A Study of 4 S Neuroblastomas.

INTRODUCTION : Neuroblastoma is one of the commonest solid tumor in the paediatric age group with an overall poor prognosis. Stage 4S Neuroblastomas as the S stands for is a special group among neuroblastomas. Interesting to note that age is a major criteria which differentiates between two groups of patients at either end of the prognostic spectrum.The neuroblastomas presenting after 1yr with all other features of 4 S seem to behave so,different from the actual 4S Neuroblastomas. These 4S NBs have many unique characteristics. Most important of them being tumor regression and tumor maturation. Another interesting fact about these tumors is that it defies the conventional definition of metastatic disease.Because in 4 S NB’s despite their widespread metastasis prognosis is considered as good and the chances that such tumors will regress is very good. There have also been disputing claims that these are incidentalomas and cannot be classified as tumors However there are enough studies to prove that these are true tumors very similar to their non 4 S counterparts and are capable of metastazing and even sometimes progressing rapidly ,with poor outcome. Though most of these tumors regress and disappear some progress on to stage 4 with resultant poor prognosis.There are few pointers to predict tumor progression and regression.This phenomenon is much less studied and understood.This study aims to evaluate the natural course of the disease and to identify the changing patterns of disease regression and maturation. The present scenario of unpredictable disease pattern and behavior gives rise to the question of whether to treat these individuals or not. Chemotherapy with its attendant complications in this age group is very risky.On the other hand, to wait and watch a tumor which has metastasized is a difficult decision.There have been various studies supporting and opposing chemotherapy in 4 S Neuroblastomas in the literature.This study aims to formulate a protocol for identifying between the cases to be treated from ...