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
Research background

Neuroblastoma (NB) is a well-documented childhood malignancy with the greatest source of knowledge originating from high-income countries. The management of NB in low- and middle countries (LMIC) is less robust due to various social and resource limitations.

Research motivation

The outcomes of various LMIC during the same period like South America, Francophone/North African countries, Asia and South Pacific Islands was evaluated.

Research objectives

This literature review was to evaluate regional development of management protocols, the challenges in treating NB in paediatric oncology units in LMIC as compared to high-income countries, new laboratory and clinical developments in the treatment of NB.

Research methods

A literature review of publications searched on PubMed, Medline, Global Health, Embase, SciELO and Google Scholar with keywords in keeping with NB and outcomes. Due to the variability in reporting, nonstandard application of definitions in the reported clinical results, heterogeneous data and paucity of information, the authors constructed limited tables to evaluate clinical and/or biological characteristics to report in the descriptive review.

Research results

Childhood malignancy awareness and advocacy still face great challenges, especially in LMICs, in accurately diagnosing malignancies, especially heterogeneous tumours such as NB. The lack of uniform treatment protocols for this variable disease is still a barrier to care. Epidemiological data are reproducible in different international studies, but data from across the world are not uniform.

Research conclusions

More research regarding tumour biology, specifically genomics, is needed not only in high-income countries but also in LMICs to determine underlying differences in molecular biology of the tumours, genetic targets and drug processing of NB patients, especially in heterogeneous populations.

Research perspectives

The focus of research for LMICs should be on creating greater awareness in the diagnosis of NB, improving diagnostics and establishing social support strategies for successful, harmonised management protocols and homogenous treatment facilities to improve outcomes. In resource-limited settings, the need for genetic markers to develop more accurate risk classifications exists. A further challenge would be to make treatments and advanced diagnostics, such as liquid biopsies and biological tests, more widely available to all countries. With advanced disease, palliative research could contribute to a greater understanding of the role of metronomic therapies and disease control in the context of NB.