Abstract

1. Introduction: Neuroblastoma (NB) is the most common extracranial solid tumor in children. As NB is the well-studied pediatric malignancy, risk based treatment has been internationally conducted for recent several years. The risk classification established by COG or INRG will be introduced in this lecture. Surgical strategy according to these risk classifications will be presented. 2. Surgical strategy for non-high risk neuroblastoma It is well known that most of the low risk NB tumors have some chances for spontaneous regression or maturation to ganlioneuroma. Also even though imcomplete resection is known to achieve disease cure in the low staged tumors. Therefore, surgical strategy should be planned with the greatest caution to minimize the treatment complication for the patients. The current treatment protocol for low and intermediate risk NB patients of the Japan Neuroblastoma Study Group (JNBSG) will be presented. In these protocols, Image Defined Risk Factor (IDRF) which have been propounded for predicting the surgical risks of localized neuroblastoma (NB) since 2009 was used as the main factor for treatment decision. 3. Surgical strategy for high risk neuroblastoma Although recent advances in multimodal therapy for high risk NB, the treatment results remain to be improved. The defining role of surgery in patients with advanced NB has been subject to much controversy and debate. As most of the recurrences included distant metastases, development of more effective systemic treatment to prevent distant metastasis is probably on the top of the list of research priority. According to this hypothesis, JNBSG has been conducted adelayed local treatment with surgery and radiation following high dose chemotherapy (HDC) with hematopoietic stem cell transplantation (HSCT) in patients with INSS 4 NB, initially to control metastatic lesions rather than local lesion. This JNBSG high risk protocol will be introduced in this lecture and the optimal surgical treatment for high risk NB patients will be discussed.