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
Surgery is the main treatment for neuroblastoma that has not spread. Chemotherapy is often used to treat neuroblastoma. Other treatments may also be used, including radiation therapy, retinoids, immunotherapy, stem cell tranplant and targeted therapy.

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.

Response to treatment

Knowing how well neuroblastoma responds to treatment helps doctors decide whether or not treatment can be stopped or more treatment is needed. Response to treatment is monitored using imaging tests. MIBG and 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.

Expert review and references

  • American Cancer Society. Neuroblastoma. Atlanta, GA: 2014: http://www.cancer.org/acs/groups/cid/documents/webcontent/003125-pdf.pdf.
  • American Society of Clinical Oncology. Neuroblastoma. 2014.
  • Bartholomew, J . Neuroblastoma. Baggott C, Fochtman D, Foley GV & Patterson Kelly, K (eds.). Nursing Care of Children and Adolescents with Cancer and Blood Disorders. 4th ed. APHON; 2011: 30: pp. 1038-1053.
  • Brodeur GM, Hogarty MC, et al . Neuroblastoma. Pizzo, P. A. & Poplack, D. G. (Eds.). Principles and Practice of Pediatric Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2011: 30:886-922.
  • Duffey-Lind, E . Neuroblastoma. Kline, N. E. (Ed.). Essentials of Pediatric Oncology Nursing: A Core Curriculum. 2nd ed. Association of Pediatric Oncology Nurses; 2004: 2:6: pp. 35-30.
  • Gaye, D . Neuroblastoma. Baggott, C. R., Kelly, K. P., Fochtman, D. et al. Nursing Care of Children and Adolescents with Cancer. 3rd ed. Philadelphia, PA: W. B. Saunders Company; 2002: 25: pp. 545-554.
  • Hendershot, C . Neuroblastoma. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.6: pp. 50-57.
  • Neuroblastoma. Janes-Hodder, H. & Keene, N. Childhood Cancer - A Parent's Guide to Solid Tumor Cancers. 2nd ed. O'Reilly; 2002: pp. 124-136.
  • Joyner BD. Medscape: Neuroblastoma Treatment and Management. WebMD LLC; 2012.
  • Lacayo NJ. Medscape: Pediatric Neuroblastoma Treatment and Management. WebMD LLC; 2012.
  • Lacayo, N. J. and Marina, N . Neuroblastoma. eMedicine.com. Omaha: eMedicine, Inc; 2007.
  • National Cancer Institute. Neuroblastoma Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.

Treatments for low-risk neuroblastoma

Treatments for low-risk neuroblastoma include surgery, chemotherapy and radiation therapy. Learn about treatment options for low-risk neuroblastoma.

Treatments for intermediate-risk neuroblastoma

Treatments for intermediate-risk neuroblastoma include chemotherapy, surgery and radiation therapy. Learn about treatment options.

Treatments for high-risk neuroblastoma

Treatments for high-risk neuroblastoma include chemotherapy, surgery, stem cell transplant, radiation, retinoids and immunotherapy. Learn about treatments.

Treatments for stage 4S neuroblastoma

There is no standard treatment for stage 4S neuroblastoma. Many children may not need to have any treatment. Learn about treatment options.

Treatments for recurrent neuroblastoma

Treatments for recurrent neuroblastoma are based on the risk group given to the cancer when it was first diagnosed. Learn about treatments by risk group.

Surgery for neuroblastoma

Most children with neuroblastoma will have surgery. The type of surgery depends on the location of the tumour. Learn about surgery and side effects.

Chemotherapy for neuroblastoma

Chemotherapy is commonly used to treat neuroblastoma, especially intermediate- or high-risk neuroblastoma. Learn about chemotherapy and side effects.

Radiation therapy for neuroblastoma

Radiation may be used to treat neuroblastoma. Learn when and how radiation therapy is used for neuroblastoma and the side effects.

Retinoids and immunotherapy

Retinoids and immunotherapy are sometimes used to treat high-risk or recurrent neuroblastoma. Learn about retinoids, immunotherapy and their side effects.

High-dose chemotherapy and stem cell rescue for neuroblastoma

Learn about stem cell transplant, which may be used to treat neuroblastoma that is high-risk, has recurred or spread to other parts of the body.

Targeted therapy for neuroblastoma

Targeted therapy 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. Targeted therapy is sometimes used to treat neuroblastoma that has the ALK mutation.

Watchful waiting for neuroblastoma

Learn about watchful waiting for neuroblastoma, which means watching closely for signs or symptoms of the disease rather than giving treatment right away.

Follow-up after treatment for neuroblastoma

Follow-up after neuroblastoma treatment varies. Learn about scheduled follow-up appointments and the procedures and tests that may be done.

Late effects for neuroblastoma

Recovering from and adjusting to life after treatment for neuroblastoma is different for each child. Recovery depends on many factors. Learn about the late effects for neuroblastoma.