Management
In a study [PMID:26287661], the combination of tolfenamic acid (TA, 30μM) and 13 cis-retinoic acid (RA, 20μM) demonstrated a substantial reduction in cell viability (p<0.0001) compared to individual treatments, suggesting a potential new therapeutic approach for managing high-risk neuroblastoma.
The study [PMID:26287661] showed that the TA+RA combination led to increased apoptotic markers, including higher caspase 3/7 activity and Annexin-V positive cells, indicating enhanced cell death mechanisms in neuroblastoma cells.
Between May 1991 and December 1995, 38 posterolateral muscle-sparing thoracotomies were performed in neonates and children, achieving excellent exposure in all but one case [PMID:9244093].
The muscle-sparing approach preserves major chest-wall muscles, likely leading to less postoperative pain and improved pulmonary function [PMID:9244093].
Prognosis & Follow-up
The research [PMID:26287661] highlighted that the TA+RA combination therapy downregulated key survival and proliferation markers such as AKT and ERK1/2, which could potentially translate into better prognosis and follow-up outcomes for patients with high-risk neuroblastoma.
Key Recommendations
The author advocates for the routine use of muscle-sparing incisions in pediatric thoracotomy procedures due to their advantages in minimizing trauma and promoting recovery [PMID:9244093]. (Evidence: Expert opinion)
References
1 Shelake S, Eslin D, Sutphin RM, Sankpal UT, Wadwani A, Kenyon LE et al.. Combination of 13 cis-retinoic acid and tolfenamic acid induces apoptosis and effectively inhibits high-risk neuroblastoma cell proliferation. International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience 2015. link 2 Jawad AJ. Experience with modified posterolateral muscle-sparing thoracotomy in neonates, infants, and children. Pediatric surgery international 1997. link
2 papers cited of 3 indexed.