Il neuroblastoma neonatale. Aspetti clinici, prognostici e terapeutici

Neuroblastoma (NB) is the most frequent neonatal tumor. The challenge of treating such tumor at this age is complicated by the physiology and developmental status of the newborn. Factors as the age-dependent maturation of various physiologic processes make neonates unusually susceptible to the detrimental effects of multimodal approaches involving surgery, chemotherapy and radiotherapy. The long-term effects of such antineoplastic therapies upon the developing neonates are only now becoming evident. On the other hand, twenty years ago only age and clinical stage of NB were the criteria employed in determining treatment and prognosis. Today the identification of certain clinical, genetic and biological features of NB allows a much better stratification of treatment, reserving a more aggressive treatment only to the high-risk patients. It is now evident that neonatal NB encompasses a subset of patients with favorable features and better outcome, in which an aggressive therapeutic approach is not necessary - and justifiable - in most cases. Such understanding is crucial before planning any treatment in a newborn with NB.