CME credit.

Top Line: Is there a benefit to maximal resection of stage 4 neuroblastoma? 
The Study: ANBL0532 showed us that a radiation boost does not make up for incomplete resection of high-risk neuroblastoma. However, the rate of incomplete resection in ANBL0532 was higher than in its predecessor trial and so were the overall rates of local progression. This analysis from the European high-risk neuroblastoma trial (HR-NBL1/SIOPEN) looks at whether a complete macroscopic excision (CME, as defined by the surgeon) in patients with stage 4 disease improves treatment outcomes. Enrolled patients had any stage 4 disease if > 1 year, or stage 4/4S + MYCN amplification if < 1 year. In comparison, about 85% of the COG trial had stage 4 disease. The SIOP approach differs from the COG approach, but the overall treatment flow is similar: induction therapy, surgery, stem cell transplant, radiation (without a boost), and maintenance. Overall, 77% underwent a CME, which was associated with a significant improvement in the rate of local progression (30→ 17%), event-free survival (33→ 40%), and overall survival (37→ 45%). As you might notice, these results differ from those of the COG trial. However, there are key differences in the study designs, treatment paradigms, and definition of “complete resection.” Lastly, it can be difficult to separate prognostic factors that connect better outcomes with the ability to perform a complete resection.
TBL: This study supports the notion that maximal excision of stage 4 neuroblastoma improves local control and survival outcomes. | Holmes, J Clin Oncol 2020


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