Van Heerden, JaquesKruger, MarianaEsterhuizen, TonyaHendricks, MarcGeel, JenniferBuchner, AneNaidu, GitaDu Plessis, JanVanemmenes, BarryUys, RonelleHadley, G.P.2020-05-272020-04Van Heerden, J., Kruger, M., Esterhuizen, T. et al. The importance of local control management in high-risk neuroblastoma in South Africa. Pediatric Surgery International 36, 457–469 (2020). https://doi.org/10.1007/s00383-020-04627-x.0179-0358 (print)1437-9813 (online)10.1007/s00383-020-04627-xhttp://hdl.handle.net/2263/74742PURPOSE : To investigate the impact of local therapies on high-risk neuroblastoma (HR-NB) outcomes in South Africa. METHODS : Data from 295 patients with HR-NB from nine pediatric oncology units between 2000 and 2014 were analysed. All patients received chemotherapy. Five-year overall (OS) and event free survival (EFS) were determined for patients who had received local therapy, either surgery or radiotherapy or both. RESULTS : Surgery was performed in only 35.9% (n = 106/295) patients. Surgical excision was done for 34.8% (n = 85/244) of abdominal primaries, 50.0% (n = 11/22) of thoracic primaries; 22.2% (n = 2/9) neck primaries and 66.7% (n = 8/12) of the paraspinal primaries. Only 15.9% (n = 47/295) of all patients received radiotherapy. Children, who had surgery, had an improved five-year OS of 32.1% versus 5.9% without surgery (p < 0.001). Completely resected disease had a five-year OS of 30.5%, incomplete resections 31.4% versus no surgery 6.0% (p < 0.001). Radiated patients had a five-year OS of 21.3% versus 14.2% without radiotherapy (p < 0.001). Patients who received radiotherapy without surgical interventions, had a marginally better five-year OS of 12.5% as opposed to 5.4% (p < 0.001). Patients who underwent surgery had a longer mean overall survival of 60.9 months, while patients, who were irradiated, had a longer mean overall survival of 7.9 months (p < 0.001). On multivariate analysis, complete metastatic remission (p < 0.001), surgical status (p = 0.027), and radiotherapy status (p = 0.040) were significant predictive factors in abdominal primaries. CONCLUSION : Surgery and radiotherapy significantly improve outcomes regardless of the primary tumor site, emphasizing the importance of local control in neuroblastoma.en© Springer-Verlag GmbH Germany, part of Springer Nature 2020. The original publication is available at : http://link.springer.comjournal/383.NeuroblastomaSurgeryRadiotherapySouth Africa (SA)Local therapiesHigh-riskIntermediate-riskPostprint Article