title: Local control in metastatic neuroblastoma in children over 1 year of age.
abstract: BACKGROUND
  Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age.
  
  
  METHODS
  Fifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis.
  
  
  RESULTS
  The 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-53%) and 46% (95% CI 26-64%) respectively, while the 5-year PFS and OS for patients who did not receive RT were 22% (95% CI 9-38%) and 27% (95% CI 13-42%) respectively (P 0.02 for PFS). Multivariate analysis confirmed the role of well-known prognostic factors, such as the presence of MYCN amplification, age and response before high-dose chemotherapy.
  
  
  CONCLUSIONS
  Our data suggest that the degree of resection does not influence survival in metastatic NBL patients treated with high-dose chemotherapy; local RT contributes to local disease control.
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. deioris@opbg.net.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: De Ioris
authors.affiliation: Surgery Department, Rome, Italy. alessandro.crocoli@opbg.net.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crocoli
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. benedetta.contoli@opbg.net.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Contoli
authors.affiliation: Imaging Department, Rome, Italy. garganese@opbg.net.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Garganese
authors.affiliation: Imaging Department, Rome, Italy. natali@opbg.net.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Natali
authors.affiliation: Imaging Department, Rome, Italy. paolo.toma@opbg.net.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tomà
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. alessandro.jenkner@opbg.net.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Jenkner
authors.affiliation: Pathology Department, Bambino Gesù Children's Hospital, Rome, Italy. renata.boldrini@opbg.net.
authors.forename: Renata
authors.initials: R
authors.lastname: Boldrini
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. mdebora.depasquale@opbg.net.
authors.forename: Maria Debora
authors.initials: MD
authors.lastname: De Pasquale
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. giuseppemaria.milano@opbg.net.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Milano
authors.affiliation: Surgery Department, Rome, Italy. silvia.madafferi@opbg.net.
authors.forename: Silvia
authors.initials: S
authors.lastname: Madafferi
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. aurora.castellano@opbg.net.
authors.forename: Aurora
authors.initials: A
authors.lastname: Castellano
authors.affiliation: Hematology/Oncology Department, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy. franco.locatelli@opbg.net.|University of Pavia, Pavia, Italy. franco.locatelli@opbg.net.
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Surgery Department, Rome, Italy. alessandro.inserra@opbg.net.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Inserra
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009362:Neoplasm Metastasis; D009447:Neuroblastoma / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome