title: Is "watchful waiting" superior to surgery in children with neurofibromatosis type 1 presenting with extracranial and extramedullary tumor mass at diagnosis?
abstract: OBJECTIVE
  The aim of this study was to compare aggressive surgery to "watchful waiting" in neurofibromatosis type 1 (NF-1) patients with benign peripheral nerve sheath tumors exceeding 150 cm(3).
  
  
  METHODS
  Observational study based on imaging studies and results of surgery was utilized.
  
  
  RESULTS
  Twenty-seven out of 114 NF-1 patients (mean age of 12.8 years) registered throughout the last 10 years were studied. The mean tumor volume was 237 cm(3). Among them, 18 (66%) underwent surgery. In 15 (84%), regrowth of a tumor was observed. Reoperation was necessary in five (27%). Two out of these five children (2/18, 11%) required a third operation. Stable process has been shown in the remaining nine children (34%) since diagnosis and in most operated children (10/18; 56%), besides the regrowth of the tumor.
  
  
  CONCLUSIONS
  "Watchful waiting" could be superior to aggressive surgery in selected patients without "oncological awareness" confirmed by imaging techniques (mostly magnetic resonance imaging). NF-1 children with gross tumor mass require lifetime imaging monitoring and complex medical evaluation.
authors.affiliation: NF Outpatient Clinic, Clinical Department of Oncological Surgery for Children and Youth, National Research Institute of Mother and Child, Kasprzaka 17a, 01-211, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wozniak
authors.forename: Marek W
authors.initials: MW
authors.lastname: Karwacki
mesh_terms: D002648:Child; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D018317:Nerve Sheath Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D009456:Neurofibromatosis 1 / Q000150:complications*; D012086:Reoperation / Q000379:methods; D013997:Time Factors