title: Short- and long-term outcome of patients with symptoms of spinal cord compression by neuroblastoma.
abstract: OBJECTIVE
  Prospective trials on neuroblastoma-induced myelopathy are lacking. Therefore, we retrospectively analysed patients in four national neuroblastoma trials.
  
  
  METHODS
  Neuroblastoma patients diagnosed between August 1989 and December 2008 were included. Clinical and molecular data were available in the national trials database. Additional details on neurological findings, treatment, and outcome were collected using a questionnaire.
  
  
  RESULTS
  Among 2603 patients, 122 (61 males and 61 females) had symptoms of spinal cord compression (SCC), and 99 of these were included in the final long-term analysis. The survival of patients with symptoms of SCC was better than that of patients without symptoms. Patients first presented with lower extremity motor impairment (95%), impaired cutaneous sensibility (58%), neuropathic pain (56%), bladder dysfunction (44%), and/or constipation (34%). Symptoms improved after first-line neurosurgery in 36 out of 52 patients and after first line chemotherapy in 30 out of 47 patients (p=0.77). After a median observation time of 8 years 1 month (range 1mo-19y 6mo), 71 out of 99 patients still had residual impairments: motor impairment (43%), scoliosis (31%), impaired bladder function (26%), constipation (19%), impaired cutaneous sensibility (17%), growth delay (14%), and neuropathic pain (5%). The initial treatment had no clear impact on the frequency of late effects.
  
  
  CONCLUSIONS
  This retrospective analysis showed no clear advantage of either first-line neurosurgery or chemotherapy and that most patients still exhibit residual symptoms and require specialized care.
authors.affiliation: Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Cologne, Germany. thorsten.simon@uk-koeln.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Catherina Annika
authors.initials: CA
authors.lastname: Niemann
authors.forename: Barbara
authors.initials: B
authors.lastname: Hero
authors.forename: Günther
authors.initials: G
authors.lastname: Henze
authors.forename: Meinolf
authors.initials: M
authors.lastname: Suttorp
authors.forename: Freimut H
authors.initials: FH
authors.lastname: Schilling
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D009447:Neuroblastoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult