Advances in the Surgical Treatment of Neuroblastoma

Abstract

Objective:This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB).Data Sources:The online database ScienceDirect (2016–2018) was utilized. The search was conducted using the keywords “neuroblastoma,” “neuroblastoma resection,” “neuroblastoma surgery,” and “high-risk neuroblastoma.”Study Selection:We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis.Results:A total of 7800 English language articles were found containing references to NB (2016–2018). The 163 articles were searched which were related to the surgical treatment of NB (2016–2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial.Conclusions:NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.

Removal of pediatric stage IV neuroblastoma by robot-assisted laparoscopy: A case report and literature review

“…The resection of the primary foci of stage IV NB is still a controversial issue, with some studies suggesting that it is only superior to a simple biopsy, and the prognosis is more dependent on biological characteristics rather than the number of resected primary foci[25,26] . However, most researchers still suggest the resection of over 95% of the tumor foci[27,28].…”

The quest to develop an effective therapy for neuroblastoma

“…However, a minimally invasive approach (laparoscopy or thoracoscopy) is also currently widely used. In addition, imageguided core needle biopsy is used frequently to provide a diagnosis that appears to provide equivalent results with potentially fewer complications (Avanzini et al, 2017;Campagna et al, 2018;Luo et al, 2018). Also, while open surgical resection is the traditional approach, a minimally invasive surgical approach is now being used more frequently for NB resection.…”

Targeting Oncogenic Transcriptional Networks in Neuroblastoma: From N-Myc to Epigenetic Drugs

“…To date, treatment of NB high-risk patients includes an intensive chemotherapy regimen with cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide (COJEC), followed by resection surgery and myeloablative therapy in combination with haematopoietic stem cell reinfusion and local radiation therapy [89]. The relevance of specific targeted therapy in NB could be crucial considering the standard strategies' weakening approach in treating high-risk patients and the extreme cancer heterogeneity, which spans from spontaneous regressions to metastatic and aggressive diseases (Figure 2) [90]. Direct targeting can be achieved by blocking the N-Myc/MAX interaction, while indirect targeting can be obtained by inhibiting enzymes involved in N-Myc post-translational modifications (PTMs) or protein-protein interactions (PPIs).…”