To achieve the best local control, initial aggressive surgical resection is usually attempted.
The risk of recurrence has been shown to depend on the extent of resection in some studies:
Extent of resection was statistically significant in determining risk of local recurrence25
CCG–921 trial showed that children with residual tumor:
- 1.5cm2 or less had a survival of 40% after 4 years
- 1.5 cm2 or greater survival was only 13% after 4 years2
However, there is some controversy about how much the extent of surgical tumor excision determines patient survival.
A recent Canadian retrospective clinical analysis11 of different regimens used to treat supratentorial PNETs for the past 10 years showed no difference in outcome, survival or event free survival in patients who had complete resection compared to those with incomplete resection.
The conclusion was that this was due to the effectiveness of post-operative adjuvant chemotherapy and RT.
Also a SIOP study of 68 patients with pineal or non pineal supratentorial PNETs did not show a statistically significant improvement in survival for those that had a gross total resection18. This observation held true regardless of tumor location and extent of metastases.
