Abstract
PURPOSE
To evaluate the impact of site of disease, size of the metastases, and impact of surgical resection of CNS metastases in patients with neuroblastoma. METHODS AND MATERIALS: Patients with neuroblastoma metastatic to the CNS were considered for surgical resection of the lesion(s) prior to undergoing conventional external beam radiation therapy (EBRT) and intraventricular radioimmunotherapy (cRIT). Lesions were classified as unifocal, multifocal, or leptomeningeal. Post-surgical EBRT consisted of 18 or 21 Gy craniospinal irradiation with a boost of 30–36 Gy to the metastatic site(s). A Mantel-Cox analysis was performed to assess the prognostic significance of disease site, size, and extent of resection on overall survival (OS).
RESULTS
93 patients with CNS neuroblastoma were assessed (2003–2017) with a follow-up of 24–177 (median 48) months since the detection of CNS disease. Lesions were unifocal parenchymal (N=54), leptomeningeal (N=6) or multifocal +/-leptomeningeal (N=33). As regards unifocal lesions, 40 (74%) were > 2 cm in largest diameter, and 44 (81%) underwent gross total resection (GTR). Following GTR, EBRT and cRIT, local control with no progression at the site was achieved in 39/44 (89%) patients. Systemic neuroblastoma in the absence of CNS progression occurred in 19/93 (20%). Improved OS was noted for those with unifocal vs multifocal disease (p=.01). Although a trend towards improved OS was associated with GTR, it was not statistically significant (p=0.12). Neither the size nor the site of the unifocal lesion impacted OS.
CONCLUSION
Local control of the metastatic lesion is successfully achieved with the combined approach of surgical resection, EBRT and cRIT in 89% of patients with unifocal CNS neuroblastoma, with a trend towards improved OS in those undergoing GTR of metastases. There is no impact on the size or location of the metastatic lesion(s).