Early computed tomography after gross total resection of neuroblastoma with image defined risk factors to objectively...

Neuroblastoma (NBL) is the most common extracranial solid malignancy of childhood, accounting for 8-10 % of paediatric cancers. It predominantly affects infants, with 90 % diagnosed before age five; about 70 % present with advanced disease. Prognosis depends on biological and clinical factors, with overall 5-year survival near 70 %. Surgical resection is central to treatment, but reliable postoperative assessment of gross total resection (GTR) remains difficult. Intraoperative and photographic evaluations are unreliable, and although CT or MRI is standard, there is no consensus on timing or modality. Imaging performed within a broad postoperative window may overlap with healing or therapy effects, reducing accuracy. This study assessed the value of early postoperative CT with computer-assisted analysis for objective evaluation of GTR and residual tumour volume.

To assess the value of early postoperative computed tomography (CT) for objective evaluation of GTR completeness and residual tumour mass in patients with advanced neuroblastoma.

The study included 61 children with neuroblastoma treated at T. Marciniak Lower Silesian Specialist Hospital (2019-2022). All underwent GTR after SIOPEN induction chemotherapy, with subjective resection >90 %. Inclusion required ≥1 IDRF and postoperative MDCT within seven days; stage I/L1 tumours without IDRF and later imaging were excluded. Pre- and postoperative images were analysed in ITK-SNAP. Tumours were manually segmented (2.5 mm layers), and volumes calculated by voxel summation. Residual mass was the difference between pre- and postoperative volumes. Statistical analysis used Mann-Whitney U, Wilcoxon, chi-square, and Spearman tests, with p < 0.05 considered significant (Statistica 13.3).

Follow-up CT was performed between postoperative days 1-7 (median = 6). Median pre- and postoperative tumour volumes were 26,220 mm³ and 1340 mm³, respectively, with a median GTR completeness of 95 % (p < 0.0001). Completeness was Group I (95-100 %) in 30 patients (49.2 %), Group II (90-95 %) in 9 (14.8 %), and Group III (<90 %) in 22 (36.1 %). No significant correlations were found between completeness and age, CT timing, histopathology, or INRG stage. Tumour location was significant (χ²₈ = 22.9; p = 0.0035): 65.8 % of adrenal tumours achieved Group I, compared with 5 non-adrenal tumours. All tumours invading two cavities failed to meet GTR criteria. Adrenal location strongly correlated with higher completeness (χ²₂ = 18.1; p = 0.00012).

Early postoperative CT, supported by computer-based volumetric analysis, offers a promising method for objective assessment of GTR in neuroblastoma surgery. Standardizing this approach could enhance the accuracy of residual tumour evaluation, improve postoperative decision-making, and support appropriate risk stratification in paediatric patients with advanced disease.