[Accomplishments of tumor surgery in neuroblastoma in childhood]

Survival rates in patients with neuroblastoma did not significantly improve during the last two decades. This is particularly true for stage IV tumors. This stage seems to be a tumor fundamentally different from the more localized stages in its biological behavior, and it is not known, whether stage IV tumors originate from a localized stage by metastatic spread. Intensive investigations regarding new therapeutic approaches on an immunological basis or by stimulation of tumor maturation have been unsuccessful by now. Surgery in neuroblastoma has to be adapted to the particular stage to be treated. Certainly, surgery has to be incorporated into a therapeutic strategy which includes the whole spectrum of modern anticancer therapy. Such a therapeutic strategy will be provided by multicenter cooperative studies, such as the neuroblastoma study designed by the German Association of Paediatric Oncology (GPO). A treatment of neuroblastoma without incorporation in a multicenter cooperative study should not be accepted as modern standard.