Surgery alone may be best treatment for local-regional neuroblastoma

By sparing patients the side effects of chemotherapy without compromising survival, surgery alone may be preferable to surgery plus chemotherapy as a treatment for local-regional neuroblastoma, according to a recent report.

The reluctance by some physicians to perform surgery alone stems from the fear that not using chemotherapy will increase the risk of widespread relapses, which are unlikely to be cured, researchers report in the July issue of the Journal of Pediatric Hematology/Oncology. The new findings indicate, however, that although such relapses can occur, they are often curable with intensive chemotherapy and anti-GD2 immunotherapy.In the current study, Dr. Brian H. Kushner and colleagues at Memorial Sloan-Kettering Cancer Center in New York assessed the outcomes of seven children who experienced widespread relapses after being treated with surgery alone for local-regional neuroblastoma. All of the relapses were treated with intensive chemotherapy plus anti-GD2 immunotherapy.Five of the patients were in complete remission more than 3 years after starting retrieval chemotherapy. The remaining two patients experienced progressive disease and one died.Surgery alone might be beneficial for two reasons, the authors note. First, “many patients will never need cytotoxic therapy” and, therefore, they will be spared the potential adverse effects. Second, as the current findings illustrate, “most of those who do have widespread relapses are likely to be cured with contemporary treatments.”While this report is one of several supporting the surgery alone approach, there is also strong evidence that many patients with local-regional neuroblastoma benefit from adjuvant chemotherapy, Dr. John M. Maris, from the Children’s Hospital of Philadelphia, and Dr. Robert P. Castleberry, from The University of Alabama at Birmingham, note in a related editorial.Results from ongoing trials are needed to better define when each treatment strategy is indicated, the editorialists add.(Source: J Pediatr Hematol Oncol 2003;25:512-519: Reuters Health: July 21, 2003: Oncolink)