Resumen
Objetivo: Demostrar la utilidad de la radioterapia intraoperatoria (RIO) en el tratamiento de los niños con neuroblastoma en estadios avanzados.
Casos clÃnicos: Presentamos 7 casos de pacientes con neuroblastoma en estadios III (n= 1) y IV (n= 6), con amplificación N-myc en 6 de ellos, tratados desde 1997 hasta 2004. Dos de los pacientes presentaron tumores irresecables, con restos tumorales macroscópicos tras la intervención.
Resultados: La supervivencia en nuestra serie de pacientes ha sido del 71,4%. No hemos registrado ninguna complicación asociada a la RIO. El tiempo medio de seguimiento es de 44 meses (margen: 7 meses-7 años). En el tratamiento del neuroblastoma de grados III-IV se ha observado una mejora de la supervivencia cuando se controla la enfermedad local primaria.
Conclusión: La RIO facilita este control, con la concentración de la radioterapia directamente sobre el lecho tumoral y respetando los campos de irradiación colaterales.
Abstract
Objective: To report our experience with intraoperative radiotherapy (IORT) in the treatment of advanced-stage neuro¬blastoma in children.
Cases report: Seven pediatric patients with a diagnosis of advanced-stage neuroblastoma (stages III and IV) treated with IORT between 1997 and 2004 were reviewed retrospectively. All of them received chemotherapy after biopsy of the tumour mass (HR-NBL ESIOP protocol), with good response. All seven underwent surgical resection of the tumour, with a single IORT dose of 5 to 15 grays.
Results: The initial biopsy showed N-myc amplification in all the patients. Chemotherapy was delivered prior to surgical resection. Gross total resection was performed in five patients. In the other two patients, surgery involved only a debulking procedure. Five patients (71.4%) were alive and continued to be disease-free after 44 months of follow-up, with no IORT-associated complications. The two patients with unresectable disease had a fatal outcome.
Conclusion: Total surgical excision is one of the best prognostic factors in advanced-stage neuroblastoma disease. Intraoperative radiotherapy is a safe procedure that appears to enhance local control with improved survival.
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