Abstract
The factors that affect survival in patients with stage 4 neuroblastoma vary. Several prospective and retrospective studies have provided conflicting conclusions regarding the benefit of combining aggressive chemotherapy with complete surgical resection. We analyzed our experience to evaluate the effect of complete surgical resection of the primary tumor on survival when disseminated disease has been controlled by chemotherapy. We retrospectively reviewed the medical records of 44 consecutive children with neuroblastoma treated between 1990 and 2000. Twenty-six children with stage 4 disease were enrolled. Most were treated with surgical resection combined with chemotherapy. The survival rate was compared based on the timing (primary versus delayed until chemotherapy had been given) and results of surgery (complete tumor resection, microscopic residual disease, and gross residual disease). The mean survival (52.8 months) of children with delayed complete surgical resection (CSR) was statistically superior to that of those with microscopic residual (20.8 months, p=0.0111) or gross residual tumor (12.2 months, p=0.0141). In the CSR group, 1-, 2-, 3-, and 5-year survival rates were 88%, 77%, 77%, and 65%, respectively, vs. 80%, 40%, 20%, and 0% in the microscopic residual group. In conclusion, complete resection of the primary tumor with no residual disease was associated with improved survival in children with advanced neuroblastoma whose metastatic disease had been controlled by chemotherapy.
Similar content being viewed by others
References
Ogita S, Tokiwa K, Majima S (1985) An evaluation of surgical treatment and chemotherapy of advanced neuroblastoma (stages III and IV) with special reference to proliferation kinetics of residual tumor. J Pediatr Surg 20:150–154
Tsuchida Y, Yokoyama J, Kaneko M, et al. (1992) Therapeutic significance of surgery in advanced neuroblastoma: a report from the study group of Japan. J Pediatr Surg 27:616–622
Haase GM, O’Leary MC, Ramsay NKC, et al. (1991) Aggressive surgery combined with intensive chemotherapy improves survival in poor-risk neuroblastoma. J Pediatr Surg 26:1119–1124
Matsumura M, Atkinson JB, Hays DM, et al. (1988) An evaluation of the role of surgery in metastatic neuroblastoma. J Pediatr Surg 23:448–453
Brodeur GM, Pritchard J, Berthold F, et al. (1993) Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol 11:1466–1477
Shafford EA, Rogers DW, Pritchard J (1984) Advanced neuroblastoma: improved response rate using a multiagent regimen (OPEC) including sequential cisplatin and VM-26. J Clin Oncol 2:742–747
Bowman LC, Hancock ML, Santana VM, et al. (1991) Impact of intensified therapy on clinical outcome in infants and children with neuroblastoma: the St. Jude Children’s Research Hospital experience, 1962–1988. J Clin Oncol 9:1599–608
Chamberlain RS, Quinones R, Dinndorf P, et al. (1994) Complete surgical resection combined with aggressive adjuvant chemotherapy and bone marrow transplantation prolongs survival in children with advanced neuroblastoma. Ann Surg Oncol 2:93–100
Kiely EM (1994) The surgical challenge of neuroblastoma. J Pediatr Surg 29:128–133
Haase GM, Wong WY, de Lorimier AA, et al. (1989) Improvement in survival after excision of primary tumor in stage III neuroblastoma. J Pediatr Surg 24:194–200
Berthold F, Hero B (2000) Neuroblastoma—current drug therapy recommendations as part of the total treatment approach. Drugs 59:1261–1277
La Quaglia MP (2001) Surgical management of neuroblastoma. Semin Pediatr Surg 10:132–139
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koh, CC., Sheu, JC., Liang, DC. et al. Complete surgical resection plus chemotherapy prolongs survival in children with stage 4 neuroblastoma. Ped Surgery Int 21, 69–72 (2005). https://doi.org/10.1007/s00383-004-1353-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-004-1353-x