Definitive Tumor Resection after Myeloablative High Dose Chemotherapy Is a Feasible and Effective Option in the Multimodal Treatment of High-Risk Neuroblastoma: A Single Institution Experience

The delayed local treatment approach (DL) in high-risk neuroblastoma (HR-NB) refers to the process in which tumor resection is performed after the completion of all the courses of chemotherapy, including myeloablative high-dose chemotherapy (HDC). Alternatively, in the conventional local treatment a...

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Published in:Journal of pediatric surgery 2020-08, Vol.55 (8), p.1655-1659
Main Authors: Hishiki, Tomoro, Fujino, Akihiro, Watanabe, Toshihiko, Tahara, Kazunori, Ohno, Michinobu, Yamada, Yohei, Tomonaga, Kotaro, Kutsukake, Mai, Fujita, Takuro, Kawakubo, Naonori, Matsumoto, Kimikazu, Kiyotani, Chikako, Shioda, Yoko, Miyazaki, Osamu, Fuji, Hiroshi, Yoshioka, Takako, Kanamori, Yutaka
Format: Article
Language:English
Subjects:
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - therapeutic use
Blood Loss, Surgical - statistics & numerical data
Combined Modality Therapy
Complication
Delayed local treatment
Humans
Induction Chemotherapy
Neuroblastoma
Neuroblastoma - drug therapy
Neuroblastoma - epidemiology
Neuroblastoma - surgery
Operative Time
Postoperative Complications - epidemiology
Resectability
Surgery
Treatment Outcome
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Summary:The delayed local treatment approach (DL) in high-risk neuroblastoma (HR-NB) refers to the process in which tumor resection is performed after the completion of all the courses of chemotherapy, including myeloablative high-dose chemotherapy (HDC). Alternatively, in the conventional local treatment approach (CL), tumor resection is performed during induction chemotherapy. In this study, we compared the surgical outcomes in HR-NB patients treated by CL and DL. Forty-seven patients with abdominal HR-NB underwent primary tumor resection from 2002 to 2018. The timing of surgery was generally determined by following the trials and guidelines available at the time. The outcomes and surgical complications between the two strategies were compared. Operation time, blood loss, and postoperative WBC counts were lower in the DL group (n = 25) when compared to the CL group (n = 22), statistical significance notwithstanding. Major vascular structures were less frequently encased in the DL group tumors, while immediate surgical complications were significantly more frequent in the CL group (P 
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2019.08.050