title: The efficacy of delayed surgery in children with high-risk neuroblastoma.
abstract: BACKGROUND
  Surgery is an important part of treatment in children with neuroblastoma; however, exact timing is unclear. Both initial and delayed surgery was suggested as the best by numerous studies.
  
  
  OBJECTIVE
  Thus, we aimed to investigate the role of delayed surgery on 31 children with high-risk neuroblastoma.
  
  
  METHODS
  Thirty-one children with high-risk neuroblastoma were enrolled into the study.
  
  
  METHODS
  Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) for windows 10.0.
  
  
  RESULTS
  There 'were 15 male and 16 female patients with a median age of 3.0 ± 3.2 years. Primary tumor site was adrenal in 27, non-adrenal in two, pelvic in one, and mediastinal in one patient. MYCN gene was amplified in four and non-amplified in 11 children on totally 15 children with available data. Lactate dehydrogenase was elevated in 30 children. The tumor volumes at diagnosis and before surgery in the whole group were 154.3 and 12.5 mL, respectively. The decline in tumor volume was statistically significant (P < 0.0001). Initial surgery was performed in three and delayed in 20 children, and eight children were inoperable. Surgical complication rate was 66.6% (two out of three patients) in initial surgery group; however, the rate was 15% (3 out of 20 patients) in delayed surgery group. The 5-year event-free survival and overall survival rates in the whole group were 44.8% and 50.8%, respectively. Primary tumor area control rate was 95%
  
  
  CONCLUSIONS
  In conclusion, the delayed surgery with intensive chemotherapy and radiotherapy has been successful for primary control in high-risk neuroblastoma patients.
authors.forename: Ali
authors.initials: A
authors.lastname: Varan
authors.affiliation: Department of Pediatric Oncology, Institute of Oncology, Ankara, Turkey.
authors.forename: Varan
authors.initials: V
authors.lastname: Ali
authors.forename: Vural
authors.initials: V
authors.lastname: Kesik
authors.forename: Kesik
authors.initials: K
authors.lastname: Vural
authors.forename: Mehmet Emin
authors.initials: ME
authors.lastname: Şenocak
authors.forename: Şenocak Mehmet
authors.initials: ŞM
authors.lastname: Emin
authors.forename: Gulsev
authors.initials: G
authors.lastname: Kale
authors.forename: Kale
authors.initials: K
authors.lastname: Gulsev
authors.forename: Canan
authors.initials: C
authors.lastname: Akyüz
authors.forename: Akyüz
authors.initials: A
authors.lastname: Canan
authors.forename: Münevver
authors.initials: M
authors.lastname: Büyükpamukçu
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor