with urinary and serum markers 1 to 2 months after therapy.
  • Imaging and markers every 1 to 3 months for the first year.
  • Imaging and markers every 4 to 6 months for years 2 through 5.
  • Imaging and markers every year after 5 years.

High risk

  • Imaging with urinary and serum markers 1 to 2 months after therapy.
  • Imaging and markers every 1 to 3 months for the first 5 years.
  • Imaging and markers every 6 months after 5 years​3​.

References

  1. 1.
    Garaventa A, Boni L, Lo Piccolo MS, et al. Localized unresectable neuroblastoma: results of treatment based on clinical prognostic factors. Annals of Oncology. Published online June 2002:956-964. doi:10.1093/annonc/mdf165
  2. 2.
    Cotterill S, Pearson A, Pritchard J, Kohler J, Foot A, European Neuroblastoma Study Group and United Kingdom Children’s Cancer Study Group. Late relapse and prognosis for neuroblastoma patients surviving 5 years or more: a report from the European Neuroblastoma Study Group “Survey”. Med Pediatr Oncol. 2001;36(1):235-238. doi:
    3.