title: Can neoadjuvant chemotherapy reduce the surgical risks for localized neuroblastoma patients with image-defined risk factors at the time of diagnosis?
abstract: OBJECTIVE
  To date, no detailed study of the changes in the image-defined risk factors (IDRFs) after neoadjuvant chemotherapy has been performed. The aim of this study was to investigate the effect of chemotherapy on IDRFs for stage L2 neuroblastomas.
  
  
  METHODS
  Fifteen stage L2 patients treated by neoadjuvant chemotherapy were selected. Changes after chemotherapy in the number of positive IDRFs, tumor size and major surgical complications were evaluated.
  
  
  RESULTS
  All IDRFs disappeared after chemotherapy in four patients (group A) and a reduction in the number of IDRFs, but not disappearance, after chemotherapy was observed in five patients (group B). No change in the number of IDRFs after chemotherapy was observed in six patients (group C). All tumors in groups A shrunk to <20 % of the pretreatment volume. Major surgical complications were observed in one of two, two of three and three of five patients who underwent tumor excision in groups A, B and C, respectively.
  
  
  CONCLUSIONS
  Only 27 % of the tumors with IDRFs became negative for IDRFs after chemotherapy. For negative IDRFs, tumors should shrink to <20 % of the volume at the time of diagnosis. Stage L2 tumors may have a potential risk for surgery even after neoadjuvant chemotherapy.
authors.affiliation: Pediatric Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Osaka, Japan. akihiroyo@gmail.com.|Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan. akihiroyo@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoneda
authors.affiliation: Radiology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Nishikawa
authors.affiliation: Pediatric Surgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Osaka, Japan.|Pediatric Surgery, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, 565-0871, Osaka, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Uehara
authors.affiliation: Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8131, Hyogo, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Oue
authors.affiliation: Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Usui
authors.affiliation: Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodo-cho, Izumi, 594-1101, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Fukuzawa
authors.affiliation: Pediatric Surgery, Graduate School of Medicine, Osaka University, 1-1 Yamadaoka, Suita, 565-0871, Osaka, Japan.
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
mesh_terms: D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D009447:Neuroblastoma / Q000188:drug therapy* / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: INRGSS; Image-defined risk factors; Neoadjuvant chemotherapy; Neuroblastoma; Stage L2; Surgical complication