The Problem Of Spontaneous Regressions Of Malignant Tumors

Abstract

The treatment of patients with neuroblastoma does not lie solely in the province of a single specialty; it requires cooperation of pediatrician, surgeon, radiologist and tumor therapist. It is essential that they all be aware of the unique characteristics of this particular tumor if optimum results are to be obtained. The many factors found to influence the prognosis for a child with neuroblastoma are discussed. Prior to the authors’ adoption of x-ray therapy as a part of the treatment of neuroblastomas (about 1937), 20 patients with neuroblastoma had only biopsy and were not given any definitive therapy: all were found to be inoperable. Two infants regarded as hopeless at the time, because of widespread and nonremovable neoplasm, are now well and completely free of disease 20 and 25 years later. Presumably, the very cellular and rapidly expanding tumor grew beyond its blood supply, then degenerated and disappeared. Possibly, there are some poorly understood antibody reactions between host and tumor, leading in some cases to dissolution of the latter. Suffice it to say that there are a few well-documented cases wherein neuroblastoma has disappeared completely and permanently. We have seen two patients who undoubtedly represent spontaneous cures. These were among patients seen during the early part of the series, and both were regarded as inoperable. In one, a 6-week-old infant, at surgery there was a large tumor arising out of the pelvis. Biopsy showed neuroblastoma. No treatment was given. Subsequently, the abdominal mass gradually disappeared. This individual was completely asymptomatic and in robust health when examined 25 years later. The other was an 11-month-old infant with a large tumor arising from the posterior mediastinum; biopsy showed neuroblastoma. No treatment was given. She was asymptomatic, with a normal roentgenogram of the chest 20 years later. In two other instances, we have encountered, at surgery, a large primary tumor of the suprarenal area with much neoplasm in the regional lymph nodes. Histologically, in each instance, both the main tumor and the smaller tumors in lymph nodes were completely benign ganglioneuromas. We suspect that these tumors were originally malignant neuroblastomas and that the primary tumor and the metastases to lymph nodes had undergone maturation into benign ganglioneuromas. Because of uncertainty, these two cases have not been included in the series in the present report. In general, spontaneous cure may be expected to occur in a very small percentage of cases of neuroblastoma.