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a Primary site radiation given b Autologous bone marrow transplant a Primary site radiation given b Autologous bone marrow transplant lyzed the effect of primary tumor resection on survival. An equally important measure of the efficacy of gross total resection is its effect on local tumor progression.

11.4.4.3.3 Local Control

Most high-risk patients have significant amounts of metastatic disease not amenable to surgical treatment except in unusual circumstances (e.g., epidural disease, isolated bony metastases). A more appropriate measure of the efficacy of gross total resection is its effect on local tumor progression. Local control rates of >80 % have been reported with a combination of gross total resection and local-regional irradiation to approximately 2000 cGy (La Quaglia et al. 1994; Kushner et al. 2001; Kuroda et al. 2000; Tokiwa et al. 2003). A recent report focusing directly on the issue of local progression confirmed that this could be minimized with gross total resection (La Quaglia et al. 2004). This contrasts with a 30% local recurrence rate in patients undergoing incomplete resection (Hans-Kogan et al. 2003) (Table 11.4.2). In summary, the available data supports use of gross total resection of the primary site and regional lymphatics in high-risk neuroblastoma.

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