Wait and see strategy in localized neuroblastoma in infants: An option not only for cases detected by mass screening

Neuroblastomas in infants may regress or mature spontaneously. Consequently, some authors have applied a wait and see strategy for tumors found by urinary mass screening. Recently, improved technique and increasing frequency of ultrasound examinations have led to an increase of neuroblastoma cases in pre- and post-natal period. We describe five cases, four diagnosed by routine ultrasound examination and one detected by urinary mass screening, who were monitored with a wait and see strategy in order to spare surgery. Median age at diagnosis was 4 months (range 2-10 months). All tumors were adrenal neuroblastomas. All patients met the following criteria: localized tumors, tumor size less than 5 cm in diameter, absence of invasive growth, vanillylmandelic acid (VMA) and homovanillic acid (HVA) less than 50 mug/mg creatinine, and informed consent of parents. Monitoring was performed by monthly ultrasound examinations and urine catecholamine analysis. Median follow-up is 14 months (5-28 months). Three tumors showed spontaneous regression, one is still under observation. In one patient the tumor increased in size and was resected after 14 months of observation displaying favorable histology, but chromosome 1p imbalance. Previous reports describe the adoption of a wait and see strategy in selected cases of localized neuroblastoma detected by mass screening. Our study confirms that this strategy may be similarly applied in incidentally or clinically detected cases. However, possible benefit has to be carefully balanced against possible risks. (C) 2004 Wiley-Liss, Inc.