title: Treatment of spinal involvement in neuroblastoma patients.
abstract: BACKGROUND
  Considerable controversy exists regarding the appropriate management of spinal involvement in neuroblastoma (NB) patients. We review a large group of such patients and offer treatment recommendations.
  
  
  METHODS
  Forty-six patients with epidural and/or neural foraminal involvement treated between 1987 and 1998 were staged according to the International NB Staging System (INSS) and classified as high-risk (INSS stage 4; n = 31) or low-risk (INSS stage <4; n = 15). Of 13 high- risk patients with normal neurologic examinations and no radiographic high-grade spinal cord compression (HGSCC), 12 were treated initially with chemotherapy, and only 1 demonstrated neurologic deterioration. HGSCC was present in 18 patients with high-risk NB; 7 of 10 (70%) treated initially with chemotherapy and 6 of 6 (100%) managed initially with operation improved or remained stable. All 9 low-risk patients with normal neurologic examinations and no HGSCC remained neurologically intact following operations (n = 7) or chemotherapy (n = 2). All 4 low-risk patients with HGSCC treated with operations improved or remained stable, and 0 of 2 (0%) low-risk patients treated initially with chemotherapy remained stable. Spinal deformities occurred in 2 of 16 patients (12.5%) treated nonoperatively and in 9 of 30 (30.0%) who underwent operations.
  
  
  CONCLUSIONS
  High-risk NB patients with spinal involvement but normal neurologic examinations should be offered chemotherapy. High-risk patients with HGSCC may respond to chemotherapy, but a small percentage will require operations for progressive neurologic deficits. Chemotherapy may be avoided in low-risk patients who are offered potentially curative operations. Patients treated with operations for epidural disease are at high risk of subsequently developing spinal deformity.
authors.affiliation: Department of Surgery, Division of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, N.Y. 10021, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Sandberg
authors.forename: Mark H
authors.initials: MH
authors.lastname: Bilsky
authors.forename: Brian H
authors.initials: BH
authors.lastname: Kushner
authors.forename: Mark M
authors.initials: MM
authors.lastname: Souweidane
authors.forename: Kim
authors.initials: K
authors.lastname: Kramer
authors.forename: Michael P
authors.initials: MP
authors.lastname: Laquaglia
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Panageas
authors.forename: Nai-Kong V
authors.initials: NK
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013116:Spinal Cord / Q000002:abnormalities; D013120:Spinal Cord Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome