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About SickKids

March 31, 2014

Site of cancer spread in neuroblastoma may give insight to improved patient outcomes, says SickKids study

By Rebecca Milec

One of the best ways to determine outcomes for neuroblastoma patients is metastasis – cancer spreading to other parts of the body. While cancer can spread to many different sites in the body, the association between its location and the patient’s prognosis has not been widely studied. Researchers at The Hospital for Sick Children (SickKids) have found that patients with a particular subtype of neuroblastoma metastasis may have better outcomes, thus possibly requiring less intensive therapy. The study was published in the March 24 issue of Journal of Clinical Oncology.

Neuroblastoma is a tumour of the nervous system and is the third most common paediatric cancer. Survival for children with high-risk metastatic neuroblastoma is less than 40 per cent.  Dr. Meredith Irwin, Staff Physician in Haematology/Oncology and Senior Scientist in Cell Biology at SickKids, Dr. Daniel Morgenstern, a former fellow in Haematology/Oncology, and colleagues looked specifically at Stage 4 neuroblastoma that has spread to distant lymph nodes (4N disease).  The study found that 4N patients had a better outcome, with a higher chance of being cancer-free after five years than other patients with metastasis. Therefore, these patients may need less intense treatment.

“Intensive therapy can have adverse effects on the body, including hearing loss and damage to the heart, lungs, kidneys and reproductive organs. Complications can be worse for young children, as their bodies are not as large or strong as adults to handle such strong toxins,” says Irwin. “Learning that 4N patients may not need such strong treatment could help to reduce the frequency and severity of these long-term side-effects.”

Many small case reports and studies had suggested that 4N patients had better outcomes, but to verify this, Irwin and her colleagues needed to study a large sample of patients. To achieve this they used the International Neuroblastoma Risk Group (INRG) database, which brings together patient data from North America, Europe, Australia and Japan. Large collaborative international databases are extremely important, explains Irwin. Although neuroblastoma is the third most common paediatric cancer, there are only 60 cases per year in Canada. Without international data, it would be very difficult to perform studies on small subgroups with different patterns of disease.

The study suggests that 4N patients may have improved outcomes because of underlying genetic and biological differences between their tumours and non-4N tumours. They are currently exploring differences in genetic data to gain insights into the biology of neuroblastoma metastasis.

This research was supported by James Birrell Fund for Neuroblastoma Research and Morgenstern’s fellowship was funded in part by the Garron Family Cancer Centre, Sears Fellowship and Restracomp.