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Table 5. Treatment Options for Neuroblastoma

Stage (COG Risk-Group Assignment)  Treatment Options 
COG = Children's Oncology Group; GM-CSF = granulocyte-macrophage colony-stimulating factor; 131I-mIBG = iodine 131-metaiodobenzylguanidine; SCT = stem cell transplant.
Low-Risk Neuroblastoma Surgery followed by observation.
Chemotherapy with or without surgery (for symptomatic disease or unresectable progressive disease after surgery).
Observation without biopsy (for perinatal neuroblastoma with small adrenal tumors).
Intermediate-Risk Neuroblastoma Chemotherapy with or without surgery.
Surgery and observation (in infants).
Radiation therapy (only for emergent therapy).
High-Risk Neuroblastoma A regimen of chemotherapy, surgery, SCT, radiation therapy, and anti-GD2 antibody ch14.18, with interleukin-2/GM-CSF and isotretinoin.
Stage 4S Neuroblastoma Observation with supportive care (for asymptomatic patients with favorable tumor biology).
Chemotherapy (for symptomatic patients, very young infants, or those with unfavorable biology).
Recurrent NeuroblastomaLocoregional recurrence in patients initially classified as low riskSurgery followed by observation or chemotherapy.
Chemotherapy that may be followed by surgery.
Metastatic recurrence in patients initially classified as low riskObservation (if metastatic disease is in a 4S pattern in an infant).
Locoregional recurrence in patients initially classified as intermediate riskSurgery (complete resection).
Surgery (incomplete resection) followed by chemotherapy.
Metastatic recurrence in patients initially classified as intermediate riskHigh-risk therapy.
Recurrence in patients initially classified as high riskChemotherapy.
131 I-mIBG alone, in combination with other therapy, or followed by stem cell rescue.
Second autologous SCT after retrieval chemotherapy.
Recurrence in the central nervous systemSurgery and radiation therapy.
Novel therapeutic approaches.