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Treatments for neuroblastoma

If your child has neuroblastoma, the healthcare team will create a treatment plan just for your child. It will be based on your child’s health and specific information about the cancer. When deciding which treatments to offer for neuroblastoma, your child’s healthcare team will consider:

  • your child’s age
  • the stage (size and location of neuroblastoma and whether it has spread)
  • the risk group
  • your child’s overall health

Doctors will closely monitor the child’s response to treatment to decide if treatment should continue, if treatment can be stopped or if they should try other treatments.

The following are treatment options for neuroblastoma.

Surgery

Surgery is the main treatment for neuroblastoma that has not spread. It is used to diagnose and stage neuroblastoma. It is also used to completely remove the tumour, if possible.

If the tumour can’t be completely removed, chemotherapy or other treatments may be used.

Second-look surgery is surgery that is done after chemotherapy and initial surgery. It is used to remove any disease that remains and to see how the cancer is responding to treatment.

Find out more about surgery for neuroblastoma.

Chemotherapy

Chemotherapy is often used to treat neuroblastoma. Chemotherapy uses anticancer drugs to destroy cancer cells. It may be used with or without surgery.

Find out more about chemotherapy for neuroblastoma.

Radiation therapy

Radiation therapy is sometimes used to treat neuroblastoma. Radiation therapy uses high-energy rays or particles to destroy cancer cells.

Find out more about radiation therapy for neuroblastoma.

High-dose chemotherapy and stem cell rescue

Special high-dose chemotherapy is sometimes used to treat neuroblastoma. This chemotherapy has a side effect of killing the cells in the bone marrow and then the child’s own healthy stem cells are given to replace the ones in the bone marrow that were destroyed. This is sometimes called a stem cell transplant.

Find out more about stem cell rescue for neuroblastoma.

Retinoids and immunotherapy

Retinoids and immunotherapy are sometimes used to treat neuroblastoma. Retinoids are a form of vitamin A that help some cancer cells mature (differentiate) into normal cells. Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. Immunotherapy is sometimes called biological therapy.

Find out more about retinoids and immunotherapy for neuroblastoma.

Targeted therapy

Targeted therapy is sometimes used to treat neuroblastoma. It uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells.

Find out more about targeted therapy for neuroblastoma.

Watchful waiting

Watchful waiting may be a treatment option for some neuroblastomas that don’t need to be treated right away. It is sometimes used for babies younger than 6 months who have stage 4S neuroblastoma with favourable prognostic factors and no symptoms.

Follow-up care

Follow-up after treatment is an important part of cancer care. Your child will need to have regular follow-up visits, especially in the first 2 years after treatment has finished. These visits allow the healthcare team to monitor your child’s progress and recovery from treatment and to monitor for late side effects from the treatments received.

Find out more about follow-up care.

Response to treatment

Knowing how well neuroblastoma responds to treatment helps doctors decide whether or not treatment can be stopped or if more treatment is needed. Response to treatment is monitored using imaging tests. MIBG or PET scans are used for measuring the primary tumour and any spread to bone, bone marrow, lymph node or soft tissue. Doctors use the following criteria to measure the response to treatment.

Complete response means that there is no evidence of disease by MIBG or PET scan in any location of soft tissue or bone, with less than 10 mm at largest diameter of primary tumour, less than 10 mm at largest diameter of target lymph nodes and no tumour in 2 bone marrow biopsies and 2 bone marrow aspirations.

Partial response means that all tumours are over 30% smaller than before treatment, there are no new metastases and an MIBG or PET scan showed at least a 50% reduction in bone metastases.

Stable disease means that some tumours may have shrunk, but by less than 30% of their original size, or the MIBG or PET scan may have improved but by less than a 50% reduction in score. This group also includes patients where there is no apparent response to treatment at all.

Progressive disease means that there is a new tumour or new spots on an MIBG scan, a tumour has grown by at least 20%, or there are cancer cells in the bone marrow that were not there before treatment.

Clinical trials

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Questions to ask about treatment

To make the decisions that are right for your child, ask the healthcare team questions about treatment.

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