Reply to: Letter to the Editor: Reflection on “Impact of Neoadjuvant Chemotherapy on Image-Defined Risk Factors in High-Risk Neuroblastoma”

Excerpt

Thank you to Drs. Wang, Chen, and He for their comments. We agree that, in general, thoracic neuroblastomas, because of their different biology and anatomy, should ideally be analyzed separately with regard to outcomes, including surgical risk and complications. In our cohort, however, the number of thoracic primary tumors was too low (only 10 patients out of our 117 cohort had thoracic neuroblastomas) to draw definitive conclusions about whether image-defined risk factors (IDRFs) for thoracic tumors respond differently to neoadjuvant chemotherapy than extrathoracic tumors. Additionally, one of the ten thoracic tumors had no IDRFs at diagnosis. So, the absolute number of IDRFs in thoracic tumors is low in our series primarily owing to the small number of thoracic neuroblastomas. However, thoracic neuroblastomas had an average of 4.2 IDRFs at diagnosis, which is similar to the average number for the cohort as a whole (5.0 IRDFs per patient). Additionally, seven out of the remaining nine patients with IDRF-positive thoracic neuroblastomas had a reduction in their IDRFs during neoadjuvant therapy. This is also consistent with the overall cohort reduction rate (76% vs 77%). …