Neuroblastoma metastatic to the central nervous system: The Memorial Sloan-Kettering Cancer Center experience and a literature review Journal Article


Authors: Kramer, K.; Kushner, B.; Heller, G.; Cheung, N. K. V.
Article Title: Neuroblastoma metastatic to the central nervous system: The Memorial Sloan-Kettering Cancer Center experience and a literature review
Abstract: BACKGROUND. The central nervous system (CNS) can be a sanctuary site for cancer cells, because the blood-brain barrier impedes penetration of most chemotherapeutic agents. The authors hypothesized that, with improved survival from childhood metastatic neuroblastoma (NB), the incidence of CNS (intraparenchymal and leptomeningeal) spread may increase. They undertook this study to assess the frequency of CNS NB, to analyze risk factors and treatment options, and to review the literature. METHODS. The authors retrospectively analyzed all patients with metastatic NB who were treated on protocols N4, N5, N6, and N7 from 1980 to 1999 at Memorial Sloan-Kettering Cancer Center (MSKCC), during which time there was an increase in the overall survival rate. RESULTS. Two hundred fifty-one patients with Stage 4 NB (Group 251) were studied, of which 127 (Group 127) were newly diagnosed patients who were treated initially at MSKCC. None had CNS NB at the time of diagnosis. Eleven patients developed documented CNS disease; 8 of these 11 recurrences were isolated in the CNS. For Group 127, the overall incidence rate of CNS NB was 6.3%, with an increase in incidence from N4-N5 to N6-N7 of from 1.7% to 11.7%. Seven patients had isolated CNS disease recurrences. Only lumbar punctures (LP) performed near the time of diagnosis in patients with known bone marrow involvement were associated with subsequent development of CNS disease. For the entire group of 251 patients, lumbar puncture at the time of diagnosis and elevated serum lactic dehydrogenase levels were prognostic. Among the larger series reported in the literature, CNS involvement from metastatic lesions was rare at the time of diagnosis and remained an uncommon complication. CONCLUSIONS. The incidence of CNS NB may be increasing. Because it is the sole site of disease recurrence in 64% of patients, the CNS may represent a sanctuary site for NB. CNS NB is associated with diagnostic lumbar punctures in patients with known bone marrow disease, raising the possibility that circulating or dural microscopic tumor cells may seed the craniospinal axis. © 2001 American Cancer Society.
Keywords: cancer survival; child; bone neoplasms; child, preschool; survival analysis; retrospective studies; major clinical study; cancer recurrence; combined modality therapy; disease association; neoplasm recurrence, local; incidence; risk factors; retrospective study; risk factor; central nervous system neoplasms; lumbar puncture; infant; neuroblastoma; tumor cell; lactate dehydrogenase; adrenal gland neoplasms; bone marrow disease; bone marrow neoplasms; central nervous system metastasis; neoplasm circulating cells; central nervous system metastases; humans; prognosis; human; male; female; priority journal; article; lumbar punctures
Journal Title: Cancer
Volume: 91
Issue: 8
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2001-04-15
Start Page: 1510
End Page: 1519
Language: English
DOI: 10.1002/1097-0142(20010415)91:8<1510::aid-cncr1159>3.0.co;2-i
PUBMED: 11301399
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 21 May 2015 -- Source: Scopus
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MSK Authors
  1. Brian Kushner
    192 Kushner
  2. Glenn Heller
    303 Heller
  3. Nai-Kong Cheung
    447 Cheung
  4. Kim Kramer
    170 Kramer