Spinal cord compression in neuroblastoma

Massad, Malek G.; Haddad, Farid S.; Slim, Michel S.; Saba, Maurice I.; Nassar, Sami I.; Abla, Adnan A.; Mansour, Alaa

doi:10.1016/0090-3019(85)90004-7

Cited by 18 publications

(33 citation statements)

References 21 publications

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“…Previous studies have reported similar results (7-15%) [1][2][3][4]. In our study, the frequency of dumbbell neuroblastomas is significantly higher in localized forms (23%) than in metastatic forms (8%) ( P = .0002), which confirms Punt's results [ 5 ] .…”

Section: Discussionsupporting

confidence: 90%

Localized dumbbell neuroblastoma: A study of 25 cases treated between 1982 and 1987 using the same protocol

Plantaz

Hartmann

Kalifa

et al. 1993

Med. Pediatr. Oncol.

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Among the 108 non-metastatic neuroblastomas treated at the lnstitut Gustave Roussy between 1982 and 1987,25 dumbbell neuroblastomas were observed. Therapeutics included: 1 ) an initial laminectomy in forms with neurological deficit; 2) surgical excision of the primary tumor; 3) preoperative chemotherapy in children in which the primary tumor was considered as unresectable at diagnosis and postoperative chemotherapy in cases of incomplete resection; and 4) radiation therapy on macroscopic residual disease. Fifteen out of 25 (60%) presented a neurological deficit. A laminectomy was performed in 14 cases. Neurological recovery was good in 4 cases, partial in 4 cases, and absent in 4 cases. Two patients were worse after the procedure. The event-free survival was 88%. This high survival rate is linked: 1 ) to the non-metastatic stage; 2) to a high proportion of children under 1 year of age (18/25) (median age = 7 months); and 3) to a high proportion of thoracic location (12/ 25). The high incidence of macroscopically incomplete excision (13/25) did not jeopardize the prognosis. Out of the 22 survivors, there were 8 cases of major neurological sequellae (36%) and 5 cases of major orthopedic ones (26%). The coexistence of a serious functional prognosis and an excellent vital prognosis for these patients has led us to analyse the therapeutic modalities, to reevaluate the necessity of routine initial neurosurgical removal by laminectomy and to discuss the use of first line chemotherapy. 0 1993 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 90%

Localized dumbbell neuroblastoma: A study of 25 cases treated between 1982 and 1987 using the same protocol

Plantaz

Hartmann

Kalifa

et al. 1993

Med. Pediatr. Oncol.

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“…Of the 19 studies that reported both the prevalence at diagnosis and at the end of follow‐up, 17 studies showed a decreased prevalence, and only two studies showed an increased prevalence of the motor deficit after time (Supplementary Fig. S5A) …”

Section: Resultsmentioning

confidence: 99%

“…8,46,50 Two studies found a lower rate of disseminated disease compared to NBL patients without spinal cord compression. 46,50 Six studies found an overall survival (OS) benefit for NBL patients with intraspinal extension compared to patients without spinal involvement, 8,37,46,[49][50][51] the difference being significant in only two studies. 46,50 An improved event-free survival (EFS) was reported in four studies, 8,44,50,51 the difference being significant in only one study.…”

Section: Characteristics Of Nbl With Intraspinal Extensionmentioning

confidence: 99%

“…1,10,34,35,41,46,48,50,51 The severity of the motor deficit at diagnosis was reported in 15 studies. 1,8,10,11,34,37,41,42,[46][47][48][49][50][51]53 The symptom to diagnosis interval, reported as a mean or median, showed considerable variation, ranging from 3 days to 2 months (median 25.5 days). 1,8,10,11,[33][34][35]37,[46][47][48][49][50][51]53 Nineteen studies reported on the prevalence of neurological motor deficit at the end of follow-up, which ranged from 17 to 69% (median 50%).…”

Section: Characteristics Of Nbl With Intraspinal Extensionmentioning

confidence: 99%

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Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review

Kraal

Blom

Noesel

et al. 2017

Pediatric Blood & Cancer

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We performed a systematic review to define the long-term health problems and optimal treatment strategy for patients with neuroblastoma with intraspinal extension. Of 685 identified studies, 28 were included in this review. The burden of long-term health problems is high; a median of 50% of patients suffered from neurological motor deficit, 34% from sphincter dysfunction, and 30% from spinal deformity. The currently available literature remains suboptimal as a guide for treatment of NBL with intraspinal extension. More well-designed, prospective studies are needed to determine the optimal treatment strategy.

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“…Because the tumor is derived from primordial neural crest cells which ultimately populate the sympathetic ganglia as well as other sites [4], spinal extension of disease occurs frequently. Invasion of the intervertebral foramina and/or the spinal canal is noted in 10–15% of patients [5, 6, 7, 8, 9, 10], and NB is the most common malignant cause of spinal cord or nerve root compression in the pediatric population [6, 11, 12, 13]. Spinal involvement and its treatment with surgery or radiation therapy often result in significant morbidity including neurological deficits as well as spinal deformities (scoliosis and kyphosis) [14, 15, 16, 17].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Spinal Involvement in Neuroblastoma Patients

Sandberg¹,

Bilsky²,

Kushner

et al. 2003

Pediatr Neurosurg

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Introduction: Considerable controversy exists regarding the appropriate management of spinal involvement in neuroblastoma (NB) patients. We review a large group of such patients and offer treatment recommendations. Methods: Forty-six patients with epidural and/or neural foraminal involvement treated between 1987 and 1998 were staged according to the International NB Staging System (INSS) and classified as high-risk (INSS stage 4; n = 31) or low-risk (INSS stage <4; n = 15). Of 13 high- risk patients with normal neurologic examinations and no radiographic high-grade spinal cord compression (HGSCC), 12 were treated initially with chemotherapy, and only 1 demonstrated neurologic deterioration. HGSCC was present in 18 patients with high-risk NB; 7 of 10 (70%) treated initially with chemotherapy and 6 of 6 (100%) managed initially with operation improved or remained stable. All 9 low-risk patients with normal neurologic examinations and no HGSCC remained neurologically intact following operations (n = 7) or chemotherapy (n = 2). All 4 low-risk patients with HGSCC treated with operations improved or remained stable, and 0 of 2 (0%) low-risk patients treated initially with chemotherapy remained stable. Spinal deformities occurred in 2 of 16 patients (12.5%) treated nonoperatively and in 9 of 30 (30.0%) who underwent operations. Conclusions: High-risk NB patients with spinal involvement but normal neurologic examinations should be offered chemotherapy. High-risk patients with HGSCC may respond to chemotherapy, but a small percentage will require operations for progressive neurologic deficits. Chemotherapy may be avoided in low-risk patients who are offered potentially curative operations. Patients treated with operations for epidural disease are at high risk of subsequently developing spinal deformity.

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Spinal cord compression in neuroblastoma

Cited by 18 publications

References 21 publications

Localized dumbbell neuroblastoma: A study of 25 cases treated between 1982 and 1987 using the same protocol

Localized dumbbell neuroblastoma: A study of 25 cases treated between 1982 and 1987 using the same protocol

Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review

Treatment of Spinal Involvement in Neuroblastoma Patients

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