Treatment of spinal involvement in neuroblastoma patients Journal Article

Authors: Sandberg, D. I.; Bilsky, M. H.; Kushner, B. H.; Souweidane, M. M.; Kramer, K.; LaQuaglia, M. P.; Panageas, K. S.; Cheung, N. K. V.
Article Title: Treatment of spinal involvement in neuroblastoma patients
Abstract: Introduction: Considerable controversy exists regarding the appropriate management of spinal involvement in neuroblastoma (NB) patients. We review a large group of such patients and offer treatment recommendations. Methods: Forty-six patients with epidural and/or neural foraminal involvement treated between 1987 and 1998 were staged according to the International NB Staging System (INSS) and classified as high-risk (INSS stage 4; n = 31) or low-risk (INSS stage <4; n = 15). Of 13 high-risk patients with normal neurologic examinations and no radiographic high-grade spinal cord compression (HGSCC), 12 were treated initially with chemotherapy, and only 1 demonstrated neurologic deterioration. HGSCC was present in 18 patients with high-risk NB; 7 of 10 (70%) treated initially with chemotherapy and 6 of 6 (100%) managed initially with operation improved or remained stable. All 9 low-risk patients with normal neurologic examinations and no HGSCC remained neurologically intact following operations (n = 7) or chemotherapy (n = 2). All 4 low-risk patients with HGSCC treated with operations improved or remained stable, and 0 of 2 (0%) low-risk patients treated initially with chemotherapy remained stable. Spinal deformities occurred in 2 of 16 patients (12.5%) treated nonoperatively and in 9 of 30 (30.0%) who underwent operations. Conclusions: High-risk NB patients with spinal involvement but normal neurologic examinations should be offered chemotherapy. High-risk patients with HGSCC may respond to chemotherapy, but a small percentage will require operations for progressive neurologic deficits. Chemotherapy may be avoided in low-risk patients who are offered potentially curative operations. Patients treated with operations for epidural disease are at high risk of subsequently developing spinal deformity. Copyright © 2003 S. Karger AG, Basel.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; child; clinical article; controlled study; treatment outcome; child, preschool; cancer surgery; surgical technique; retrospective studies; review; combined modality therapy; follow up; neurosurgery; antineoplastic agent; neoplasm staging; treatment indication; antineoplastic combined chemotherapy protocols; morbidity; risk factors; algorithms; high risk patient; infant; neuroblastoma; spinal cord; spinal cord compression; spine; spinal cord metastasis; neurologic examination; cord compression; spinal cord neoplasms; spine malformation; humans; prognosis; human; male; female; priority journal
Journal Title: Pediatric Neurosurgery
Volume: 39
Issue: 6
ISSN: 1016-2291
Publisher: Karger  
Date Published: 2003-12-01
Start Page: 291
End Page: 298
Language: English
DOI: 10.1159/000075256
PUBMED: 14734862
PROVIDER: scopus
Notes: Export Date: 25 September 2014 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Brian Kushner
    191 Kushner
  2. Nai-Kong Cheung
    446 Cheung
  3. Kim Kramer
    170 Kramer
  4. Mark H Bilsky
    222 Bilsky
  5. Katherine S Panageas
    329 Panageas