Treatment Options for Neuroblastoma

Low-Risk Neuroblastoma
Intermediate-Risk Neuroblastoma
High-Risk Neuroblastoma
Progressive/Recurrent Neuroblastoma

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but may be right for your child.

Treatment of low-risk neuroblastoma may include the following:

• Watchful waiting alone for certain infants.
• Surgery followed by watchful waiting.
• Surgery followed by combination chemotherapy, when serious health problems occur.
• Radiation therapy to treat tumors that are causing serious health problems and do not respond quickly to chemotherapy.

Treatment of intermediate-risk neuroblastoma may include the following:

• Surgery alone.
• Surgery followed by chemotherapy. Sometimes a second surgery is needed.
• Watchful waiting alone for certain infants.
• Surgery followed by chemotherapy. Radiation therapy may given to treat tumors that are causing serious health problems and do not respond quickly to surgery and chemotherapy.
• Chemotherapy followed by surgery.
• Radiation therapy to treat tumors that are causing serious problems and do not respond quickly to chemotherapy.

Treatment of high-risk neuroblastoma may include the following:

• Combination chemotherapy followed by surgery to remove as much of the tumor as possible, followed by high-dose chemotherapy and stem cell transplant.
• Radiation therapy to the tumor site and, sometimes, if needed, to other parts of the body with cancer.
• 13-cis retinoic acid after recovery from previous treatment.
• A clinical trial of new regimens of chemotherapy and radioactive iodine therapy followed by more chemotherapy, stem cell rescue, and external-beam radiation therapy.
• A clinical trial of chemotherapy and stem cell transplant followed by 13-cis retinoic acid with or without monoclonal antibody therapy and biologic therapy.

Patients with Recurrent CNS Neuroblastoma

Treatment for neuroblastoma that recurs (comes back) in the central nervous system (CNS; brain and spinal cord) may include the following:

• Surgery to remove the tumor followed by radiation therapy.
• Radiation therapy to the brain and spinal cord.
• Surgery, radiation therapy, and chemotherapy followed by targeted therapy with a radioactive substance linked to a monoclonal antibody.

Patients First Treated for Low-Risk Neuroblastoma

Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:

• Surgery followed by watchful waiting or chemotherapy.
• High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.

Treatment for recurrent neuroblastoma that has spread to other parts of the body may include the following:

• Watchful waiting.
• Surgery followed by chemotherapy.
• High-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.
• A clinical trial of a new treatment.

Patients First Treated for Intermediate-Risk Neuroblastoma

Treatment for recurrent neuroblastoma that is found in one place in the body may include the following:

• Surgery, with or without chemotherapy.
• A clinical trial of a new treatment.

For recurrent neuroblastoma that has spread to other parts of the body, treatment is usually high-dose chemotherapy, stem cell transplant, and 13-cis retinoic acid.

Patients First Treated for High-Risk Neuroblastoma

Treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma may include the following:

• A second course of high-dose chemotherapy and stem cell transplant.
• Chemotherapy with one or more anticancer drugs.
• Radioactive iodine therapy to relieve symptoms and improve quality of life.

Because there is no standard treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma, patients may want to consider a clinical trial. For information about clinical trials, please see the NCI Web site.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with neuroblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.