Ultrasonic resection of neuroblastomas. Long-term local tumor control

H. Applebaum and L. E. Feinfeld
Division of Pediatric Surgery, Kaiser Permanente Medical Center, Los Angeles, Calif., USA.

OBJECTIVE: To evaluate the effectiveness of ultrasonic aspiration in achieving local tumor control of bulky neutroblastomas that are considered unresectable by conventional means. DESIGN: A retrospective review of 12 patients undergoing ultrasonic aspiration as part of multimodal treatment protocols. SETTING: A pediatric oncology referral center. PATIENTS: Twelve children with large neuroblastomas located in the abdomen (n = 5), chest (n = 5), and neck (n = 2). Follow-up was 1.5 to 7.5 years. INTERVENTIONS: Ultrasonic aspiration of the tumor was primary therapy (n = 7) or followed initial chemotherapy (n = 5). All patients underwent subsequent chemotherapy or autologous bone marrow transplantation. MAIN OUTCOME MEASURES: The incidences of residual disease and local recurrence were examined. RESULTS: Tumor-related symptoms were effectively relieved in all 12 patients. Recurrent local disease led to death in two. One patient died of distant metastases. CONCLUSIONS: Ultrasonic aspiration minimized blood loss and did not cause damage to adjacent organs. It provided nearly complete tumor resection, enhanced the effectiveness of chemotherapy protocols, and decreased the need for supportive care. Ultrasonic aspiration is a safe and effective method for obtaining local control of large neuroblastomas.