title: Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection.
abstract: BACKGROUND
  Patients with neuroblastoma are now stratified at diagnosis according to the presence and number of image-defined risk factors (IDRFs). We examined the added value of IDRF assessment after neoadjuvant chemotherapy for predicting surgical resection.
  
  
  METHODS
  From 2009-2012, 39 out of 91 patients operated on in our institution for neuroblastic tumors received neoadjuvant chemotherapy based on ongoing SIOPEN protocols or treatment guidelines. IDRFs were assessed both at diagnosis and preoperatively on CT and/or MRI.
  
  
  RESULTS
  Median age at diagnosis was 30 months [range 2-191]. The tumor locations were adrenal (n = 20), paravertebral (n = 13) and perivascular (n = 6). INRGSS stages were L2 (n = 13), M (n = 25) and Ms (n = 1). Eleven tumors (28%) were MYCN-amplified. Chemotherapy reduced the number of IDRFs in 54% of patients overall (21/39): 61.5% (16/26) of M and Ms patients, and 38.5% (5/13) of non metastatic patients (P < 0.001). The number of IDRFs lost after chemotherapy was proportional to the degree of tumor shrinkage (P = 0.002), independent of the primary tumor location (P = 0.73), although the number was higher in patients with left versus right adrenal locations (P = 0.004). Patients with neuroblastoma on post-surgical histology lost more IDRFs (median: 1[0-9]) than patients with ganglioneuroblastoma (median: 0[0-4]) (P < 0.001). The completeness of resection was related only to the number of preoperative IDRFs (P = 0.028).
  
  
  CONCLUSIONS
  IDRF assessment after neoadjuvant chemotherapy is useful for predicting completeness of resection of neurogenic tumors. A larger international study is needed to confirm these results and to explore a possible correlation between preoperative IDRF status and survival.
authors.affiliation: Pediatric surgery department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Radiology department, Curie institute, Paris, France.
authors.forename: Hervé J
authors.initials: HJ
authors.lastname: Brisse
authors.affiliation: Pediatric Oncology department, Gustave- Roussy Institute, Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Minard-Colin
authors.affiliation: Pediatric Oncology department, Curie institute, Paris, France.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schleiermacher
authors.affiliation: Pathology department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Galmiche-Rolland
authors.affiliation: Biostatistics department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Le Cossec
authors.affiliation: Biostatistics department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Elie
authors.affiliation: Radiology department, Gustave-Roussy Institute, Paris, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Canale
authors.affiliation: Pediatric Oncology department, Curie institute, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Michon
authors.affiliation: Pediatric Oncology department, Gustave- Roussy Institute, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.affiliation: Pediatric surgery department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003952:Diagnostic Imaging / Q000379:methods; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018305:Ganglioneuroblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009447:Neuroblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin
keywords: IDRF; neuroblastoma; surgical complications