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Experience with "second-look" operations in pediatric solid tumors
Abstract:
"Second-look" operations were performed in 32 infants and children with initially unresectable or recurrent solid tumors treated with combination chemotherapy and/or irradiation. Tumors were resectable in 26 of 32 cases (81%). These procedures often yielded information affecting staging and treatment. Disease-free survival was achieved in 18 of 32 patients (56%). Mortality was related to progressive disease in seven cases and opportunistic infections due to immunosuppression in three. Four additional patients are alive with evidence of persistent tumor. Second-look procedures were beneficial in patients with Wilms' tumor previously operated upon by a flank approach and in children with bilateral tumors. These procedures were particularly useful in children with stage III localized neuroblastoma and cases of metastatic neuroblastoma that respond to chemotherapy. Second-look operations were also useful in selected cases of rhabdomyosarcoma, teratoma, and Ewing's sarcoma. These observations suggest that combination chemotherapy has increased the use of second-look operations in a variety of less favorable (e.g. initially unresectable or recurrent) pediatric solid tumors.
Insights
Second-look operations improved outcomes for pediatric solid tumors, making 81% of initially unresectable or recurrent tumors resectable. This approach enhanced staging and treatment, achieving disease-free survival in 56% of patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Cancer Treatment
Background:
- Many pediatric solid tumors are initially unresectable or recur after treatment.
- Combination chemotherapy and irradiation are standard treatments for these advanced tumors.
- The role of "second-look" operations in managing these complex cases requires further elucidation.
Purpose of the Study:
- To evaluate the efficacy and impact of "second-look" operations in pediatric patients with initially unresectable or recurrent solid tumors.
- To assess the resectability rates, information gained, survival outcomes, and mortality associated with these procedures.
Main Methods:
- Retrospective analysis of 32 infants and children undergoing "second-look" operations after neoadjuvant chemotherapy and/or irradiation.
- Assessment of tumor resectability, staging information, disease-free survival, and causes of mortality.
- Specific evaluation of benefits in Wilms' tumor, neuroblastoma, rhabdomyosarcoma, teratoma, and Ewing's sarcoma.
Main Results:
- Tumors were resectable in 26 of 32 patients (81%).
- Disease-free survival was achieved in 18 of 32 patients (56%).
- Second-look procedures provided valuable staging and treatment information, particularly for Wilms' tumor, bilateral tumors, stage III neuroblastoma, and metastatic neuroblastoma responding to chemotherapy.
Conclusions:
- "Second-look" operations are beneficial in managing initially unresectable or recurrent pediatric solid tumors.
- These procedures enhance treatment strategies and improve survival outcomes in selected pediatric cancer patients.
- The increasing use of combination chemotherapy has expanded the applicability of "second-look" operations in pediatric oncology.