Kiely E M
Department of Paediatric Surgery, Hospitals for Sick Children, London, England.
J Pediatr Surg. 1994 Feb;29(2):128-33. doi: 10.1016/0022-3468(94)90307-7.
The first successful excision of a neuroblastoma took place in 1916. For many years there was no other form of treatment, and the outlook remained dismal. The use of radiotherapy (1928) and subsequently combination chemotherapy (1965) had a modest impact. More accurate staging has allowed a more coherent approach to diagnosis and treatment. Surgery has not been standardized to the same degree. A review of the author's experience with 129 patients over a 10-year period confirms that surgery is the mainstay of treatment for localized nonadvanced disease (stages I and II). Fourteen of 15 such patients are alive and disease-free. Combination chemotherapy may shrink advanced tumors (stages III and IV) and ablate metastases. Subsequent complete surgical excision does not improve survival. Approximately two thirds of those with stage III disease and one third of those with stage IV disease survive regardless of whether excision is complete. The present results do not support the value of complete surgical excision.
1916年首次成功切除神经母细胞瘤。多年来没有其他治疗方式，预后依然不佳。放射治疗（1928年）以及随后的联合化疗（1965年）产生的影响不大。更精确的分期使得诊断和治疗方法更加连贯。手术尚未达到相同程度的标准化。回顾作者在10年期间对129例患者的经验证实，手术是局限性非晚期疾病（I期和II期）治疗的主要手段。15例此类患者中有14例存活且无疾病。联合化疗可能会使晚期肿瘤（III期和IV期）缩小并消除转移灶。随后的完整手术切除并不能提高生存率。无论切除是否完整，大约三分之二的III期疾病患者和三分之一的IV期疾病患者存活。目前的结果不支持完整手术切除的价值。
