Current biologic and therapeutic implications in the surgery of neuroblastoma.

Advances in the understanding of neuroblastoma biology have helped distinguish those patients who require maximum therapy from those who do not. However, management of children with advanced disease remains a significant problem. New more intensive multiagent chemotherapy, ablative chemoradiotherapy with bone marrow transplantation, radiolabelled monoclonal antibody technology and a host of biologic response modifiers are currently being intensively studied. Nevertheless, surgery remains crucial for diagnosis, for providing adequate tissue for biological and histopathologic staging, for primary and secondary resections as well as restaging after therapy. Major surgical questions remain to be addressed in cooperative group studies.