An evaluation of the role of surgery in metastatic neuroblastoma

The role of surgery was evaluated in 320 patients with metastatic neuroblastoma (Children's Cancer Study Group [CCSG] stage IV. excluding IV-S) enrolled in two CCSG treatment protocols between June 1978 and November 1982. The regimens consisted of combination chemotherapy, radiation therapy, and surgery. Two hundred seventyseven surgical procedures were performed in 214 of the 320 eligible patients. Surgical intervention at the primary site was performed at initiation of therapy in 86 patients. There was a slight survival advantage when complete resection of the primary tumor was achieved ( P =.09). Delayed surgery was performed in 89 patients. Gross complete resection of primary tumor was feasible in 57 of these patients (64.0%). However, survival analysis showed that resolution of metastases had a more important impact on subsequent length of survival than resectability at the delayed procedure ( P =.005).