The Impact of Chemotherapy and Radiation Therapy on Secondary Operations for Neuroblastoma

Abstract

From Jan. 1969-July 1979, 37 children with neuroblastoma were cared for at the Oklahoma Children''s Memorial Hospital [Oklahoma City, Oklahoma, USA]. Nineteen patients with extensive disease were studied to examine the interrelationships of chemotherapy, radiation therapy and secondary surgery. Eleven children had secondary surgery in the abdomen or cervical region with 1 postoperative death. All patients had chemotherapy [cyclophosphamide, vincristine, papaverine, 5-trifluoromethyl-2''-deoxyuridine] and 10 had radiation therapy between the primary and secondary operation or death. Five children survived. Four of 5 survivors were less than 1 yr of age at diagnosis and initial treatment. Fourteen of 15 patients, 1 yr of age or older, died. Each case had pathologic examination of tumor before and after therapy. All survivors showed sequential maturation of tumor tissue but only 1 nonsurvivor had this finding. Unusual metastatic spread was found in patients having combined therapy. Multimodal therapy for advanced neuroblastoma accentuates the need for sensible timing and utilization of secondary operative procedures. The secondary procedures ideally eradicate the primary focus of tumor, and may serve to excise selective areas of metastatic disease or to biopsy residual disease in aiding continuing therapy. Secondary surgery ought to follow the onset of radiation therapy by 4-6 wk, or of chemotherapy by 12-24 wk. This delay allows maximum control of primary and generalized disease, and maturation, differentiation, encapsulation and shrinkage of extensive initially unresectable primary tumors.