1
|
Shah NR, Weadock WJ, Williams KM, Moreci R, Stoll T, Joshi A, Petroze R, Newman EA. Use of modern three-dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors. Pediatr Blood Cancer 2024; 71:e30933. [PMID: 38430473 DOI: 10.1002/pbc.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In complex pediatric surgical oncology, surgical planning is contingent upon data gathered from preoperative imaging. Three-dimensional (3D) modeling and printing has been shown to be beneficial for adult presurgical planning, though pediatric literature is less robust. The study reviews our institutional experience with the use of 3D image segmentation and printed models in approaching resection of extracranial solid tumors in children. METHODS This is a single institutional series from 2021 to 2023. Models were based on computed tomography and magnetic resonance imaging studies, optimized for 3D imaging. The feasibility and creation of the models is reviewed, including specific techniques, software, and printing materials from our institution. Clinical implications for surgical planning are also described, along with detailed preoperative and intraoperative images. RESULTS 3D modeling and printing was performed for four pediatric patients diagnosed with extracranial solid tumors. Diagnoses included Ewing sarcoma, hepatoblastoma, synovial sarcoma, and osteosarcoma. No intraoperative complications or discrepancies with the preoperative 3D-printed model were noted. No evidence of local recurrence was identified in any patient thus far. CONCLUSION Our institutional series demonstrates a wide spectrum of clinical application for 3D modeling and printing technology within pediatric surgical oncology. This technology may aid in surgical planning for both resection and reconstruction, can be applied to a diverse breadth of diagnoses, and may potentially augment patient and/or family education about their condition.
Collapse
Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William J Weadock
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Keyonna M Williams
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tammy Stoll
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aparna Joshi
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robin Petroze
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
2
|
Jacobson JC, Clark RA, Chung DH. High-Risk Neuroblastoma: A Surgical Perspective. Children (Basel) 2023; 10. [PMID: 36832517 DOI: 10.3390/children10020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
High-risk neuroblastoma requires multimodal treatment including systemic chemotherapy, surgical resection, radiation therapy, stem cell transplant, and immunotherapy. Surgeons play a vital role in obtaining local control of neuroblastoma and must therefore be knowledgeable about this complex pathology. This article provides a review of the optimal timing and extent of resection, the impact of various image-defined risk factors on surgical planning, and surgical approaches and techniques to enhance the resection of tumors in different anatomic locations.
Collapse
|
3
|
Commander SJ, Cerullo M, Arjunji N, Leraas HJ, Thornton S, Ravindra K, Tracy ET. Improved Survival and Higher Rates of Surgical Resection Associated with Hepatocellular Carcinoma in Children as Compared to Young Adults. Int J Cancer 2022; 151:2206-2214. [PMID: 35841394 DOI: 10.1002/ijc.34215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children with a 5-year overall survival of 30%. Few studies have examined the similarities and differences between pediatric and adult HCC. This paper aims to examine the relationship between tumor characteristics, treatments, and outcomes in pediatric and adult patients with HCC. The 2019 National Cancer Database was queried for patients with HCC. Patients were stratified by age: pediatric <21 years (n = 214) and young adults 21-40 (n = 1102). Descriptive statistics and chi square were performed. The mean age at diagnosis was 15.5 years (SD 5.6) in the pediatric and 33 years (5.3) in the adult group. Children had a comparable rate of metastasis (30% vs 28%, P = 0.47) and increased fibrolamellar histology (32% vs 9%). Surgical resection was more common in children compared with adults (74% vs 62%, P < 0.001), children also had more lymph nodes examined (39% vs 19%, P < 0.001), positive lymph nodes (35% vs 17%, P = 0.02), and surgical resection when metastasis were present at diagnosis (46% vs 18%, P < 0.001). The 1, 3, and 5-year overall survival was higher for pediatric patients than adults (81%, 65%, 55%, vs 70%, 54%, 48%,) Despite higher prevalence of fibrolamellar histology, greater number of positive lymph nodes, and comparable rates of metastasis at diagnosis, children with HCC have improved overall survival compared with adults. Age did not significantly contribute to survivorship, so it is likely that the more aggressive surgical approach contributed to the improved overall survival in pediatric patients. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Marcelo Cerullo
- Department of General Surgery, Duke University Medical Center
| | - Neha Arjunji
- School of Medicine, Duke University Medical Center
| | - Harold J Leraas
- Division of Pediatric Surgery, Duke University Medical Center
| | | | - Kadiyala Ravindra
- Division of Abdominal Transplantation, Duke University Medical Center
| | | |
Collapse
|
4
|
Pio L, Sarnacki S. Editorial: Innovative approaches in pediatric surgical oncology. Front Pediatr 2022; 10:989822. [PMID: 35989983 PMCID: PMC9386678 DOI: 10.3389/fped.2022.989822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Luca Pio
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States.,Learning Planet Institute, Université de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Paediatric Surgery, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| |
Collapse
|
5
|
Commander SJ, Cerullo M, Leraas HJ, Reed CR, Achey MA, Wachsmuth LP, Schooler GR, Tracy ET. Hepatic vascular malignancies in children are associated with increased rates of surgical resection and improved overall survival compared with adults. Pediatr Blood Cancer 2021; 68:e28864. [PMID: 33661569 PMCID: PMC9878303 DOI: 10.1002/pbc.28864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/19/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hepatic vascular malignancies (HVMs) are rare malignancies, with no standardized treatment regimens. The most common HVMs, angiosarcoma and malignant epithelioid hemangioendothelioma (EHE), are often grouped together in the literature complicating our ability to achieve reliable survival data and treatment strategies. OBJECTIVE To compare the disease characteristics of HVMs, with a subanalysis on pediatric patients. METHODS The 2016 National Cancer Database was queried for patients with HVMs using international classification of diseases-oncology-3 (ICD-O-3) codes yielding 699 patients. Descriptive statistics, chi-square, Kaplan-Meier, and log-rank analyses were performed. RESULTS We found 478 patients (68%) with angiosarcoma and 221 (32%) with EHE. The median (Q1, Q3) age for angiosarcoma patients was 65 years (56, 75) versus 54 years (37, 65) in EHE patients (P < .001). The rate of resection was lower in patients with angiosarcoma than EHE (13% vs 32%, P < .001). The mean 1-, 3-, and 5-year overall survival for angiosarcoma patients was 17%, 8%, and 6%, respectively, versus 80%, 65%, and 62% in EHE patients (P < .0001). A subgroup analysis was performed on pediatric patients demonstrating six with angiosarcoma and 10 with EHE. The mean 1-, 3-, and 5-year overall survival for pediatric angiosarcoma patients was 67%, 50%, and 50%, respectively, and 90%, 90%, and 90% for pediatric EHE patients. CONCLUSION In the largest study of HVMs to date, we found angiosarcoma has significantly worse overall survival than EHE. Pediatric patients appear to have improved survival and higher rates of resection. Larger studies of HVMs are needed to clearly differentiate tumor types, standardize care, and improve survivorship.
Collapse
Affiliation(s)
- Sarah Jane Commander
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marcelo Cerullo
- Department of General Surgery, Duke University Medical Center, Durham, North Carolina
| | - Harold J. Leraas
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Christopher R. Reed
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Meredith A. Achey
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lucas P. Wachsmuth
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Gary R. Schooler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elisabeth T. Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
6
|
Blanc T, Pio L, Clermidi P, Muller C, Orbach D, Minard-Colin V, Harte C, Meignan P, Kohaut J, Heloury Y, Sarnacki S. Robotic-assisted laparoscopic management of renal tumors in children: Preliminary results. Pediatr Blood Cancer 2019; 66 Suppl 3:e27867. [PMID: 31136081 DOI: 10.1002/pbc.27867] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/12/2019] [Accepted: 05/17/2019] [Indexed: 12/24/2022]
Abstract
AIM We present the preliminary results of robotic-assisted laparoscopic (RAL) total and partial nephrectomy for renal malignant tumors in children. METHODS This is a prospective study of patients operated with RAL between December 2016 and September 2018. Patients with Wilms tumors were treated according to the SIOP-2001 protocol. Patient and tumor characteristics, type of surgery, surgical-related morbidity, and oncologic outcomes were recorded. Results were compared with a series of patients with similar age- and tumor-related characteristics operated during the same period by an open surgical approach. RESULTS Ten children underwent RAL nephrectomy with a mean age of five years (3.2-14.1 years). Total nephrectomy was done in six cases for Wilms tumor and in one case for renal sarcoma; three cases were converted. Complete removal of tumor without rupture was achieved in all cases. Postoperative course was uneventful, and patients were discharged between days 2 and 7. Neither recurrence nor medium-term complications occurred. Nine patients are alive with a median follow-up of 16 months (6-27 months) and one female died from complications of central nervous system metastases one year after surgery. When compared with the open surgical approach group, median tumor volume was smaller (P = 0.005), hospital stay was shorter (P = 0.01), and operative time was similar (P = 0.20). CONCLUSIONS RAL total and partial nephrectomy procedure for renal tumor in children may be an option in carefully selected cases. Indication should be discussed at tumor boards and surgery performed while adhering strictly to oncological surgical rules.
Collapse
Affiliation(s)
- Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker-Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker-Enfants Malades, Paris, France
| | - Luca Pio
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Pauline Clermidi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Cecile Muller
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Daniel Orbach
- Department of Pediatric Oncology, Oncology Center SIREDO (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Veronique Minard-Colin
- Department of Oncology for Child and Adolescents, Gustave Roussy, Cancer Center, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Meignan
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Jules Kohaut
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Yves Heloury
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sabine Sarnacki
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| |
Collapse
|
7
|
Pio L, Blanc T, de Saint Denis T, Irtan S, Valteau-Couanet D, Michon J, Brisse H, Galmiche-Rolland L, Joyeux L, Odent T, Harte C, Glorion C, Zerah M, Sarnacki S. Multidisciplinary surgical strategy for dumbbell neuroblastoma: A single-center experience of 32 cases. Pediatr Blood Cancer 2019; 66 Suppl 3:e27670. [PMID: 30828979 DOI: 10.1002/pbc.27670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prognosis of dumbbell neuroblastoma (NBL) is mainly determined by the sequelae induced by the tumor itself and the neurosurgical approach. However, after primary chemotherapy, surgical management of the residual tumor, especially the spinal canal component, remains controversial. METHODS We conducted a single-center retrospective cohort study over the last 15 years (2002-2017) including patients treated for NBL with spinal canal extension focusing on timing and type of surgery, complications, and functional and oncological follow-up. RESULTS Thirty-two children (14 M, 18 F) were managed for NBL, with the majority (26) presenting with NBL stroma poor while four had ganglioneuroblastoma intermixed, one nodular, and one ganglioneuroma. All but two patients received neoadjuvant chemotherapy. Upfront laminotomy for spinal cord decompression was performed in two patients; nine patients had extraspinal surgery with a follow-up neurosurgical procedure in seven cases; eight patients had initial neurosurgery followed by an extraspinal procedure, while six patients underwent a combined multidisciplinary approach. With a median follow up of 3.6 years (0.1-14.9), 29 patients (90.6) are alive and two out of three (19, 65.5%) have functional sequelae. CONCLUSION Patients with NBL with persistent spinal canal extension of the tumor after neoadjuvant chemotherapy treated at our center had outcomes that compare favorably with the literature. This is likely due to the multidisciplinary approach to optimal surgical strategy and continuous evaluation of the respective risks of tumor progression. Neurological disability results from initial spinal cord compression or the radicular sacrifice required for tumor resection.
Collapse
Affiliation(s)
- Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Timothé de Saint Denis
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | | | - Jean Michon
- Department of Pediatric Oncology, Oncology Center SIREDO (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France
| | - Hervé Brisse
- Imaging Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luc Joyeux
- Department of Pediatric Surgery, Queen fabiola Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Odent
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Orthopedics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Glorion
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Orthopedics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Zerah
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| |
Collapse
|
8
|
Abdelhafeez A, Ortega-Laureano L, Murphy AJ, Davidoff AM, Fernandez-Pineda I, Sandoval JA. Minimally Invasive Surgery in Pediatric Surgical Oncology: Practice Evolution at a Contemporary Single-Center Institution and a Guideline Proposal for a Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2019; 29:1046-1051. [PMID: 31241404 DOI: 10.1089/lap.2018.0467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the lack of randomized or controlled trials for minimally invasive surgery (MIS) in pediatric surgical oncology, the integration of MIS into the surgical practice of pediatric oncology has become increasingly popular. The aim of this study was to evaluate the implementation of MIS in a pediatric tertiary cancer center and compare present use of MIS to that in a previous analysis at our center. Methods: We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. Results: A total of 252 MIS procedures were performed: 73 laparoscopic (29%) and 179 thoracoscopic (71%). MIS was used for diagnostic purposes in 59% (146 thoracoscopic and 34 laparoscopic) and the therapeutic resection in 24% (39 laparoscopic cases and 33 thoracoscopic cases). Conversion to an open procedure occurred in 18 tumor resections (6%) and in 22 diagnostic biopsies (7%), mostly due to technical challenges in identifying or mobilizing tumors. Complications occurred in seven tumor resections (2%) and included three pneumothoraces, two bleeding complications, one bowel injury, and one wound infection. Complications occurred in 10 diagnostic biopsies (3%), mostly pneumothoraces. No tumor upstaging or trocar site recurrences occurred (follow-up time, 1-15 years). Conclusions: Over the last decade, we demonstrate the evolution of MIS in the management of solid tumors in children. We encourage surgeons and oncologists to join the call to arms to establish prospective trials evaluating MIS in pediatric surgical oncology.
Collapse
Affiliation(s)
| | | | - Andrew J Murphy
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A Sandoval
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
- 2HSHS Medical Group Pediatric Surgery, St. John's Children's Hospital, Springfield, Illinois
| |
Collapse
|
9
|
Avanzini S, Pio L, Erminio G, Granata C, Holmes K, Gambart M, Buffa P, Castel V, Valteau Couanet D, Garaventa A, Pistorio A, Cecchetto G, Martucciello G, Mattioli G, Sarnacki S. Image-defined risk factors in unresectable neuroblastoma: SIOPEN study on incidence, chemotherapy-induced variation, and impact on surgical outcomes. Pediatr Blood Cancer 2017; 64. [PMID: 28440012 DOI: 10.1002/pbc.26605] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the impact of image-defined risk factor (IDRF) modification after chemotherapy on surgical outcomes, event-free survival (EFS), and overall survival (OS) among patients enrolled in the European Unresectable Neuroblastoma (EUNB) study. METHODS IDRFs were assigned according to the corresponding surgical risk factors list reported in the database. Surgical outcomes, EFS, and OS were related to IDRF modification with chemotherapy. The predictive value of preoperative IDRF for surgical outcomes was analyzed. Cox proportional hazards models for EFS and OS, including preoperative IDRF, surgical outcomes, and other known clinical risk factors, were created. RESULTS Of the 160 patients enrolled in the EUNB study, 143 patients met the inclusion criteria. A total of 228 IDRF were thus collected. Following chemotherapy, 76 (33%) IDRF disappeared in 32.2% of patients, 33 (14%) new IDRF appeared in 18.8% of patients, and 49% of patients did not show any IDRF change. Complete resection/minimal residual disease (71.2%) was more frequent among children who had disappearance/numerical reduction of IDRF (P = 0.005). Infiltration of the branches of the mesenteric artery was predictive of an unfavorable surgical outcome. Prolonged preoperative chemotherapy over five courses and encasement of the celiac axis and/or mesenteric artery origin impacted EFS and OS. CONCLUSIONS The unchanged IDRF pattern in 50% of patients and the appearance of new IDRF during chemotherapy in approximately 20% of patients strengthens the idea that prolonged chemotherapy is useless for improving surgical resection in this population of patients. In addition, midline perivascular abdominal preoperative IDRF appeared to be predictive not only of surgical outcomes but also of EFS and OS.
Collapse
Affiliation(s)
| | - Luca Pio
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giovanni Erminio
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Claudio Granata
- Pediatric Radiology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Keith Holmes
- Department of Pediatric Surgery, St George's Hospital, London, UK
| | - Marion Gambart
- Hemato-Oncology Unit, Children's Hospital, Toulouse, France
| | - Piero Buffa
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy
| | | | - Dominique Valteau Couanet
- Département d'oncologie pédiatrique, GHU Paris-Sud-CLCC Institut de cancérologie Gustave, Roussy, France
| | - Alberto Garaventa
- Department of Hematology-Oncology, Istituto Giannina Gaslini, Genova, Italy
| | - Angela Pistorio
- Epidemiology, Biostatistics and Committees Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Cecchetto
- Pediatric Surgery Unit, Department of Woman's and Child's Health, Padova University Hospital, Padova, Italy
| | - Giuseppe Martucciello
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Pediatric Surgery Unit, Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurology, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Sabine Sarnacki
- Pediatric Surgery Department, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
| |
Collapse
|