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Radiographic assessment of resectability of locoregional disease in children with high‐risk neuroblastoma during neoadjuvant chemotherapy
Author(s) -
Davidoff Andrew M.,
Corey Bethany L.,
Hoffer Fredric A.,
Santana Victor M.,
Furman Wayne L.,
Shochat Stephen J.
Publication year - 2005
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20041
Subject(s) - medicine , neuroblastoma , chemotherapy , disease , primary tumor , neoadjuvant therapy , surgery , radiology , induction chemotherapy , nephrectomy , oncology , cancer , metastasis , genetics , breast cancer , kidney , biology , cell culture
Background The optimal timing for attempting removal of the primary tumor and regional disease in patients with high‐risk neuroblastoma is uncertain. The purpose of this study was to evaluate resectability of the primary tumor and regional disease, as determined radiographically, in children with high‐risk neuroblastoma during neoadjuvant chemotherapy. Procedure Patients enrolled in our institutional high‐risk neuroblastoma protocol were evaluated prospectively by CT scan and/or MRI to determine the resectability of their primary tumor and regional disease at diagnosis, after two cycles of experimental therapy and after standard induction therapy. Tumors were considered to be unresectable if there was significant involvement with major vascular structures or contiguous organs, or would likely require nephrectomy to remove the entire tumor. Results Twenty‐four patients were referred prior to surgery for treatment of high‐risk neuroblastoma. Seven of 24 (29%) patients were felt to be resectable at diagnosis, with an additional 9 patients becoming resectable after the initial experimental therapy. Thus, overall, 16 of 24 (67%) patients were felt to be resectable by the completion of the initial therapy. Only four additional patients of the remaining eight were considered resectable after the completion of standard induction therapy. Conclusions Based on these data, we conclude that complete resection of the primary tumor and regional disease in children with high‐risk neuroblastoma can be performed after an initial phase therapy in the majority of patients. Since earlier tumor removal may decrease the chance for the subsequent development of chemotherapy‐resistant disease, we are recommending surgical resection as soon as the locoregional disease appears to be resectable. © 2004 Wiley‐Liss, Inc.