Natural history of neuroblastoma found by mass screening

Abstract

Woods and colleagues (Dec 21/28, p 1682)1Wood WG Tuchman M Robinson LL et al.A population-based study of the usefulness of screening for neuroblastoma.Lancet. 1996; 348: 1682-1688Summary Full Text Full Text PDF PubMed Scopus (180) Google Scholar reported that screening for neuroblastoma in Quebec increased the incidence of neuroblastoma in infants without decreasing the incidence of unfavourable advanced-stage disease in older children. These results accord with the findings of our previous study2Yamamoto K Hayashi Y Hanada R et al.Mass screening and age-specific incidence of neuroblastoma in Saitama Prefecture, Japan.J Clin Oncol. 1995; 13: 2033-2038PubMed Google Scholar and those of Bessho3Bessho F Effect of mass screening on age specific incidence of neuroblastoma.Int J Cancer. 1996; 67: 520-522Crossref PubMed Scopus (37) Google Scholar in Japan. Neuroblastoma is a heterogeneous disease. Biological studies revealed that there are at least two groups of neuroblastoma: one with favourable features in infants, the other with unfavourable features in children older than 1 year. The former type of tumour does not develop into the latter type of tumour. Mass screening was initiated in Japan to improve overall outcome of neuroblastoma by detection of preclinical tumours in infants. However, most of the tumours identified by screening were those with favourable features in infants.4Hayashi Y Inaba T Hanada R et al.Chromsome findings and prognosis in 15 patients with neuroblastoma found by VMA mass screening.J Pediatr. 1988; 112: 576Summary Full Text PDF PubMed Scopus (40) Google Scholar, 5Kaneko Y Kanda N Maseki N et al.Current urinary mass screening for catecholamine metabolites at 6 months of age may be detecting only a small portion of high-risk neuroblastoma: a chromosome and N-myc amplification study.J Clin Oncol. 1990; 8: 2005-2013PubMed Google Scholar These findings led to the hypothesis that neuroblastoma identified by screening could regress spontaneously. We investigated the clinical course of the disease in 12 patients with localised neuroblastoma of less than 5 cm in diameter who had not had any therapeutic intervention; the patients were selected from a group of 25 with neuroblastoma who had been screened between April, 1994, and March, 1996. The patients attended Saitama Children's Medical Centre about once every month. The size of the tumours was measured by abdominal ultrasonography. Urine concentrations of vanillylmandelic acid and homovanillic acid were also measured. We found that the size of the tumours decreased in 11 of the 12 patients. The urine concentration of homovanillic acid fell in all 12 patients during observation periods that ranged from 4 to 27 months. Thus, it seems that there is another subset of neuro-blastoma that regress spontaneously. These tumours are mostly preclinical in infants, can be detected by screening with catecolamine metabolites, and have similar favourable biological characteristics to stage IV-S tumours.