Neuroblastoma: treatment outcome after incomplete resection of primary tumors.
OBJECTIVE
For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection.


METHODS
The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group.


RESULTS
Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive.


CONCLUSIONS
For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents.
Moon
Suk-Bae
SB
Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea. medica95@medimail.co.kr
Park
Kwi-Won
KW
Jung
Sung-Eun
SE
Youn
Woong-Jae
WJ
D000310:Adrenal Gland Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003879:Dermatologic Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D016259:Genes, myc; D006801:Humans; D007223:Infant; D007376:Interleukin-2 / Q000627:therapeutic use; D015474:Isotretinoin / Q000627:therapeutic use; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000235:genetics / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D010386:Pelvic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D003879:Dermatologic Agents; D007376:Interleukin-2; D015474:Isotretinoin