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REVIEW ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 19  |  Page : 2332-2337

Advances in the Surgical Treatment of Neuroblastoma


Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052, China

Correspondence Address:
Dr. Jia-Xiang Wang
Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan 450052
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.241803

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Objective: This study was to review the efficacy of surgical resections in different clinical situations for a better understanding of the meaning of surgery in the treatment of neuroblastoma (NB). Data Sources: The online database ScienceDirect (201–2018) was utilized. The search was conducted using the keywords “neuroblastoma,” “neuroblastoma resection,” “neuroblastoma surgery,” and “high-risk neuroblastoma.” Study Selection: We retrospectively analyzed of patients who underwent surgical resections in different clinical situations. The article included findings from selected relevant randomized controlled trials, systematic reviews, and meta-analyses or good-quality observational studies. Abstracts only, letters, and editorial notes were excluded. Full-text articles and abstracts were extracted and reviewed to identify key articles discussing surgery management of NB, which were then selected for critical analysis. Results: A total of 7800 English language articles were found containing references to NB (201–2018). The 163 articles were searched which were related to the surgical treatment of NB (201–2018). Through the analysis of these important articles, we found that the treatments of NB at low- and intermediate-risk groups were basically the same. High-risk patients remained controversial. Conclusions: NB prognosis varies tremendously based on the stage and biologic features of the tumor. After reviewing the relevant literature, patients with low-risk disease are often managed with surgical resection or observation alone with tumors likely to spontaneously regress that are not causing symptoms. Intermediate patients are treated with chemotherapy with the number of cycles depending on their response as well as surgical resection of the primary tumor. High-risk patients remain controversial. Multidisciplinary intensive treatment is essential, especially for patients who received subtotal tumor resection. Minimally invasive surgery for the treatment of NBs without image-defined risk factors in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome. We conclude that ≥90% resection of the primary tumor is both feasible and safe in most patients with high-risk NB. New targeted therapies are crucial to improve survival.

 

 Abstract in Chinese

神经母细胞瘤外科治疗进展

摘要

背景:在过去的几年中,神经母细胞瘤(NBL)手术治疗已经取得了一些进展,并对局部神经母细胞瘤手术治疗的作用进行了一些研究,但手术时机和原发肿瘤切除范围对高危患者预后的影响仍存在争议。本文回顾了手术切除在不同临床情况下的疗效,以便更好地理解手术治疗在神经母细胞瘤治疗中的意义。

数据资料:在ScienceDirect 数据库中我们通过使用关键词“神经母细胞瘤”、“神经母细胞瘤切除术”、“神经母细胞瘤手术”和“高危组神经母细胞瘤”检索从2016到2018有关神经母细胞的文章。

研究选择:我们回顾性分析了在不同临床情况下接受手术切除的患者。这些文章包括相关的随机对照试验,综述和meta分析和高质量的报告研究。只有摘要和编辑注释的文献被排除在外,我们回顾性分析与NBL外科治疗有关的含全文文章和摘要的文献。

结果:共检索到7800篇有关神经母细胞瘤的文献(2016~2018年)。检索到163篇与神经母细胞瘤外科治疗相关的文献(2016~2018)。通过分析这些重要文献,我们发现低中危神经母细胞瘤的治疗基本相同。但是高危患者仍存在争议。

结论:神经母细胞瘤的预后根据肿瘤的分期和生物学特征而有很大差异。在回顾相关文献后,低危患者通常通过手术切除或仅仅随访观察,肿瘤可能自发地消退而不会引起症状。中危患者接受化疗的周期取决于原发肿瘤的手术切除的效果。高危患者治疗仍存在争议。多学科强化治疗是必不可少的,尤其是对于接受次全切除术的患者。如果IDRFs评估没有风险因素,对于低中危患儿,微创手术是安全可行的。我们认为,在大多数高危神经母细胞瘤患者中,90%以上切除是可行的和安全的。新的治疗目标是提高患者生存率。



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