Authors: Tadaharu Okazaki Sumio Kohno Junichi Mimaya Shiro Hasegawa Naoto Urushihara Atsushi Yoshida Shinya Kawano Junichi Kusafuka Yasuo Horikoshi Yoshifumi Takashima Katsuhiko Aoki Minoru Hamazaki
Publish Date: 2003/12/19
Volume: 20, Issue: 1, Pages: 27-32
Abstract
Japan has a nationwide massscreening program for neuroblastoma in 6monthold infants Neuroblastoma can regress spontaneously and some institutions observe selected cases We evaluated the management of screened neuroblastoma at our hospital since 1997 when an observation program was introduced Criteria for the observation program were stageI stageII or stageIVs tumors urinary vanillylmandelic acid VMA and homovanillic acid HVA levels 40 μg/mg creatinine tumor 5 cm in diameter no invasion to the intraspinal canal or great vessels and parental consent to participate Patients who did not meet observation criteria underwent surgery or mild chemotherapy according to the location of the tumor If patients met observation criteria after chemotherapy surgical intervention was no longer performed Thirtysix patients attended our hospital for screened neuroblastoma from 1997 to 2002 Thirtythree patients who were managed at our hospital participated in this study Ten subjects met observation criteria Tumors regressed in 7 patients mean followup period 363 months with corresponding decreases in VMA and HVA levels group A Three underwent surgery group B because of increasing VMA and HVA levels increase in tumor size or guardian’s request Twentythree subjects did not meet observation criteria Four patients underwent primary surgery group C and 19 patients had chemotherapy initially Fourteen patients met observation criteria after chemotherapy and two are still having chemotherapy group D Three patients required surgery due to insufficient regression of their tumors group E Fourteen subjects in group D had marked decreases in VMA and HVA levels and tumor size mean followup period 291 months and tumors were not detected using imaging techniques in 8 patients Histological examination of all resected specimens during the study period showed favorable histology and no Nmyc amplification There was no evidence of unfavorable prognosis in any of the 33 subjects although 1 patient who underwent primary surgery had a vanishing kidney 1 year later and 1 patient had multiple bony metastases after complete resection of tumor which was treated by chemotherapy Until the real significance of mass screening for neuroblastoma as a public health measure is confirmed observation with careful followup should be adopted more extensively because it has a favorable outcome in many cases and is associated with minimal therapeutic complications
Keywords: