COMPLETE SURGICAL RESECTION COMBINED WITH AGGRESSIVE ADJUVANT CHEMOTHERAPY AND BONE-MARROW TRANSPLANTATION PROLONGS SURVIVAL IN CHILDREN WITH ADVANCED NEUROBLASTOMA

Background: A multi-modality approach combining surgery with aggressiv e chemotherapy and radiation is used to treat advanced neuroblastoma. Despite this treatment, children with advanced disease have a 20% 2-ye ar survival rate. Controversy has developed regarding the efficacy of combining aggressive chemotherapy with repeated surgical intervention aimed at providing a complete surgical resection (CSR) of the primary tumor and metastatic sites, Several prospective and retrospective stud ies have provided conflicting reports regarding the benefit of this ap proach on overall survival. Therefore, we evaluated the efficacy of CS R versus partial surgical resection (PSR) using a strategy combining s urgery with aggressive chemotherapy, radiation, and bone marrow transp lantation (BMT) for stage IV neuroblastoma. Methods: A retrospective s tudy was performed with review of the medical records of 52 consecutiv e children with neuroblastoma treated between 1985 and 1993. Twenty-ei ght of these 52 children presented with advanced disease, 24 of which had sufficient data to allow for analysis, All children were managed w ith protocols designed by the Children's Cancer Group (CCG), Statistic al analysis was performed using Student's t test, X(2) test, and Kapla n-Meier survival curves. Results: Mean survival (35.1 months) and prog ression-free survival (29.1 months) for the CSR children was statistic ally superior to that of the PSR children (20.36 and 16.5 months, p = 0.04 and 0.04, respectively). Similar significance was demonstrated us ing life table analysis of mean and progression-free survival of these two groups (p = 0.05 and < 0.01, respectively), One-, 2-, and 3-year survival rates for the CSR versus the PSR group were 100%, 80%, and 40 % versus 77%, 38%, and 15%, respectively. An analysis of the BMT group compared with those children treated with aggressive conventional the rapy showed improvement in mean and progression-free survival. Conclus ions: Aggressive surgical resection aimed at removing all gross diseas e is warranted for stage IV neuroblastoma, CSR is associated with prol onged mean and progression-free survival. BMT prolongs mean and progre ssion-free survival in children with stage IV disease, These results s uggest that CSR and BMT offer increased potential for long-term remiss ion in children with advanced neuroblastoma.