Neuroblastoma

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Treatments for high-risk neuroblastoma

The following are treatment options for high-risk neuroblastoma. Your healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan.

Treatment for high-risk neuroblastoma is often aggressive. It usually includes a combination of therapies, including chemotherapy, surgery, radiation therapy, stem cell transplant and biological therapy. Treatment is often divided into the following 3 phases.

Induction is done to try to get the cancer into remission by destroying or removing as much of the cancer as possible. High-dose chemotherapy is given by switching between different combinations of drugs. Surgery may be done after chemotherapy to remove as much of the tumour as possible.

Consolidation is done to try to get rid of any cancer cells that are still in the body. The treatments are more intense than those used in the induction phase. High-dose chemotherapy is given and then followed with stem cell transplant. Radiation therapy may be given to the primary tumour before, during and after high-dose chemotherapy and stem cell transplant.

Maintenance is done to try to lower the chance that the neuroblastoma will come back, or recur. Maintenance often involves retinoids and immunotherapy.

Chemotherapy

Chemotherapy is often used to treat high-risk neuroblastoma. It is usually the first treatment given after surgery to diagnose neuroblastoma. It is used to shrink the tumour, including where it has grown into or is touching nearby organs and structures. Chemotherapy also shrinks the blood vessels that supply the tumour. Shrinking the tumour and its blood vessels make the tumour easier to remove.

Chemotherapy usually involves different combinations of drugs given one after the other. These drugs include:

  • carboplatin (Paraplatin, Paraplatin AQ)
  • cyclophosphamide (Cytoxan, Procytox)
  • vincristine (Oncovin)
  • doxorubicin (Adriamycin)
  • etoposide (Vepesid, VP-16)
  • cisplatin (Platinol AQ)
  • topotecan (Hycamtin)

Surgery

Surgery is often used to treat high-risk neuroblastoma. It is first used to get tissue samples to diagnose the tumour. Surgery is often done again after chemotherapy to remove as much of the tumour as possible.

Stem cell transplant

Stem cell transplant may be used to treat high-risk neuroblastoma.

Before treatment begins, the healthcare team will harvest and store some of your child’s stem cells. They are usually collected from the blood. The child is then given high-dose chemotherapy to destroy any cancer cells in the body. Sometimes radiation may be given as well.

After high-dose chemotherapy with or without radiation therapy, a stem cell transplant is done to replace the stem cells that were damaged or destroyed by high-dose chemotherapy. The child is given the stem cells that were collected before chemotherapy (called autologous peripheral blood stem cell transplant).

Radiation therapy

Radiation therapy may be used to treat high-risk neuroblastoma. It may be given in preparation for stem cell transplant, after stem cell transplant or both. It may also be given to treat emergencies, such as spinal cord compression, or to treat areas where the cancer has spread (called metastatic sites) that did not respond well to other therapies.

After surgery, radiation therapy is sometimes given to the area from where the tumour was removed (called the tumour bed) even if the entire tumour was completely removed. This is done to destroy any cancer cells that may be left behind after surgery. Radiation therapy to the tumour bed may be given before, during and after high-dose chemotherapy and stem cell transplant.

Sometimes targeted radiation with radioactive metaiodobenzylguanidine (MIBG) is used to treat high-risk neuroblastoma. It may be used along with high-dose chemotherapy and stem cell transplant. This treatment is only available in a few Canadian centers and is only given within a clinical trial.

Retinoids and immunotherapy

Retinoids and immunotherapy may be given after stem cell transplant to treat high-risk neuroblastoma. A combination of drugs is usually given, including 13-cis-retinoic acid (Isotretinoin, Accutane), interleukin-2 (Aldesleukin, Proleukin), sargramostim (Leukine) and dinutuximab (Ch14.18). This may be given within a clinical trial.

Clinical trials

Many children with high-risk neuroblastoma are treated in a clinical trial. Clinical trials look at new and better ways to prevent, find and treat cancer. Find out more about clinical trials.

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