Poster Presentation Advances in Neuroblastoma Research Congress 2016

Primary tumor resection after high dose chemotherapy with autologous hematopoietic stem cell transplantation is a safe and feasible option. A report from the Japanese neuroblastoma study group (JNBSG) (#316)

Tomoro Hishiki 1 , Akihiro Yoneda 2 , Tatsuo Kuroda 3 , Kazuaki Tokiwa 4 , Kazuya Ise 5 , Shigeru Ono 6 , Yoshiaki Kinoshita 7 , Shuichiro Uehara 2 , Kimikazu Matsumoto 8 , Masaaki Kumagai 8 , Hiroyuki Shichino 9 , Toshinori Soejima 10 , Tetsuya Takimoto 8 , Junichi Hara 2 , Tatsuro Tajiri 11 , Akira Nakagawara 12
  1. Chiba Children's Hospital, Chiba, Japan
  2. Osaka City General Hospital, Osaka
  3. Keio University, Tokyo, Japan
  4. Maizuru Medical Center, Kyoto
  5. Iwate Medical University, Morioka
  6. Jichi Medical University, Shimotsuke
  7. Kyushu University, Fukuoka
  8. National Center for Child Health and Development, Tokyo
  9. National Center for Global Health and Medicine, Tokyo
  10. Hyogo Cancer Center, Akashi
  11. Kyoto Prefectural University of Medicine, Kyoto
  12. Saga Medical Center Koseikan, Saga

Background In the current high-risk neuroblastoma (NB) clinical trial JN-H-11, primary tumor resection is scheduled after the completion of the entire chemotherapy regimen, including myeloablative chemotherapy with autologous hematopoietic stem cell transplantation (HDC). We assessed the safeness and feasibility of this approach by comparing the surgical outcome and complications of resections after HDC to those of resections performed at conventional timings.

Methods Case report forms and surgical records of 30 cases from the JN-H-07 study in which tumor resection was performed after 3 or 4 courses of induction chemotherapy (conventional group), and 39 cases from the JN-H-11 study in which surgery took place after HDC (delayed group) were analyzed. Background of patients, operation time, blood loss, blood transfusion requirement, surgical complications were analyzed.

Results Mean operation time (conventional 285 min vs delayed 296 min), blood loss (270g vs 134g), and blood loss / estimated blood volume ratio (23% vs 12%) did not differ between the two groups. There were more procedures in the delayed group that required platelet transfusion (conventional:13%, delayed:36%). No major surgical complications other than bleeding were encountered in both groups. Nephrectomy was carried out in 20% of the conventional group and 7.7% of the delayed group.

Discussion The “delayed local treatment” concept is widely accepted in our country, although there remain concerns regarding safeness of the approach, since surgeries are to be performed on patients under severely immunocompromised and myelosuppressive conditions. Our results suggest that surgery after HDC could be performed safely with acceptable complication rates.