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Watch and See Strategy in Selected Neuroblastoma Case Scenarios

Success and Limitations

Fawzy, Mohamed MD*,†; El Zomor, Hossam MD*,†; El Menawi, Salma MSc; Elkinaai, Naglaa MD†,§; Ahmed, Gehad MD∥,¶; Refaat, Amal MD†,#; Elahmadawy, Mai MD†,**; Zaghloul, Mohamed MD†,††

Journal of Pediatric Hematology/Oncology: August 2019 - Volume 41 - Issue 6 - p e384–e387
doi: 10.1097/MPH.0000000000001421
Online Articles: Original Articles

Neuroblastoma (NBL) in infants has the potential to regress/mature spontaneously. The literature showed some cases, subjected to initial observation, with reasonable outcome. Deferring/avoiding active treatment was investigated in selected favorable NBL cases. Patients enrolled on the watch and see strategy (W&S) had small primary tumor, localized stages 1 to 2, uncomplicated stage 4s, or stage 3. Tissue biopsy was not mandatory for infants below 6 months with localized mass. On progression, active intervention was indicated according to disease stage and risk after biological characterization. In total, 32 patients were enrolled on W&S strategy; male/female:2.6/1. Twelve had stages 1 to 2, 16 had stage 4s, and 4 were stage 3. Primary adrenal site was reported in 85% patients, and 65% patients had small mass (≤5 cm). Five-year overall and event-free survival were 100% and 80.9±7%, respectively, with a 43-month median follow-up duration. Spontaneous total/near total resolution of mass occurred in 50% patients. Median time to regression was 1.7 months, and 20.7 months until resolution. Only 19% patients witnessed progression; median time to progression was 4.8 months. W&S is a reasonable approach for localized and uncomplicated stages 3 and 4S NBL. Extended tumor size is a newly investigated entity in the present study. All progressive cases were safely rescued with 100% survival outcome.

*Pediatric Oncology Department

Clinical Research Department

§Pathology Department

Surgical Oncology Department

#Radiology Department

**Nuclear Medicine Department

††Radiotherapy Department, Children’s Cancer Hospital Egypt

NCI, Cairo University

Faculty of Medicine, Helwan University, Cairo, Egypt

The authors declare no conflict of interest.

Reprints: Salma El Menawi, MSc, Children’s Cancer Hospital Egypt, 1 Seket Al-Emam Street, El-Madbah El-Kadeem Yard, El-Saida Zenab, Cairo 11617, Egypt (e-mail:

Received October 25, 2018

Accepted December 24, 2018

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