Residual tumor in cases of intermediate-risk neuroblastoma did not influence the prognosis

Abstract

Background: It remains unclear whether a residual tumor mass following therapy influences the prognosis of neuroblastoma. Methods: We retrospectively reviewed 20 patients with intermediate-risk tumors treated at our institution between 1993 and 2012 to elucidate whether additional treatment is required for residual tumors. Results: The patient ages at diagnosis ranged from 0 days to 7 years. The 5-year overall survival rate was 94.4%. Thirteen patients had Stage 3 disease and seven patients had Stage 4 disease. Nine patients showed intraspinal extension. Twelve patients had a residual tumor mass at the completion of therapy, and eight showed intraspinal extension. Five of these 12 patients showed metaiodobenzylguanidine (MIBG) uptake at the end of treatment, but the uptake disappeared during the follow-up period. Except for one patient who died due to treatment complications, the rest are all alive, and nine are alive with a residual mass. We examined the residual mass in four patients and found that these tissues had differentiated into a ganglioneuroma or changed to a necrotic tissue. For the three patients with neurological symptoms at the end of treatment, some slight neurological symptoms still remained during the follow-up. Five patients with an intraspinal mass eventually presented with new symptoms. Conclusions: The presence of a residual mass at the end of treatment did not influence the patients' prognosis. Therefore, an invasive radical surgical resection and additional treatment may not be necessary. Cases with a residual intraspinal mass also require a long-term follow-up to assess the neurological prognosis.

Characteristics and management of ganglioneuroma and ganglioneuroblastoma‐intermixed in children and adolescents

“…Increasingly, subsets of patients with pNTs, including those with low‐ and intermediate‐risk NB with favorable clinical and biological characteristics (e.g., infants with small perinatal adrenal masses or those with favorable histology and absence of segmental aberrations) are observed based on frequent spontaneous regression or differentiation and excellent overall outcomes . There is also evidence to support that complete resection is not required for additional subsets of patients with low‐risk or intermediate‐risk NB with favorable biology . In addition, DeCarolis et al.…”

Residual meta‐iodobenzyl guanidine (MIBG) positivity following therapy for metastatic neuroblastoma: Patient characteristics, imaging, and outcome

“…In particular, the rare INSS4 intermediaterisk patients with persistent lesions following upfront chemotherapy may not require SCT based on our case series (including three intermediate risk) and other reports. [10][11][12][13] Furthermore, although patients with high-risk NB with residual lesions post induction have been shown to have an inferior outcome, these results may not extrapolate to residual lesions in these rare intermediate-risk "refractory" patients or high-risk patients with persistent lesions post SCT or immunotherapy. 8 Of the 11 patients in our analytic cohort who did not progress, eight of 11 were classified as high risk.…”

Pediatric Patients with Adrenal Neuroblastoma: A SEER Analysis, 2004–2013

“…26 Iehara et al also reported that a residual mass at the end of treatment of NB did not influence the patients' prognoses in this study. 27 Therefore, invasive radical surgical resection and additional treatment, which will increase the severe complications or life-threatening conditions, may not be necessary.…”