Abstract
Purpose
For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection.
Methods
The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group.
Results
Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive.
Conclusions
For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Grosfeld JL (2006) Neuroblastoma. In: Grosfeld JL, O’Neill JA, Fonkalsrud EW, Coran AG (eds) Pediatric surgery, 6th edn. Mosby, St. Louis, pp 467–494
Matthay KK, Perez C, Seeger RC et al (1998) Successful treatment of stage III neuroblastoma based on prospective biologic staging: a Children’s Cancer Group study. J Clin Oncol 16:1256–1264
Adkins ES, Sawin R, Gerbing RB et al (2004) Efficacy of complete resection for high-risk neuroblastoma: a Children’s Cancer Group study. J Pediatr Surg 39:931–936
Michon J, De Bernardi B, Rubie H et al (2000) Surgery as the only treatment for INSS stage 2 neuroblastoma: risk factors predicting relapse. Med Pediatr Oncol 35:758
La Quaglia MP, Kushner BH, Su W et al (2004) The impact of gross total resection on local control and survival in high-risk neuroblastoma. J Pediatr Surg 39:412–417
Stram DO, Matthay KK, O’Leary M et al (1996) Consolidation chemoradiotherapy and autologous bone marrow transplantation versus continued chemotherapy for metastatic neuroblastoma: a report of two concurrent Children’s Cancer Group studies. J Clin Oncol 14:2417–2426
Kiely EM (1993) Radical surgery for abdominal neuroblastoma. Semin Surg Oncol 9:489–492
Reynolds CP, Matthay KK, Villablanca JG et al (2003) Retinoid therapy of high-risk neuroblastoma. Cancer Lett 197:185–192
Matthay KK, Villablanca JG, Seeger RC et al (1999) Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis retinoic acid. N Engl J Med 341:1165–1173
Ryu KH, Ahn HS, Koo HH et al (2003) Autologous stem cell transplantation for the treatment of neuroblastoma in Korea. J Korean Med Sci 18:242–247
Lode HN, Xiang R, Dreier T et al (1998) Natural killer cell-mediated eradication of neuroblastoma metastases to bone marrow by targeted interleukin-2 therapy. Blood 91:1706–1715
Vivancos P, Granena A (1999) Treatment with interleukin-2 (IL-2) and interferon after autologous bone marrow or peripheral blood stem cell transplantation in onco-hematological malignancies with a high risk of relapse. Bone Marrow Transplant 23:169–172
Ladenstein R, Phillip T, Lasset C et al (1998) Multivariate analysis of risk factors for stage 4 neuroblastoma over the age of one year treated with mega therapy and stem cell transplantation: a report from the European Bone Marrow Transplantation Solid Tumor Registry. J Clin Oncol 16:953–965
George RE, Li S, Medeiros-Nancarrow C, Neuberg D et al (2006) High-risk neuroblastoma treated with tandem autologous peripheral-blood stem cell-supported transplantation: long-term survival update. J Clin Oncol 20:2891–2896
Matthay KK, Reynolds CP, Seeger RC et al (2009) Long-term results for children with high-risk neuroblastoma treated on a randomized trial of myeloablative therapy followed by 13-cis-retinoic acid: a children’s oncology group study. J Clin Oncol 27:1007–1013
Handgretinger R, Greil J, Schürmann U et al (1997) Positive selection and transplantation of peripheral CD34+ progenitor cells: feasibility and purging efficacy in pediatric patients with neuroblastoma. J Hematother 6:235–242
Lode HN, Handgretinger R, Schuermann U et al (1997) Detection of neuroblastoma cells in CD34+ selected peripheral stem cells using a combination of tyrosine hydroxylase nested RT-PCR and anti-ganglioside GD2 immunocytochemistry. Eur J Cancer 33:2024–2030
Häfer R, Voigt A, Gruhn B et al (1999) Neuroblastoma cells can express the hematopoietic progenitor cell antigen CD34 as detected at surface protein and mRNA level. J Neuroimmunol 96:201–206
Castel V, Tovar JA, Costa E et al (2002) The role of surgery in stage IV neuroblastoma. J Pediatr Surg 37:1574–1578
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moon, SB., Park, KW., Jung, SE. et al. Neuroblastoma: treatment outcome after incomplete resection of primary tumors. Pediatr Surg Int 25, 789–793 (2009). https://doi.org/10.1007/s00383-009-2417-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-009-2417-8