Surgical treatment of neuroblastoma with micrometastasis.
OBJECTIVE
The aim of this study was to define the role of surgery in neuroblastoma with micrometastasis, which is detectable only by the polymerase chain reaction (PCR) method.


METHODS
Fifty samples (peripheral blood 9, bone marrow 41) were harvested sequentially from 27 neuroblastoma patients, and the micrometastases were examined using the previously described single-step PCR method. The results were reviewed with the clinical courses.


RESULTS
Radical surgery was performed in 9 patients with bone marrow micrometastasis. Event-free survival was obtained in 2 patients with stage IV disease (25.0%) for a follow-up period of 2 to 6 years in this group. Both patients received intraoperative radiation and subsequent autologous bone marrow transplantation (ABMT) using purged marrow. Radical surgery was performed in 18 patients without micrometastasis, and 6 of 9 advanced patients (66.7%) survived without the disease including 4 patients who received unpurged stem cell transplantation.


CONCLUSIONS
Persistent micrometastasis in bone marrow should be considered predictive as a poor prognostic factor in neuroblastoma. Intensive local control with surgery and radiation is important for the patients with micrometastasis and should be followed by ABMT using purged marrow. Unpurged marrow may be safely used if the single-step PCR detects no micrometastasis.
Kuroda
T
T
Department of Surgery, National Children's Hospital, National Children's Medical Research Center, Tokyo, Japan.
Saeki
M
M
Nakano
M
M
Mizutani
S
S
Endo
M
M
Akiyama
H
H
D000310:Adrenal Gland Neoplasms / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D046508:Culture Techniques; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000473:pathology* / Q000601:surgery*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome
D004273:DNA, Neoplasm