Abstract
Purpose
The implications of surgical intervention for neuroblastomas were assessed in one institution.
Methods
We analyzed the clinical characteristics and extension of resection in 123 pediatric patients with neuroblastoma diagnosed between 1985 and 2004.
Results
The 5-year survival rate of the 82 patients under 12 months of age, 59 of whom were treated with complete resection of the primary tumor, was 97%. The 5-year survival rate of the 41 patients over 12 months of age did not differ significantly according to whether complete (n = 19) or incomplete resection (n = 22) was performed (46 vs. 38%, respectively). No local recurrence was observed in ten patients over 12 months of age with stage 4 disease who underwent complete resection of the primary tumor; however, four of these ten patients died of metastatic recurrence.
Conclusion
Considering that the majority of infantile neuroblastomas in this study had favorable biology, complete resection might be unnecessary for patients under 12 years of age. For advanced neuroblastomas in patients over 12 months of age, the main treatment for metastasis is systemic chemotherapy, although extirpation of the primary tumor without extensive surgery might prevent local recurrence when combined with radiation therapy.
References
Crist WM, Kun LE. Common solid tumors of childhood. N Engl J Med. 1991;324:461–71.
Bodeur GM. Molecular basis for heterogeneity in human neuroblastoma. Eur J Cancer. 1995;31:505–10.
Tajiri T, Shono K, Tanaka S, Suita S. Evaluation of genetic heterogeneity in neuroblastoma. Surgery (St. Louis). 2002;131:283–7.
Kubota M. The role of surgery in the treatment of neuroblastoma. Surg Today. 2010;40:526–32.
Tanaka S, Tajiri T, Noguchi S, Ihara K, Hara T, Suita S. Clinical significance of a highly sensitive analysis for gene dosage and the expression level of MYCN in neuroblastoma. J Pediatr Surg. 2004;39:63–8.
Brodeur GM, Pritchard J, Berthold F. Revision of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol. 1993;11:1466–77.
Matsumura T, Sawada T, Shikata T. New trend in treatment strategy for neuroblastoma infants in Japan. Proceedings of the 32nd Annual Meeting of American Society of Clinical Oncology. J Clin Oncol. 1996;15:461.
Iehara T, Hosoi H, Akazawa K, Matsumoto Y, Suita S, et al. MYCN gene amplification is a powerful prognostic factor even in infantile neuroblastoma detected by mass screening. Br J Cancer. 2006;94:1510–5.
Kaneko M, Tsuchida Y, Uchino J, Takeda T, Iwafuchi M, Ohnuma N, et al. Treatment results of advanced neuroblastoma with the First Japanese Study Group Protocol. J Pediatr Hematol Oncol. 1999;21:190–7.
Kaneko M, Tsuchida Y, Mugishima H, Ohnuma N, Yamamoto K, Kawa K, et al. Intensified chemotherapy increases the survival rates in state 4 neuroblastoma with MYCN amplification. J Pediatr Hematol Oncol. 2002;24:613–21.
Brodeur GM, Maris JM, Yamashiro DJ. Biology and genetics of human neuroblastomas. J Pediatr Hematol Oncol. 1997;19:93–101.
Suita S, Tajiri T, Kaneko M, Hirai M, Mugishima H, Sugimoto T, Tsuchida Y. Implications of MYCN amplification in patients with stage 4 neuroblastoma who undergo intensive chemotherapy. J Pediatr Surg. 2007;42:489–93.
Suita S, Tajiri T, Higashi M, Tanaka S, Kinoshita Y, Takahashi Y, et al. Insights into infant neuroblastomas based on an analysis of neuroblastomas detected by mass screening at 6 months of age in Japan. Eur J Pediatr Surg. 2007;17:23–8.
Yamamoto K, Hanada R, Tanimura M, Aihara T, Hayashi Y. Natural history of neuroblastoma found by mass screening. Lancet. 1997;349:1102.
Cecchetto G, Mosseri V, De Bernardi B. Surgical risk factors in primary surgery for localized neuroblastoma: the LNESG1 study of the European International Society of Pediatric Oncology Neuroblastoma Group. J Clin Oncol. 2005;23:8483–9.
Simon T, Hero B, Bohm GB, Schweinitz D, Berthold F. Review of image defined risk factors in localized neuroblastoma patients: results of the GPOH NB97 trial. Pediatr Blood Cancer. 2008;50:965–9.
La Quaglia MP, Kushner BH, Heller G. Stage 4 neuroblastoma diagnosed at more than 1 year of age: gross total resection and clinical outcome. J Pediatr Surg. 1994;29:1162–6.
Adkins ES, Sawin R, Gerbing RB, London WB, Matthay KK, Haase GM. Efficacy of complete resection for high risk neuroblastoma: a Children’s Cancer Group study. J Pediatr Surg. 2004;39:931–6.
Kuroda T, Saeki M, Honna T. Clinical significance of intensive surgery with intraoperative radiation for advanced neuroblastoma: does it really make sense? J Pediatr Surg. 2003;38:1735–8.
Castel V, Tovar JA, Costa E. The role of surgery in stage IV neuroblastoma. J Pediatr Surg. 2002;37:1574–8.
Kaneko M, Ohkawa H, Iwakawa M. Is extensive surgery required for treatment of advanced neuroblastoma? J Pediatr Surg. 1997;32:1616–9.
Acknowledgments
This work was supported in part by a grant-in-aid for scientific research from the Japanese Society for the Promotion of Science.
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Tajiri, T., Souzaki, R., Kinoshita, Y. et al. Implications of surgical intervention in the treatment of neuroblastomas: 20-year experience of a single institution. Surg Today 42, 220–224 (2012). https://doi.org/10.1007/s00595-011-0053-0
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DOI: https://doi.org/10.1007/s00595-011-0053-0