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Surgery alone effective in stage IIa, IIb pediatric neuroblastoma
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Children with stage IIa or IIb neuroblastoma achieved excellent survival rates when treated with maximally safe tumor resection alone for the treatment of their disease, according to the results of the Children’s Oncology Group study P9641.
This means that only a minority of this patient population may have to undergo chemotherapy.
The COG P9641 study included children aged less than 22 years with biopsy proven low-risk neuroblastoma. Because prior studies had indicated that surgery alone resulted in OS of 95% or greater, the purpose of this trial was to demonstrate that surgery alone could extend this high survival rate to 3 years in patients with IIa and IIb disease.
The researchers enrolled 915 eligible patients between 1998 and 2004. All patients underwent tumor resection alone except for those patients with less than 50% tumor resection at diagnosis or with unresectable progressive disease.
“Our data demonstrate that the use of surgery alone is curative therapy for most patients with low-risk neuroblastoma,” Douglas R. Strother, MD, chief of the division of pediatric oncology and blood and marrow transplantation at Alberta Children’s Hospital, and colleagues wrote.
Specifically, the 5-year event-free survival was 89% and the OS was 97% among the entire patient population. When looking at just those patients with stage IIa or IIb disease, the event-free survival was 87% and the OS was 96%.Those patients with stage IIb disease and unfavorable histology or diploid tumors had significantly worse event-free survival and OS compared with those without (see chart).
Among the minority of patients who required chemotherapy, the 5-year OS was 98%. Twenty-one percent of patients achieved complete response, 31% achieved very good partial response and 29% achieved partial response.
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