BACKGROUND/ PURPOSE: The treatment approach for patients with high-risk neuroblastoma has been one of dose intensification chemotherapy and aggressive treatment of the primary tumor. Local tumor control is examined in high-risk patients treated with tandem stem cell transplant, aggressive surgery, and selected radiation therapy (XRT). METHODS: Seventy-six patients with high-risk stage III/IV neuroblastoma were treated on a standard protocol incorporating aggressive surgical resection with or without local XRT followed by tandem high-dose chemotherapy and stem cell rescue. Patients were evaluated for degree of surgical resection, site of progression, and outcome. RESULTS: Overall event-free survival for the series is 56%. Forty-eight had gross total resection, 12 had greater than 90% resection, 10 had 50% to 90% resection, and 6 had biopsy only or no surgery. Surgical complications occurred in 29% with no deaths. There were no isolated local failures. Two patients had local recurrence after gross total resection. Surgeon assessment of completeness of resection agreed with postoperative radiological findings 66% of the time. CONCLUSION: Aggressive surgical treatment with local XRT and myeloablative chemotherapy with stem cell rescue provides excellent local control in high-risk neuroblastoma, although distant failures, particularly osseous, remain a problem. Poor correlation exists between the surgeon's perception of completeness of resection and findings on postoperative imaging studies.
BACKGROUND/ PURPOSE: The treatment approach for patients with high-risk neuroblastoma has been one of dose intensification chemotherapy and aggressive treatment of the primary tumor. Local tumor control is examined in high-risk patients treated with tandem stem cell transplant, aggressive surgery, and selected radiation therapy (XRT). METHODS: Seventy-six patients with high-risk stage III/IV neuroblastoma were treated on a standard protocol incorporating aggressive surgical resection with or without local XRT followed by tandem high-dose chemotherapy and stem cell rescue. Patients were evaluated for degree of surgical resection, site of progression, and outcome. RESULTS: Overall event-free survival for the series is 56%. Forty-eight had gross total resection, 12 had greater than 90% resection, 10 had 50% to 90% resection, and 6 had biopsy only or no surgery. Surgical complications occurred in 29% with no deaths. There were no isolated local failures. Two patients had local recurrence after gross total resection. Surgeon assessment of completeness of resection agreed with postoperative radiological findings 66% of the time. CONCLUSION: Aggressive surgical treatment with local XRT and myeloablative chemotherapy with stem cell rescue provides excellent local control in high-risk neuroblastoma, although distant failures, particularly osseous, remain a problem. Poor correlation exists between the surgeon's perception of completeness of resection and findings on postoperative imaging studies.
Authors: Daniel von Allmen; Andrew M Davidoff; Wendy B London; Collin Van Ryn; Daphne A Haas-Kogan; Susan G Kreissman; Geetika Khanna; Nancy Rosen; Julie R Park; Michael P La Quaglia Journal: J Clin Oncol Date: 2016-11-21 Impact factor: 44.544
Authors: Matthew J Ferris; Hasan Danish; Jeffrey M Switchenko; Claudia Deng; Bradley A George; Kelly C Goldsmith; Karen J Wasilewski; W Thomas Cash; Mohammad K Khan; Bree R Eaton; Natia Esiashvili Journal: Int J Radiat Oncol Biol Phys Date: 2016-11-27 Impact factor: 7.038
Authors: Emily R Christison-Lagay; David G Darcy; Eric J Stanelle; Stacy Dasilva; Edward Avila; Michael P La Quaglia Journal: J Pediatr Surg Date: 2013-10-05 Impact factor: 2.545