THE ROLE OF SURGERY IN THE MANAGEMENT OF STAGE-IV NEUROBLASTOMA - A SINGLE INSTITUTION STUDY

The role of surgery in the management of Stage IV neuroblastoma is sti ll far from clear. Seventy-nine patients with this diagnosis presented to the Children's Hospital of Philadelphia during the 10-year period, 1977 to 1986. Four-year survival was 23%. A major resection of the pr imary tumor was undertaken in 54 patients. The timing of the procedure (at presentation or delayed) had no effect on survival. The patients were divided into three groups based on the extent of surgical resecti on: Group 1, no surgery or biopsy only (25); Group 2, complete gross r esection (34); Group 3, incomplete resection with residual gross disea se (20). Four-year survival was 16, 15, and 45%, respectively. The pat ients were then classified as favorable or unfavorable, on the basis o f biological prognostic factors at presentation. When this analysis wa s combined with the extent of surgery it was discovered that Group 3 c ontained a higher proportion of favorable patients, accounting for the better survival. Within each group survival correlated with the expec ted prognosis. The outcome for a patient with Stage IV neuroblastoma d epends on the biological characteristics of the tumor, and there is cu rrently no evidence that these can be favorably altered by the timing or extent of surgical resection. Defining the appropriate role of surg ery in the management of these patients will require a prospective ran domized study which takes into account the inherent biological variabi lity of the disease. (C) 1995 Wiley-Liss, Inc.