CONNATAL LOCALIZED NEUROBLASTOMA - THE CASE TO DELAY TREATMENT

BACKGROUND. Spontaneous regression is well documented for a subset of widespread neuroblastomas (Stage 4S) and for localized residual tumors after incomplete resection. Possible spontaneous regression of untrea ted localized neuroblastoma in infants is frequently discussed, but ha s very rarely been demonstrated clinically. METHODS. We report four pa tients with localized neuroblastoma detected early; all were tumors of the adrenal gland. One patient was detected antenatally by ultrasound , the other three tumors were detected incidentally by sonography at t he ages of birth, 1 week, and 7 weeks, respectively. In three patients treatment was delayed in order to await a possible spontaneous regres sion, and in one patient treatment was delayed due to an uncertain dia gnosis. RESULTS. Local tumor growth was observed in three patients, an d the tumors were removed 7, 12, and 16 weeks, respectively, after the initial diagnosis of neuroblastoma. AU three patients are free of dis ease. The fourth patient developed liver metastases 4 weeks after the first suspicion of neuroblastoma. Progressive disease ended in death a t the age of 17 months. CONCLUSIONS. None of the four patients showed spontaneous tumor regression. Noninvasive examinations and invasive in vestigations (in two patients) were unable to predict the tumor's beha vior. Based on present knowledge, a general ''wait and see'' strategy cannot be recommended for early and incidentally detected neuroblastom a patients. (C) 1996 American Cancer Society.