Clinical significance of intensive surgery with intraoperative radiation for advanced neuroblastoma: does it really make sense?

Kuroda, Takeshi; Saeki, Morihisa; Honna, Toshiro; Masaki, Hidekazu; Tsunematsu, Yukiko

doi:10.1016/j.jpedsurg.2003.08.043

Cited by 28 publications

(22 citation statements)

References 19 publications

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“…EBRT also has been described that it was effective in advanced neuroblastoma [19][20][21]. The importance of intensive local treatment for advanced neuroblastoma was emphasized in other studies [22][23][24][25][26]. In this study we have been able to evaluate the impact of IORT in 12 children diagnosed with advanced neuroblastoma over a 10-year period.…”

Section: Discussionmentioning

confidence: 83%

“…Neuroblastoma is the most common solid tumor in childhood [7]. The clinical significance of intensive surgical therapy as a means to control the local lesion has been controversial in the treatment of advanced neuroblastoma [8,9]. Renal vascular problems and other major complications were reported after extensive surgical resection of neuroblastoma [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

et al. 2007

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The purpose of this study is to evaluate the efficacy of intraoperative radiation therapy (IORT) and the problem of securing the IORT field in advanced pediatric neuroblastoma. Between 1996 and 2005, 12 children received IORT for advanced pediatric neuroblastoma patients. Electron beam energies ranged from 10 to 12 MeV and median dose was 10 Gy (8-12 Gy). All of them had surgery with IORT against the primary tumor site and the abdominal aorta surroundings. A gross total resection (GTR) was achieved in 10 patients and subtotal resection (STR) was two patients. All of 12 patients were classified as high risk. Nine patients were alive 17-120 (mean 48 months) after diagnosis. Local tumor control was achieved in 100% of patients, of whom one experienced local recurrence outside the IORT field. At the operation, it was difficult to secure the IORT field because of the angle of the radiation cylinder in three patients. One of the three of these patients experienced local recurrence outside of the IORT field in the upper side of superior mesenteric artery and two of three patients had an external beam radiation after surgery, and there was no local recurrence. One patient had a postoperative ileus, and one patient had transient diarrhea and hydronephrosis. For advanced neuroblastoma patients, IORT produced excellent local control after surgery. However, there is a problem of securing the IORT field. For local control, it is necessary to add an external beam radiation after IORT when it is difficult to secure the IORT field.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

et al. 2007

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“…Conversely, Adkins et al [18] reported that complete resection was of little benefit for high-risk neuroblastomas treated by CCG-3891. Kuroda et al [19] found that intensive surgery with intraoperative radiation therapy dramatically increased local eradication and improved the outcome of patients even if they had advanced neuroblastomas with MYCN amplification. On the other hand, Castel et al [20] found that delayed surgery after chemotherapy contributes to the good control of stage IV disease, although the final outcome of these patients was determined more by metastatic relapses than by the degree of resection.…”

Section: Discussionmentioning

confidence: 99%

Implications of surgical intervention in the treatment of neuroblastomas: 20-year experience of a single institution

et al. 2012

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Considering that the majority of infantile neuroblastomas in this study had favorable biology, complete resection might be unnecessary for patients under 12 years of age. For advanced neuroblastomas in patients over 12 months of age, the main treatment for metastasis is systemic chemotherapy, although extirpation of the primary tumor without extensive surgery might prevent local recurrence when combined with radiation therapy.

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“…17 Studies of high-risk NB patients classifi ed by the INSS reported favorable effects of surgical resection on the survival or prognosis (Table 3). 5,9,10,[18][19][20][21] Intense chemotherapy with stem cell transplant apparently increases the tumor resectability in high-risk NB, thereby increasing the ratio of GTR or total excision. 9,20 Even though two studies have shown the apparent favorable effects of GTR or total excision on survival, 9,19 other results are not so straightforward.…”

Section: High-risk Nbmentioning

confidence: 99%

The role of surgery in the treatment of neuroblastoma

Kubota

2010

Surg Today

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The role of surgery varies greatly according to the clinical condition of the patients with neuroblastoma. A surgical resection is the mainstay of treatment for a localized tumor. However, in the era of intense chemotherapy associated with hematopoietic stem cell plant rescue, surgical resections are recommended without sacrificing the kidney or major vessels. Tumor biology further defines the necessity of supportive chemotherapy or radiation after surgical resection. The presence of diverse terminology concerning the range of resection may impose some confusion in the understanding of the previous papers. Therefore, the definition of a surgical resection was initially stated. In high-risk patients, the advantages of surgery for a patient's survival seem to be limited. This article reviews the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma. The results of surgical resections are summarized according to the International Neuroblastoma Staging System. Finally, the long-term results regarding the strategy-related survival of the patients in the Niigata tumor board are briefly introduced.

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Clinical significance of intensive surgery with intraoperative radiation for advanced neuroblastoma: does it really make sense?

Cited by 28 publications

References 19 publications

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

Intraoperative radiation therapy for advanced neuroblastoma: the problem of securing the IORT field

Implications of surgical intervention in the treatment of neuroblastomas: 20-year experience of a single institution

The role of surgery in the treatment of neuroblastoma

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