THE STRATEGY TO TREAT DISSEMINATED NEUROBLASTOMA UTILIZING BONE-MARROW TRANSPLANTATION - WHAT IS THE SURGEONS ROLE

The current role of surgery was evaluated in seven consecutive patient s with high-risk neuroblastoma (six stage 4 patients and one stage 3, abdominal origin, and all over 12 months of age at diagnosis) treated with new modalities utilizing bone marrow transplantation (BMT). In si x of these seven patients, a grossly complete excision of the primary tumor was achieved, and four have survived for 133, 69, 39, and 28 mon ths with no further evidence of disease. The remaining patient with ce liac neuroblastoma only underwent a biopsy during a second-look laparo tomy after chemoradiotherapy, and thereafter developed local and dista nt recurrences and ultimately succumbed to the tumor. The timing of su rgical intervention varied, either before or after chemotherapy, and d id not appear to affect the ultimate survival. Although surgical excis ion of the primary tumor remains a very high priority in the overall t reatment scheme, the most important factor remains the eradication of the tumor by well-planned courses of intensive chemotherapy (e.g., A1 Protocol of the Study Group of Japan). Thus, after having induced comp lete remission, for consolidation, it is necessary to kill all remaini ng tumor cells by giving supralethal doses of chemotherapy including t otal body irradiation (TBI) assisted by BMT.