Aggressive surgical therapy and radiotherapy for patients with high-risk neuroblastoma treated with rapid sequence tandem transplant.
OBJECTIVE
The treatment approach for patients with high-risk neuroblastoma has been one of dose intensification chemotherapy and aggressive treatment of the primary tumor. Local tumor control is examined in high-risk patients treated with tandem stem cell transplant, aggressive surgery, and selected radiation therapy (XRT).


METHODS
Seventy-six patients with high-risk stage III/IV neuroblastoma were treated on a standard protocol incorporating aggressive surgical resection with or without local XRT followed by tandem high-dose chemotherapy and stem cell rescue. Patients were evaluated for degree of surgical resection, site of progression, and outcome.


RESULTS
Overall event-free survival for the series is 56%. Forty-eight had gross total resection, 12 had greater than 90% resection, 10 had 50% to 90% resection, and 6 had biopsy only or no surgery. Surgical complications occurred in 29% with no deaths. There were no isolated local failures. Two patients had local recurrence after gross total resection. Surgeon assessment of completeness of resection agreed with postoperative radiological findings 66% of the time.


CONCLUSIONS
Aggressive surgical treatment with local XRT and myeloablative chemotherapy with stem cell rescue provides excellent local control in high-risk neuroblastoma, although distant failures, particularly osseous, remain a problem. Poor correlation exists between the surgeon's perception of completeness of resection and findings on postoperative imaging studies.
von Allmen
Daniel
D
Division of Pediatric Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA. vonallme@med.unc.edu
Grupp
Stephan
S
Diller
Lisa
L
Marcus
Karen
K
Ecklund
Kirsten
K
Meyer
James
J
Shamberger
Robert C
RC
D000008:Abdominal Neoplasms / Q000601:surgery* / Q000628:therapy; D000310:Adrenal Gland Neoplasms / Q000601:surgery* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000601:surgery* / Q000628:therapy; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000601:surgery* / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014916:Whole-Body Irradiation