Klin Onkol 2001; 14(1): 20-24.
Abstract:
Background: There are about 10% of all newly diagnosed neuroblastoma patients with intraspinal tumor extension. Longterm event free survival (EFS) of these children is good. Neurosurgical decompression has been used as astandard therapeutical approach but is often connected with development of late spinal deformity. The published data give evidence for the possibility of decompression of spinal canal by chemotherapy and lead us to more conservative approach.
Type of study: Retrospective analysis of treatment strategy and late effects in 158 neuroblastoma patients treated in the Department of Pediatric Oncology in Prague from 1989 till 1998. Methods and results: 20 out of 158 neuroblastoma patients were diagnosed with intraspinal tumor extension. Laminectomy was the inclusive treatment method with immediate mild clinical effect only in 3 from 12 symptomatic patients. The worsening of neurological impairment occured in two children. There was no improvement in the others. The improvement of neurological status was more connected with tumor regression due to chemotherapy. The long-term EFS of these children with intraspinal extension is signifficantly better in comparrison to the entire group of neuroblastoma patients (75% vs 47%). Regarding to the premise of curative oncological approach, treatment related late effects should be taken into the account. 76% patients developed long term scoliosis after laminectomy.
Summary: The conservative decompression of spinal canal in dumbbell neuroblastoma without signs of rapid worsening of neurological impairment is the equivalent approach to the neurosurgical operation more suitable in term of late effects.
