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* Surgical intervention alone may be curative as a single therapeutic modality for the management of low risk neuroblastoma patients.
* Surgical intervention alone may be curative as a single therapeutic modality for the management of '''low risk''' neuroblastoma patients.
 
* Surgical intervention must be followed by chemotherapy for the management of '''intermediate risk''' neuroblastoma patients.
Intermediate
* The potential benefit of aggressive surgical approaches in '''high-risk''' patients with metastatic disease to achieve complete tumor resectionhas not been unequivocally demonstrated.<ref name="gov">Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015</ref>
 
* Surgical complications following neuroblastoma resection may include:<ref>Neuroblastomas. Patient (2015) http://patient.info/doctor/neuroblastomas Accessed on October, 11 2015</ref>
Surgery and observation (in infants)
* Intussusception
 
* Internal haemorrhage due to vessel injuries
The need for chemotherapy in all asymptomatic infants with stage 3 or 4 disease is somewhat controversial, as some European studies have shown favorable outcomes with surgery and observation as described below.[9]
* Nerve injuries
 
Evidence (surgery and observation in infants):
 
Infants classified as stage 4 (from 4S) due to a primary tumor infiltrating across the midline (INSS 3) or positive bone scintigraphy not associated with changes in the cortical bone documented on plain radiographs and/or computed tomography were reported to have a better outcome compared to other stage 4 infants (EFS, 90% vs. 27%).[11]
International Society of Paediatric Oncology European Neuroblastoma Group (SIOPEN) conducted a prospective trial of 125 infants (n = 41 with INSS 3 primary tumors or positive scintigraphy) with disseminated neuroblastoma without MYCN amplification to see if these patients could be observed in the absence of symptoms. However, treating physicians did not always follow the wait-and-see strategy.[9]
 
There was no significant difference in 2-year OS in patients with unresectable primary tumors and patients with resectable primary tumors (97% vs. 100%) and patients with negative or with positive skeletal scintigraphy without radiologic abnormalities (100% vs. 97%).
 
A German prospective clinical trial enrolled 340 infants aged 1 year or younger whose tumors were stage 1, 2, or 3, verified histologically, and lacked MYCN amplification. Of the 190 infants undergoing resection, there were eight infants with stage 3 disease. A total of 93 infants whose tumors were not resectable without high-risk surgery, due to age or organ involvement, were observed without chemotherapy, which included 21 stage 3 patients. Fifty-seven infants, including 41 stage 3 patients, were treated with chemotherapy to control threatening symptoms.[6]
 
Three-year OS was excellent for the entire group of infants with unresected tumors (99%), infants receiving chemotherapy (95%), and infants with resected tumors (98%) (P = .45).

Latest revision as of 17:22, 11 October 2015

  • Surgical intervention alone may be curative as a single therapeutic modality for the management of low risk neuroblastoma patients.
  • Surgical intervention must be followed by chemotherapy for the management of intermediate risk neuroblastoma patients.
  • The potential benefit of aggressive surgical approaches in high-risk patients with metastatic disease to achieve complete tumor resectionhas not been unequivocally demonstrated.[1]
  • Surgical complications following neuroblastoma resection may include:[2]
  • Intussusception
  • Internal haemorrhage due to vessel injuries
* Nerve injuries
  1. ↑ Neuroblastoma treatment–for health professionals. National Cancer Institute (2015) http://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq#section/_1 Accessed on October, 8 2015
  2. ↑ Neuroblastomas. Patient (2015) http://patient.info/doctor/neuroblastomas Accessed on October, 11 2015
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