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.
Division of Pediatric Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC 27599, USA. vonallme@med.unc.edu
Daniel
D
von Allmen
Stephan
S
Grupp
Lisa
L
Diller
Karen
K
Marcus
Kirsten
K
Ecklund
James
J
Meyer
Robert C
RC
Shamberger
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