Surgical treatment of retroperitoneal neuroblastoma in children. Clinical experience

Purpose of the study. Was to analyze our experience of surgical treatment of retroperitoneal neuroblastoma in children and the influence of radical surgical treatment on the disease outcomes.

Materials and methods. The study included 35 patients (14 girls and 21 boys, mean age 3.3 years) receiving treatment for retroperitoneal neuroblastoma at the Department of Pediatric Oncology, National Medical Research Centre for Oncology, in 2016–2018. 32 patients underwent surgical treatment. The disease progression during neoadjuvant polychemotherapy was registered in 3 patients. Initially, surgery was performed in 5 patients; the rest of the patients underwent percutaneous trepan biopsy with immunohistochemical testing and subsequent neoadjuvant polychemotherapy. No patients developed complications in the early postoperative period. In the article, we present our experience in the surgical treatment of pediatric patients with retroperitoneal neuroblastomas.

Results. Patients have been observed during 12 to 24 months. 23 of 28 radically operated patients are alive and have no signs of the disease recurrence or progression. 2 patients developed tumor recurrence and received anti-recurrence PCT and DGT. Currently the patients are in remission. 3 patients showed systemic progression due to primarily advanced disease.

Conclusion. Administration of modern surgical techniques and instrumentation allows radical surgical treatment for a large percentage of patients with locally advanced neuroblastoma.

1. Proleskovskaya IV, Nazaruk SI, Konoplya NE. Local control for patients with high-risk neuroblastoma: within the NB2004M protocol (Republic of Belarus). Oncological Journal. 2017;11(2(42)):21–27. (In Russ.).

2. Kazantsev AP. Neuroblastoma. Modern ideas about staging and forecasting. Bulletin of the FGBNU "N. N. Blokhin RSC". 2015;26(3):3–22. (In Russ.).

3. Durnov LA. Malignant tumors in young children. Moscow, Med., 1984. (In Russ.).

4. Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Altekruse S, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). National Cancer Institute, Bethesda, 2012.

5. Gurney JG, Ross JA, Wall DA, Bleyer WA, Severson RK, Robison LL. Infant cancer in the U.S.: histology-specific incidence and trends, 1973 to 1992. J Pediatr Hematol Oncol. 1997 Oct;19(5):428–432. https://doi.org/10.1097/00043426-199709000-00004

6. Esiashvili N, Anderson C, Katzenstein HM. Neuroblastoma. Curr Probl Cancer. 2009 Dec;33(6):333–360. https://doi.org/10.1016/j.currproblcancer.2009.12.001

7. Nuchtern JG, London WB, Barnewolt CE, Naranjo A, McGrady PW, Geiger JD, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children’s Oncology Group study. Ann Surg. 2012 Oct;256(4):573–580. https://doi.org/10.1097/SLA.0b013e31826cbbbd

8. Hero B, Simon T, Spitz R, Ernestus K, Gnekow AK, Scheel-Walter H-G, et al. Localized infant neuroblastomas often show spontaneous regression: results of the prospective trials NB95-S and NB97. J Clin Oncol. 2008 Mar 20;26(9):1504–1510. https://doi.org/10.1200/JCO.2007.12.3349

9. Khizhnikov AV, Kazantsev AP. Treatment of high-risk neuroblastoma. Oncopediatrics. 2017;4(2):131–140. (In Russ.). https://doi.org/10.15690/onco.v4i2.1707

10. Garaventa A, Bellagamba O, Lo Piccolo MS, Milanaccio C, Lanino E, Bertolazzi L, et al. 131I-metaiodobenzylguanidine (131I-MIBG) therapy for residual neuroblastoma: a mono-institutional experience with 43 patients. Br J Cancer. 1999 Dec;81(8):1378–1384. https://doi.org/10.1038/sj.bjc.6694223

11. Hutchinson RJ, Sisson JC, Miser JS, Zasadny KR, Normolle DP, Shulkin BL, et al. Long-term results of [131I]metaiodobenzylguanidine treatment of refractory advanced neuroblastoma. J Nucl Biol Med. 1991 Dec;35(4):237–240.

12. Pasqualini C, Dufour C, Goma G, Raquin M-A, Lapierre V, Valteau-Couanet D. Tandem high-dose chemotherapy with thiotepa and busulfan-melphalan and autologous stem cell transplantation in very high-risk neuroblastoma patients. Bone Marrow Transplant. 2016 Feb;51(2):227–231. https://doi.org/10.1038/bmt.2015.264

13. Sung KW, Son MH, Lee SH, Yoo KH, Koo HH, Kim JY, et al. Tandem high-dose chemotherapy and autologous stem cell transplantation in patients with high-risk neuroblastoma: results of SMC NB-2004 study. Bone Marrow Transplant. 2013 Jan;48(1):68–73. https://doi.org/10.1038/bmt.2012.86

14. Kit OI, Kuznetsov SA, Kolesnikov EN, Mkrtchyan GA, Starzhetskaya MV, Bespalova AI, et al. Experience in surgical treatment of locally common forms of retroperitoneal neuroblastoma. Russian Journal of Pediatric Hematology and Oncology. 2019;6(S1):127. (In Russ.).

15. La Quaglia MP, Kushner BH, Su W, Heller G, Kramer K, Abramson S, et al. The impact of gross total resection on local control and survival in high-risk neuroblastoma. J Pediatr Surg. 2004 Mar;39(3):412–417. https://doi.org/10.1016/j.jpedsurg.2003.11.028

16. Adkins ES, Sawin R, Gerbing RB, London WB, Matthay KK, Haase GM. Efficacy of complete resection for high-risk neuroblastoma: a Children’s Cancer Group study. J Pediatr Surg. 2004 Jun;39(6):931–936. https://doi.org/10.1016/j.jpedsurg.2004.02.041

17. La Quaglia MP, Kushner BH, Heller G, Bonilla MA, Lindsley KL, Cheung NK. Stage 4 neuroblastoma diagnosed at more than 1 year of age: gross total resection and clinical outcome. J Pediatr Surg. 1994 Aug;29(8):1162–1165. https://doi.org/10.1016/0022-3468(94)90301-8

18. Kushner BH, Kramer K, LaQuaglia MP, Modak S, Yataghene K, Cheung N-KV. Reduction from seven to five cycles of intensive induction chemotherapy in children with high-risk neuroblastoma. J Clin Oncol. 2004 Dec 15;22(24):4888–4892. https://doi.org/10.1200/JCO.2004.02.101

19. Tsuchida Y, Kaneko M. Surgery in pediatric solid tumors with special reference to advanced neuroblastoma. Acta Paediatr Taiwan. 2002 Apr;43(2):67–71.

20. Von Schweinitz D, Hero B, Berthold F. The impact of surgical radicality on outcome in childhood neuroblastoma. Eur J Pediatr Surg. 2002 Dec;12(6):402–409. https://doi.org/10.1055/s-2002-36952

21. Castel V, Tovar JA, Costa E, Cuadros J, Ruiz A, Rollan V, et al. The role of surgery in stage IV neuroblastoma. J Pediatr Surg. 2002 Nov;37(11):1574–1578. https://doi.org/10.1053/jpsu.2002.36187

22. Simon T, Häberle B, Hero B, von Schweinitz D, Berthold F. Role of surgery in the treatment of patients with stage 4 neuroblastoma age 18 months or older at diagnosis. J Clin Oncol. 2013 Feb 20;31(6):752–758. https://doi.org/10.1200/JCO.2012.45.9339

23. Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, et al. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol. 2009 Jan 10;27(2):298–303. https://doi.org/10.1200/JCO.2008.16.6876

24. Kazantsev AP, Khizhnikov AV, Matinyan NV, Davydov MI. Ganglioneuroblastoma of the right gemithorax in a 2 years old child. Journal of N. N. Blokhin Russian Cancer Research Center RAMS. 2015;26(3):88–91. (In Russ.).

25. Häberle B, Hero B, Berthold F, von Schweinitz D. Characteristics and outcome of thoracic neuroblastoma. Eur J Pediatr Surg. 2002 Jun;12(3):145–150.

26. Horiuchi A, Muraji T, Tsugawa C, Nishijima E, Satho S, Takamizawa S, et al. Thoracic neuroblastoma: outcome of incomplete resection. Pediatr Surg Int. 2004 Sep;20(9):714–718. https://doi.org/10.1007/s00383-003-1049-7

27. Akgun B, Ates D, Kaplan M. Ganglioneuroblastoma of the thoracic spinal cord: a very rare case report. Acta Medica (Hradec Kralove). 2012;55(1):50–52. https://doi.org/10.14712/18059694.2015.76