Surgery Alone Remains Primary Treatment for Stage I and II Neuroblastoma
Neuroblastoma is a type of cancerous tumor that can occur in children, most often in those younger than 2 years old. This cancer can affect the chest, abdomen, adrenal gland or neck, and in some cases there is extension of the cancer to the spine. Depending on the stage of disease (the extent of disease at the time of diagnosis), neuroblastoma can be treated with surgery, chemotherapy, and/or radiation. However, doctors try to avoid using radiation therapy and chemotherapy when possible, because these treatments could have negative effects on a child’s growth and development.
When the cancer is localized (stage I or II, with or without involvement of the lymph nodes), meaning that it is present only in the area of the body in which it first developed, surgery alone is usually the primary (first and possibly only) treatment used. The survival rate for these children is excellent; however, a few suffer relapse of the cancer and ultimately die of their disease. Following the progress of young persons affected by neuroblastoma over time is important to make sure that the most effective treatment strategies are being used and that any necessary changes to these strategies are made.
The Children’s Cancer Group investigated the treatment of 374 children with stage I or II neuroblastoma, to determine whether the current treatment strategy of using surgery as the primary treatment is the most effective approach. In patients with stage I disease, surgery was the only therapy used. In patients with stage II disease, surgery was the only therapy used for many, but for some who had compression of the spinal cord, radiation therapy was also used. If there was a recurrence of cancer, surgery was tried again. If surgical efforts failed, chemotherapy and sometimes radiation therapy were provided.
Results showed that the overall survival rate for the children was 98%. Fourteen of the 384 children suffered a recurrence. These patients were then treated with surgery and/or chemotherapy. One child with stage I neuroblastoma (< 1%) and 6 children with stage II disease (2.5%) eventually died.
From these findings, the researchers concluded that primary treatment utilizing surgery alone for patients with neuroblastoma stage I or II produces an excellent survival rate of 98%. Additional treatments were needed in approximately 10% of patients with stage I disease, and 20% in those with stage II disease. Certain factors that may alert doctors that a child may have a less favorable chance for survival include: 1) if a child with stage II cancer also carries a gene called MYCN; or 2) if a child is older than age 2 years and either his/her cells show unfavorable results when examined under a microscope (histology results) or his/her lymph nodes are affected by the cancer. (Journal of Clinical Oncology, Vol 18, No 1, p 18, 2000).