# Metastatic Disease — GCMD Library living collection

Everything in the library about metastatic disease — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 86 cited statements

## Episodes
### Evidence & Research
- [BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323) — video · [machine version](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323.md)
- [BOB Ped Surg 2023 - Andrew Fleming, AAP  - Presentation](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366) — video · [machine version](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366.md)
- [Malignant peripheral nerve sheath tumors: a report from Children’s Oncology Group study ARST0332](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726) — video · 1:11 · [machine version](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726.md)

### In-Depth Reviews
- [Topics in 10: Neuroblastoma](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0) Introduction and Overview (Ep 1)
- [0:38](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=38) Clinical Presentation and Initial Workup (Ep 1)
- [2:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=131) MIBG Accuracy and Pre-Biopsy Staging (Ep 1)
- [3:53](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=233) Surgical Approach for Localized Disease (Ep 1)
- [5:08](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=308) Biopsy Results and Risk Stratification (Ep 1)
- [6:48](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=408) Treatment for Intermediate and Low Risk Disease (Ep 1)
- [7:50](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=470) Management of Metastatic and MS Disease (Ep 1)
- [9:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=540) Clinical Pearls and Conclusion (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=0) Session Introduction and Poll Results (Ep 2)
- [3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181) Study Presentation: Pediatric Melanoma Management (Ep 2)
- [8:56](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=536) Q&A Discussion (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0) Introduction and Background on Hepatoblastoma (Ep 3)
- [2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120) Study Rationale and Methods (Ep 3)
- [4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240) Results: Patient Cohort and Pulmonary Metastasectomy (Ep 3)
- [6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360) Survival Analysis and Conclusions (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=0) Introduction and study context (Ep 4)
- [0:22](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=22) Study design and treatment arms (Ep 4)
- [0:34](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=34) Outcomes and clinical implications (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The Children's Oncology Group published a prospective trial on malignant peripheral nerve sheath tumors in the Journal of the National Cancer Institute in 2025." — Jill Knepprath (clinical) [Ep 4 · 0:11](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=11)
- "Patients were assigned to four treatment groups: observation, adjuvant radiation, adjuvant chemoradiation, and neoadjuvant chemoradiation." — Jill Knepprath (clinical) [Ep 4 · 0:24](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=24)
- "Resection has a major influence on survival for patients with malignant peripheral nerve sheath tumors." — Jill Knepprath (clinical) [Ep 4 · 0:35](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=35)
- "Female patients with malignant peripheral nerve sheath tumors had improved outcomes." — Jill Knepprath (epidemiological) [Ep 4 · 0:40](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=40)
- "Patients without metastatic disease had improved outcomes." — Jill Knepprath (clinical) [Ep 4 · 0:40](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=40)
- "Low-risk patients had improved outcomes." — Jill Knepprath (clinical) [Ep 4 · 0:40](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=40)
- "In patients receiving neoadjuvant therapy, 23% showed a response." — Jill Knepprath (clinical) [Ep 4 · 0:46](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=46)
- "In patients receiving neoadjuvant therapy, 45% were stable." — Jill Knepprath (clinical) [Ep 4 · 0:46](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=46)
- "In patients receiving neoadjuvant therapy, 32% had progressive disease." — Jill Knepprath (clinical) [Ep 4 · 0:46](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=46)
- "There was no difference in survival based on the response to neoadjuvant therapy among patients who went on to have resection." — Jill Knepprath (clinical) [Ep 4 · 0:59](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=59)
- "Resection should be done for patients with malignant peripheral nerve sheath tumors whenever possible, even if they show a good response to chemoradiation." — Jill Knepprath (guideline) [Ep 4 · 1:03](https://library.globalcastmd.com/watch/malignant-peripheral-nerve-sheath-tumors-a-report-from-children-s-oncology-group-study-arst0332-11726?t=63)
- "Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old" — Stephen Scoville (epidemiological) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults" — Stephen Scoville (clinical) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Management of pediatric melanoma is based on adult studies despite differences in disease mechanisms" — Stephen Scoville (clinical) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Tumors less than 8 millimeters thick are largely managed with wide local excision" — Stephen Scoville (guideline) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Tumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies" — Stephen Scoville (guideline) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Two adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections" — Stephen Scoville (clinical) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "There is no pediatric data to support ultrasound observation versus completion lymph node dissection" — Stephen Scoville (clinical) [Ep 2 · 3:01](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=181)
- "Study included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions" — Stephen Scoville (clinical) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- "Breslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters" — Stephen Scoville (clinical) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=250)
- "Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%)" — Stephen Scoville (clinical) [Ep 2 · 5:20](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=320)
- "Patients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy" — Stephen Scoville (clinical) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- "There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups" — Stephen Scoville (clinical) [Ep 2 · 6:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=390)
- "Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group" — Stephen Scoville (clinical) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Only 21% of those who underwent completion lymph node dissection had additional positive nodal disease" — Stephen Scoville (clinical) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden" — Stephen Scoville (clinical) [Ep 2 · 7:30](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=450)
- "Recurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death" — Stephen Scoville (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=480)
- "Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate" — Stephen Scoville (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- "Management of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease" — Stephen Scoville (clinical) [Ep 2 · 8:31](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=511)
- "Before the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults" — Stephen Scoville (clinical) [Ep 2 · 9:15](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- "For most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection" — Stephen Scoville (opinion) [Ep 2 · 9:15](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=555)
- "Not all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size" — Stephen Scoville (clinical) [Ep 2 · 10:45](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=645)
- "If a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection" — Stephen Scoville (opinion) [Ep 2 · 11:46](https://library.globalcastmd.com/watch/bob-in-ped-surg-2023-ipso-winner-steven-scoville-md-6323?t=706)
- "Hepatoblastoma is the most common pediatric liver cancer" — Andrew Fleming (epidemiological) [Ep 3 · 0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0)
- "The number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group" — Andrew Fleming (clinical) [Ep 3 · 0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=30)
- "PRETEXT group in combination with presence/absence of metastatic disease, alpha fetoprotein at diagnosis, PRETEXT modifiers, patient age and resectability at diagnosis can be used to risk stratify patients according to the AHEAD 1531 clinical trial" — Andrew Fleming (guideline) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=60)
- "Complete surgical resection has been determined to be necessary for patient survival" — Andrew Fleming (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=90)
- "Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients" — Andrew Fleming (clinical) [Ep 3 · 1:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=105)
- "The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature" — Andrew Fleming (epidemiological) [Ep 3 · 2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120)
- "No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging" — Andrew Fleming (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=180)
- "Among 50 patients included for analysis, 24 were determined to be high risk" — Andrew Fleming (epidemiological) [Ep 3 · 4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240)
- "All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 3 · 4:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=255)
- "14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient" — Andrew Fleming (clinical) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=270)
- "Median of three nodules per patient contained pathologically confirmed viable hepatoblastoma, confirming a high degree of concordance between radiographic evidence of disease and pathological confirmation of disease" — Andrew Fleming (clinical) [Ep 3 · 5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=300)
- "On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality" — Andrew Fleming (clinical) [Ep 3 · 5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=330)
- "The overall survival of the entire cohort is quite high" — Andrew Fleming (clinical) [Ep 3 · 6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360)
- "The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease" — Andrew Fleming (clinical) [Ep 3 · 6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=375)
- "The overall survival and event-free survival of the group in whom we were unable to render them no evidence of disease is significantly lower, with no patients in these cohorts surviving past two years" — Andrew Fleming (clinical) [Ep 3 · 6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=390)
- "The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [Ep 3 · 7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=420)
- "The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed" — Andrew Fleming (clinical) [Ep 3 · 7:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=435)
- "Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections" — Andrew Fleming (clinical) [Ep 3 · 7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=450)
- "No evidence of disease status is necessary for survival in patients with hepatoblastoma" — Andrew Fleming (clinical) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients" — Andrew Fleming (clinical) [Ep 3 · 7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465)
- "Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old." — Rae Hanke (host_summary) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- "In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass." — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression." — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor." — Daniel von Allmen (clinical) [Ep 1 · 1:07](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- "Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "About 10% of neuroblastomas are MIBG negative." — Daniel von Allmen (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease." — Daniel von Allmen (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient." — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "The prior neuroblastoma staging system required tissue diagnosis before assigning a stage." — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy." — Daniel von Allmen (clinical) [Ep 1 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor." — Daniel von Allmen (opinion) [Ep 1 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist." — Daniel von Allmen (clinical) [Ep 1 · 4:44](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- "The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status." — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue." — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk." — Daniel von Allmen (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk." — Daniel von Allmen (epidemiological) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma." — Daniel von Allmen (clinical) [Ep 1 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy." — Daniel von Allmen (clinical) [Ep 1 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have." — Daniel von Allmen (clinical) [Ep 1 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection." — Daniel von Allmen (clinical) [Ep 1 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation." — Daniel von Allmen (clinical) [Ep 1 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure." — Daniel von Allmen (clinical) [Ep 1 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "In patients with MS disease, simple observation can be the treatment path." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "You can biopsy the skin lesions in MS disease and that will give you the diagnosis." — Daniel von Allmen (clinical) [Ep 1 · 8:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)

## Changelog
- Sep 10: 1 item no longer name metastatic disease
- Sep 7: 5 items added automatically

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