Neuroblastoma treatment in children: Single-center case series and review of the literature.
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OBJECTIVE: Description of the clinical presentation and tumor behavior, its general and pathological characteristics, diagnostic and therapeutic approaches, as well as treatment outcomes in children with neuroblastoma (NB) at a single-center. Special focus was placed on the duration of the diagnostic process and the correlation between disease stage, presence of metastases, and treatment outcomes. Given the small cohort, this report is presented as a descriptive case series complemented by a focused review of the literature NB. MATERIAL AND METHODS: A retrospective study was conducted for the time period from January 1st, 2010, to December 31st, 2024. The study included 13 patients (7 males, 6 females; median age: 44 months; range, 0-114) diagnosed with NB who underwent surgery and were hospitalized at the Department of Pediatric Surgery, Clinical Center of the University of Sarajevo. Demographic, clinical, biochemical, radiological, and treatment data were extracted from medical records. A narrative review of major published NB cohorts was conducted to compare our observations with existing evidence. RESULTS: The median age at diagnosis was 44 months. The largest number of patients were in the age group of 2-4 years, and most presented with stage four disease (according to International Neuroblastoma Staging System classification). The tumor was located in the adrenal gland in 92.3% of cases. The median survival time was 36 months. Patients had elevated serum neuron-specific enolase, urinary vanillylmandelic acid, as well as blood ferritin and lactate dehydrogenase levels. The most common symptoms were loss of appetite, presence of a palpable mass, and abdominal pain. Metastases were present in 76.9% of patients, and stage four was associated with aggressive metastatic dissemination. A multimodal approach was used in treatment. The median time from symptom onset to primary care physician consultation was 12 days, and the median time from physician consultation to diagnosis was 14 days. Relapse occurred in 46.2% of cases, most frequently in patients with stage four disease. A total of 7 patients (46.2%) survived. CONCLUSION: Advanced-stage disease at diagnosis, metastatic burden, and unfavorable outcomes, are dominating factors in our single-center experience. When compared with larger published cohorts, our findings align with global patterns. Due to inherent sample size limitations, these observations are hypothesis-generating and the need for larger, multicenter studies remains.