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Surgery failed to improve survival in advanced neuroblastoma
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Primary tumor resection had no impact on event-free survival or OS among a cohort of young patients with metastatic neuroblastoma, according to study results.
Although intensive treatment options have improved the prognosis of metastatic neuroblastoma, many patients who demonstrate an initial positive response to treatment still die from the disease.
Previous trials focused on autologous stem cell transplantation during first-line therapy. However, the role of surgery in the treatment of patients with neuroblastomas remains unclear, according to background information provided by researchers.
Thorsten Simon, MD, of the department of pediatric oncology and hematology at Children’s Hospital at the University of Cologne in Germany, and colleagues analyzed the impact of tumor resection on patients aged older than 18 months and younger than 22 years with stage IV, high-risk neuroblastoma previously treated with intensive multimodality therapy.
Researchers enrolled 278 patients between Nov. 1, 1996 and Dec. 31, 2003.
Two independent physicians reviewed operation notes and imaging reports. The physicians correlated tumor resections with the local control rate and outcomes.
Researchers distinguished between two operations: the tumor operation performed before induction chemotherapy (first operation) and the most extensive removal of primary tumor tissue done at any time during first-line therapy (best operation).
Enrolled patients had a median age of 3.4 years at diagnosis. Researchers observed the surviving patients for a median of 9.1 years.
Before induction chemotherapy, complete resection was achieved in 17 patients (6.1%), incomplete resection was achieved in 12 patients (4.3%). Surgeons obtained biopsies from 91 patients (32.7%). The researchers said 175 patients (55.8%) did not require surgery.
The presence of one or more image-defined risk factors (IDRF) was associated with a lower rate of complete resection at the first operation compared with no IDRFs (1.1% vs. 18.3%; P<.001), according to study results.
After induction chemotherapy, 152 patients (54.7%) underwent complete resection, 12 patients (4.3%) underwent a biopsy and 25 patients (9%) required no operation on the primary tumor.
The extent of the first operation had no impact on 5-year event-free survival (P=.207), local PFS (P=.195) or OS (P=.351) of all 278 patients, according to study results.
Similarly, researchers found the extent of best operation had no impact on EFS (P=.877), LPFS (P=.299) or OS (P=.778), researchers found.
Results of multivariate analysis showed that surgery did not affect EFS, local PFS or OS.
“The results of this study do not justify aggressive surgery in patients undergoing high-intensity multimodal treatment for metastatic neuroblastoma,” Simon and colleagues concluded.
Disclosure: Simon reports no relevant financial disclosures.
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