Neuroblastoma with Dr. Meera Kotagal

Neuroblastoma makes up about 8 to 10% of all pediatric cancers and about 15% of cancer-related deaths.

For patients with relapsed high risk neuroblastoma, the survival rate is 0%.

90% of neuroblastomas have elevated HVA and VMA (catecholamine metabolites).

Neuroblastomas are not typically thought of as causing elevated blood pressure despite producing catecholamines.

Image-defined risk factors (IDRFs) are best understood as things that touch important structures: vessels, brachial plexus, or trachea.

Intermediate risk neuroblastoma patients receive neoadjuvant chemotherapy with 2, 4, 6, or 8 cycles depending on chromosomal factors, followed by surgical resection.

The key surgical principle for neuroblastoma resection is to stay on the vessels and work from normal to abnormal anatomy.

Image-defined risk factors (IDRFs) are associated with increased risk of surgical complications.

When percutaneous core biopsies are performed by experienced practitioners who obtain multiple cores, the adequacy of these biopsies significantly improves and they are not inferior to open surgical biopsies.

At Cincinnati Children's, radiologists obtain 25 cores from different parts of neuroblastoma tumors during percutaneous biopsy.

For neuroblastoma, unlike most tumors, the goal is to get as much tumor as possible but complete resection of every ounce of tumor is not expected.

Tumor extending into neural foramina or other difficult locations should not be aggressively pursued; the goal is maximal safe resection without causing harm.

The observation protocol for infants with neuroblastoma has been expanded from primary adrenal tumors to L1 tumors in children under 6 months.