Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2020; 11(8): 629-643
Published online Aug 24, 2020. doi: 10.5306/wjco.v11.i8.629
Management of neuroblastoma in limited-resource settings
Jaques van Heerden, Mariana Kruger
Jaques van Heerden, Mariana Kruger, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
Jaques van Heerden, Department of Paediatric Haematology and Oncology, Antwerp University Hospital, Edegem 2650, Belgium
Author contributions: van Heerden J conceptualised and designed the study, sourced and screened articles, collected the data and performed the data analysis and wrote the manuscript; Kruger M conceptualised and designed the study, evaluated the source articles and critically reviewed and edited the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have not been adopted, because the review is a descriptive review.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jaques van Heerden, MD, Doctor, Department of Paediatric Haematology and Oncology, Antwerp University Hospital, No. 10 Wilrijkstreet, Edegem 2650, Belgium.
Received: April 28, 2020
Peer-review started: April 28, 2020
First decision: June 20, 2020
Revised: June 23, 2020
Accepted: July 26, 2020
Article in press: July 26, 2020
Published online: August 24, 2020

Neuroblastoma (NB) is a heterogeneous disease with variable outcomes among countries. Little is known about NB in low- and middle-income countries (LMICs).


The aim of this review was to evaluate regional management protocols and challenges in treating NB in paediatric oncology units in LMICs compared to high-income countries (HICs).


PubMed, Global Health, Embase, SciELO, African Index Medicus and Google Scholar were searched for publications with keywords pertaining to NB, LMICs and outcomes. Only English language manuscripts and abstracts were included. A descriptive review was done, and tables illustrating the findings were constructed.


Limited information beyond single-institution experiences regarding NB outcomes in LMICs was available. The disease characteristics varied among countries for the following variables: sex, age at presentation, MYCN amplification, stage and outcome. LMICs were found to be burdened with a higher percentage of stage 4 and high-risk NB compared to HICs. Implementation of evidence-based treatment protocols was still a barrier to care. Many socioeconomic variables also influenced the diagnosis, management and follow-up of patients with NB.


Patients presented at a later age with more advanced disease in LMICs. Management was limited by the lack of resources and genetic studies for improved NB classification. Further research is needed to develop modified diagnostic and treatment protocols for LMICs in the face of limited resources.

Keywords: Neuroblastoma, Limited resources, Management, Outcomes, Low- and middle-income countries

Core tip: Neuroblastoma (NB) is a childhood malignancy of the sympathetic system that accounts for a large percentage of the childhood malignancy mortality. The heterogenous presentation contributes to various treatment challenges especially in low- and middle-income countries (LMICs). NB in LMICs has not been investigated beyond single institutions, but the limited reports differ from those in high-income countries (HICs). The incidence of NB in LMICs has been reported to be lower than HICs, but the disease presents with a higher incidence of high-risk and advanced disease. Furthermore, the limited resources in these countries contribute to the challenges in the management of NB that leads to a high mortality rate. The genetic profile of NB in LMICs is also not known due to limited capacity to perform genetic investigations. This article aims to comprehensively describe NB in LMICs.