Past and future role of surgery in neuroblastoma

The significance of surgery in the treatment of neuroblastoma remains unresolved. Moderate surgical resection has been employed in both infantile and advanced neuroblastoma since 1985 at the University of Tsukuba Hospital. Resection of the original tumor accompanied by lymph node sampling was performed in 39 cases of infantile neuroblastoma detected by mass screening. The patients are alive without tumor and with no treatment sequelae. In 20 patients with advanced neuroblastoma aged 1 year or older, the same surgery was performed with intraoperative radiation after more than 5 cycles of induction chemotherapy. Four patients experienced local recurrence with recurrence of remote metastases which were the cause of patient death. The overall survival rate of patients with stage 4 neuroblastoma was 70% at 5 years and 62% at 10 years. A clinical trial in which local therapy will be performed after myeloablative chemotherapy will be carried out from 2005 to evaluate separately the efficacy of chemotherapy and local therapy avoiding their direct interference. This will elucidate the value of local therapy and also moderate surgical resection in the treatment of advanced neuroblastoma.