COMPLETE SURGICAL RESECTION COMBINED WITH AGGRESSIVE ADJUVANT CHEMOTHERAPY AND BONE-MARROW TRANSPLANTATION PROLONGS SURVIVAL IN CHILDREN WITH ADVANCED NEUROBLASTOMA
Rs. Chamberlain et al., COMPLETE SURGICAL RESECTION COMBINED WITH AGGRESSIVE ADJUVANT CHEMOTHERAPY AND BONE-MARROW TRANSPLANTATION PROLONGS SURVIVAL IN CHILDREN WITH ADVANCED NEUROBLASTOMA, Annals of surgical oncology, 2(2), 1995, pp. 93-100
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.