The impact of gross total resection on local control and survival in high-risk neuroblastoma
Section snippets
Materials and methods
Institutional review board permission was obtained. Criteria for entry into this retrospective study included age of 1 year or older at diagnosis and stage 4 disease by INSS criteria. All patients received the majority of their treatment at Memorial Sloan-Kettering Cancer Center. Patient data were obtained from operative records and the pediatric and neuroblastoma databases. Our center evaluates and treats 70 to 90 neuroblastoma patients per year. From this cohort there were 143 consecutive
Patient characteristics
The median age at diagnosis was 3.3 years and ranged from 1.0 to 29.0 years. The male to female ratio was 82:59 and there were 116 whites, 20 African-Americans, and 5 Asian-Americans. The median follow-up was 2.0 years (range, 0.4 to 18.3 years). All patients had evidence by bone marrow aspiration, MIBG scans, or both of marrow infiltration. MYCN was determined in 102 patients (72%) and was amplified in 32 (31%) of these. All patients underwent imaging studies of cortical bone (bone survey
Discussion
The gold standard for testing the hypothesis that primary tumor removal affects outcome is a prospective randomized trial in which half the patients receive surgery and half do not. Currently, such a trial is not feasible because of the very poor prognosis in these patients (30% event-free survival) and the low probability that salvage therapy will work. Thus, the pediatric surgical oncologist is confronted with removing these often difficult tumors without strong evidence of efficacy from
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