Sabine Irtan

63 statements · 2 topics · summaries given as host listed separately

Neuroblastoma · guest expert

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Radiological detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies.
quote · High-risk Neuroblastoma
We showed no impact of the radiological postoperative residue on EFS and OS. But we had an impact on the MIBG positive residue on EFS and OS with a difference of more than 20% of survival.
quote · High-risk Neuroblastoma
Patients with er neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured.
quote · Neuroblastoma
The difference between patients with MIBG-positive residue and patients with no residue or no MIBG-positive residue was still present for patients with partial or minimal response with a 10% survival difference.
clinical · Neuroblastoma

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Sabine's statements about High-risk Neuroblastoma 36 statements

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Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025

Quotation Patients with er neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. Open
Statement Patients with high-risk neuroblastoma require chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. Open
Statement The role of surgery in high-risk neuroblastoma remains controversial. Open
Quotation The role of surgery in this context remains controversial. Open
Statement Kewarm's 2020 JCO paper stated that complete macroscopic excision of the primary tumor improved both overall and event-free survival in 1,531 patients with stage 4 neuroblastoma. Open
Statement Kewarm's study based success of intervention and judgment on post-operative residue on the operative report, with no systematic radiological assessment. Open
Quotation No systematic radiological assessment of residue has been performed so far. Open
Statement The study included 283 patients (108 females, 175 males) diagnosed at a median age of 35 months. Open
Statement The primary tumor site was the abdomen in 95% of patients. Open
Statement The tumor origin was the adrenal gland in 81% of patients. Open
Statement Post-operative imaging was performed at a median of 62 days after surgery and was mainly CT scan or MRI. Open
Statement Residue was present in half of the patients. Open
Statement The median volume of the residue was 0.27 mL. Open
Statement In 28 patients the residue was a microcalcification. Open
Statement Excluding patients with microcalcifications, the median residue volume was 1.04 mL. Open
Statement Only 11% of patients had a residue of more than 5 mL. Open
Statement The residue was linked to the presence of IDRF in 71% of patients. Open
Statement MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available. Open
Quotation We showed no impact of the radiological postoperative residue on EFS and OS. But we had an impact on the MIBG positive residue on EFS and OS with a difference of more than 20% of survival. Open
Statement Radiological post-operative residue showed no impact on event-free survival and overall survival. Open
Statement MIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival. Open
Statement Patients with MIBG-positive residue had 25% and 27% five-year event-free survival. Open
Statement Patients with no residue or no MIBG-positive residue had 51% five-year event-free survival. Open
Statement The survival difference between MIBG-positive and MIBG-negative residue groups was confirmed for five-year overall survival. Open
Statement External validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results. Open
Statement The survival difference between MIBG-positive residue and no/MIBG-negative residue was present even for patients with partial or minimal metastatic response, with a 10% survival difference. Open
Statement Half of patients operated on in expert centers have a tumor residue objectively identified on post-operative images of less than 1 mL. Open
Statement The residue was MIBG-positive in around 20% of patients. Open
Statement Radiologically detected post-operative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning. Open
Quotation Radiological detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies. Open
Statement Complete resection should be maintained as a major surgical goal. Open
Quotation We confirmed that complete resection should be maintained as a major surgical goal. However, metastatic response is an important prognostic cofactor. Open
Statement Metastatic response is an important prognostic cofactor. Open
Statement For patients where the surgeon reported leaving nothing, almost half had residue on post-operative images. Open
Quotation Between what the surgeon said and what the radiologist says, there's a discrepancy that uh can impact also uh the, the question of should we let a residue or not. Open
Statement For patients where the surgeon reported leaving residue, imaging found residue in two-thirds and no residue in one-third. Open
Sabine's statements about Neuroblastoma 27 statements

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Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025

Statement Patients with high-risk neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. Open
Quotation Patients with er neuroblastoma need a heavy burden of treatment associating chemotherapy, immunotherapy, radiotherapy, and surgery to be cured. Open
Statement The role of surgery in high-risk neuroblastoma remains controversial. Open
Quotation The role of surgery in this context remains controversial. Open
Statement The study included 283 patients (108 females, 175 males) who had a diagnosis at a median age of 35 months. Open
Statement The primary tumor site was the abdomen in 95% of patients. Open
Statement The tumor origin was the adrenal gland in 81% of patients. Open
Statement The postoperative imaging was performed at a median of 62 days after surgery and was mainly a CT scan or MRI. Open
Statement Residue was present in half of the patients on post-operative imaging. Open
Statement The median volume of the residue was 0.27 mL. Open
Statement The residue was a microcalcification in 28 patients. Open
Statement Excluding patients with microcalcifications, the median residue volume was 1.04 mL, and only 11% of patients had a residue of more than 5 mL. Open
Statement MIBG positivity of the residue was present in 70.5% of patients with a post-operative MIBG available. Open
Statement The residue was linked to the presence of IDRF in 71% of patients. Open
Statement There was no impact of the radiological postoperative residue on event-free survival and overall survival. Open
Statement MIBG-positive residue had an impact on event-free survival and overall survival with a difference of more than 20% of survival. Open
Statement Patients who had an MIBG-positive residue had 25% and 27% five-year event-free survival, whereas patients with no residue or no MIBG-positive residue had 51% five-year event-free survival. Open
Statement External validation on the entire high-risk neuroblastoma cohort in patients with stage 4 neuroblastoma who had surgery and post-surgical MIBG evaluation confirmed the results, especially in patients with complete response of the metastasis. Open
Statement The difference between patients with MIBG-positive residue and patients with no residue or no MIBG-positive residue was still present for patients with partial or minimal response with a 10% survival difference. Open
Statement Half of the patients operated on in expert centers have a tumor residue objectively identified on postoperative images of less than 1 mL. Open
Statement The residue was MIBG-positive in around 20% of patients. Open
Statement Radiologically detected postoperative tumor residues impact outcomes only if active disease was demonstrated through post-operative MIBG scanning, which could have an impact on future radiotherapy strategies. Open
Statement Complete resection should be maintained as a major surgical goal. Open
Statement Metastatic response is an important prognostic cofactor in stage 4 neuroblastoma. Open
Statement For patients for whom the surgeon said they left nothing, almost half of the patients had still something on the postoperative images. Open
Quotation I completely agree that Between what the surgeon said and what the radiologist says, there's a discrepancy that uh can impact also uh the, the question of should we let a residue or not. Open
Statement For patients for whom the surgeon said they left something, residue was found in two-thirds of patients and no residue was found in one-third of patients. Open

Summaries Sabine gave as host · 2 summaries

Recaps of other experts' statements, not Sabine's own clinical position.

Summaries Sabine gave as host · Neuroblastoma 2 summaries

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Dr. Sabine Irtan - Best of the Best in Pediatric Surgery 2025

Host summary Sabine Irtan summarizing the discussion: Kewarm stated in a 2020 GCO paper that complete macroscopic excision of the primary tumor improved both overall and event-free survival in a cohort of 1,531 patients with stage 4 neuroblastoma. Open
Host summary Sabine Irtan summarizing the discussion: In Kewarm's study, the success of the intervention and judgment on the post-operative residue was based on the operative report with no systematic radiological assessment of residue performed. Open