The impact of gross total resection on local control and survival in high-risk neuroblastoma

Value of surgical resection in children with high‐risk neuroblastoma

“…We found that only 38% of children evaluated at our HSCT center for treatment of NB had undergone a GTR of their primary tumor. Although a limited number of studies suggest a possible advantage of GTR [11,12], our findings do not demonstrate an association between GTR and improved outcomes in high-risk NB, consistent with much of the current literature [9,[13][14][15][16].…”

“…Along with a spectrum of non-standardized definitions and methods, the literature on the role of surgery in high-risk NB provides a spectrum of conclusions, ranging from studies that suggest GTR is absolutely necessary to improve survival [12] to others that indicate surgery may be of no value [14]. Examining the results of several studies suggests that resection >90% may be a more appropriate cut-off than GTR to achieve optimal survival [9,15,18].…”

“…Gross total resection (GTR) was defined as no visible or palpable disease at the end of operation. Less than GTR included those patients undergoing no surgery, biopsy only, partial resection (50-90%), or near-gross total resection (>90% but with palpable or visible tumor remaining) [12,15]. Other variables of interest included: age, gender, tumor location, INSS stage, radiographic results, MYCN amplification status, Shimada classification, lactate dehydrogenase (LDH), neo-adjuvant therapies, and radiographic response to neoadjuvant therapy (complete response, very good partial response, and partial response vs. mixed response, no response, Background.…”

“…The optimal role of surgical therapy for high-risk NB is poorly defined and the value of gross total resection (GTR) for highrisk NB remains intensely debated [9][10][11][12][13][14][15][16][17][18]. Surgeons are often challenged with determining the aggressiveness with which to pursue GTR, particularly in the setting of bulky or extensive intraabdominal involvement.…”

Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment

“…This slight improvement can be related to the greater and greater aggressiveness of the treatment: intensified chemotherapy increases the percentage of clinical remissions, the introduction of megatherapy helps to eradicate resistant clones, and the addition of 'maintenance' therapy is expected to control any minimal residual disease (Cheung et al, 1998;Pession et al, 1998;Garaventa et al, 1999;Matthay et al, 1999;Pinkerton et al, 2000). The use of aggressive surgery and radiotherapy to the primary tumour site may also contribute to reducing the risk of local relapse (Kushner et al, 2001;Haas-Kogan et al, 2003;La Quaglia et al, 2004). Nowadays, the majority of clinical trials on advanced neuroblastoma are organised according to the sequence: 'induction' of remission with chemotherapy and local treatment at the primary tumour site, 'consolidation' with megatherapy, and 'maintenance' therapy (Matthay et al, 1999;Berthold and Hero, 2000;De Bernardi et al, 2003).…”