Neuroblastoma | Spontaneous Remission Database

Abstract

The frequency with which childhood cancers are observed increases annually. In the experience of the Pediatric Department of Memorial Hospital for Cancer and Allied Diseases neuroblastoma is foremost in incidence among the solid malignant tumors that occur in children. This review of 236 cases emphasizes features of clinical significance in diagnosis, therapy, and prognosis. The diagnosis is quite readily made in some instances, while in others it may present insurmountable difficulties. Plans for treatment require considerations regarding the site, or in metastatic cases sites, the operability of the tumor, and the use of pre- or postoperative irradiation and chemotherapy. The method of management must often be altered by the problems encountered in the individual case. There is now a larger number of survivors and metastatic disease does not always indicate a fatal prognosis. Recognition of the not infrequent bizarre clinical course, at times resulting in even ‘spontaneous’ arrest, makes caution in the appraisal of therapeutic successes mandatory.

Case Details

Personal Characteristics

58 untreated cases, 20 infants under 1 year, 25 children treated conventionally, 46 children treated with vitamin b12

Clinical Characteristics

The single most important prognostic factor was found to be the age at symptomatic onset of the disease, the critical division being less than or over the age of one year. This biological difference was not overt in the untreated group, which included 20 infants under 1 year. Only 1 of these survived, the sole instance of complete spontaneous regression among the 129 children in the whole series. The average period of survival among the 19 fatal cases in infancy was merely 3 months. The conventionally treated group of 25 children included 9 infants, five of whom, all without any evidence of metastases, survived. Of the four fatal cases, three showed evidence of secondary spread, and the average survival period among the fatal cases in this group was 8 1/2 months. Survival seemed to be of a high order when onset in infancy was coupled with absence of metastases. Of the vitamin b12-treated group of 46 children, 4 were not evaluated, owing to their followup period being less than 1 year. Of the 42 remaining children, 17 manifested the disease in infancy, and all of these showed clinical remission, in spite of secondary spread, except to the skeleton, in all but 4 instances. Maintained remission for periods of 1 to 8 years in 13, complete regression of tumour in a child succumbing to poliomyelitis, and temporary remission with ultimate recurrence of disease and fatal issue in 3 further cases is the score at present. The average period of survival among the 4 fatal cases with onset in infancy in this group was 19 months. Remission of tumour in the age group over 1 year was much less common; it was observed in 5 of the 25 cases so defined.

Remission Characteristics

Maintained remission for periods of 1 to 8 years in 13, complete regression of tumour in a child succumbing to poliomyelitis, and temporary remission with ultimate recurrence of disease and fatal issue in 3 further cases

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Local forms of treatment, i.e., surgery and/or radiotherapy

Non-Clinical Treatment

Massive doses of vitamin b12 with or without surgery and/or radiotherapy