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From Berthold F,Hero B (2000) Neuroblastoma:current drug therapy recommendations as part of the total treatment approach. Drugs 59:1261-1277

From Berthold F,Hero B (2000) Neuroblastoma:current drug therapy recommendations as part of the total treatment approach. Drugs 59:1261-1277

The INSS classification utilizes surgical resectabil-ity as one of the criteria for stage determination; thus, depending on the skills of an individual surgeon, the radiologically same midline neuroblastoma may be classified as stage 3 if incompletely resected or stage

1 if completely resected. Discussions of the participating institutions with the trial office in Germany demonstrated that the discrimination between stage

2 and stage 3 may also be difficult in selected cases. Another controversy relates to the stage-4S classification. While age over 1 year and the presence of bone metastasis is uniformly accepted to qualify for stage 4, the size of the primary tumor and the presence of metastases to sites other than bone marrow (<10%), liver, and skin are not. Some investigators believe that large stage-3 tumors and non-regional lymph node metastases may well be compatible with the biological characteristics of stage-4S neuroblastoma.

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