Hepatic metastasis from neuroblastoma.
Neuroblastoma is a common solid tumor of infancy and childhood. From 1967 to 1986 we evaluated and treated 58 children with neuroblastoma; in ten (17%) of these children, symptomatic hepatic metastasis developed. The ten children ranged in age from 2 days to 2 years 3 months. The most common symptoms attributable to hepatic metastasis were abdominal enlargement, abdominal pain, respiratory difficulty due to upward pressure on the diaphragm, and obstruction of the inferior vena cava. At the time of initial diagnosis, two children had stage III disease, three had stage IV disease, and five had stage IV-S disease. Six were initially given chemotherapy; all six of these patients required radiation therapy when hepatic enlargement progressed. In the other four cases, radiation therapy was used alone or in combination with chemotherapy. Irradiation or irradiation plus chemotherapy produced complete resolution of local symptoms in seven cases, and a partial response in one case. The seven children who had a complete response are alive without evidence of recurrent disease; the remaining three children died of their tumor. The roles of chemotherapy, surgery, and radiation therapy in the management of symptomatic hepatic metastasis from neuroblastoma are discussed.
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