Document Detail


The treatment of neuroblastoma with intraspinal extension with chemotherapy followed by surgical removal of residual disease. A prospective study of 42 patients--results of the NBL 90 Study of the French Society of Pediatric Oncology.
MedLine Citation:
PMID:  8674009     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Neuroblastoma is the most common malignant cause of spinal compression in the pediatric population. More than 30% of patients who are impaired prior to treatment remain impaired after the completion of therapy. Those who do not improve after decompressive laminectomy may go on to develop severe delayed spinal deformities. METHODS: To decrease the long term sequelae of routine neurosurgical intervention for all intraspinal extensions of neuroblastoma, the French NBL 90 Study was formulated to use chemotherapy as a first-line treatment for all nonmetastatic neuroblastomas with intraspinal extension. Neurosurgical decompression and excision was recommended only for patients demonstrating rapid neurologic deterioration. RESULTS: The overall survival of the 42 patients registered was 97%. Initial neurologic impairment was present in 27 patients (64%), including 11 with paraplegia. Thirty-two patients received chemotherapy as first-line treatment. Complete regression of the intraspinal component was observed in 13 patients and partial regression of greater than 50% of the initial volume in 5 patients. Of 19 evaluable patients presenting with a neurologic deficit and treated with primary chemotherapy, recovery was completed in 11 and partial in 3. Four patients failed to recover from long-standing pretreatment paraplegia. Only one patient worsened during therapy, and recovered completely after emergent neurosurgical intervention. Seven patients underwent initial neurosurgical procedures; six had a neurologic deficit and five recovered completely, including all three who presented with acute onset of paraplegia. Three patients had extraspinal surgery as exclusive treatment. Six patients (15%) suffered severe neurologic sequelae. Only one of the patients who underwent surgery required spinal stabilization for progressive deformity, but follow-up is limited. CONCLUSIONS: By treating patients with dumbbell neuroblastoma initially with chemotherapy, the authors were able to reduce the size of the intraspinal mass in 58% of patients, improve partial neurologic deficits in 92%, and avoid neurosurgical decompression in 60%. Neurologic deficits also improved in 83% of patients requiring emergent neurosurgical intervention.
Authors:
D Plantaz; H Rubie; J Michon; F Mechinaud; C Coze; P Chastagner; D Frappaz; M Gigaud; J G Passagia; O Hartmann
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cancer     Volume:  78     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-08-15     Completed Date:  1996-08-15     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  311-9     Citation Subset:  AIM; IM    
Affiliation:
Pediatric Department, Centre Hospitalier Universitaire, Hospital Michallon, Grenoble, France.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Antineoplastic Combined Chemotherapy Protocols / administration & dosage,  therapeutic use*
Child
Child, Preschool
Female
Follow-Up Studies
France
Humans
Infant
Infant, Newborn
Laminectomy
Male
Neoplasm, Residual / surgery
Neuroblastoma / complications,  drug therapy*,  surgery*
Neurologic Examination
Paraplegia / etiology
Prospective Studies
Remission Induction
Spinal Cord Compression / etiology,  surgery
Spinal Neoplasms / complications,  drug therapy*,  surgery*
Survival Rate
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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