What are the treatments for neuroblastoma?
Your child’s physician will determine a specific course of treatment for your child’s neuroblastoma based on the tumor risk group and other factors. The types of treatment that are used in neuroblastoma include:
- Surgery: Surgery is used to remove the tumor either at diagnosis or after using chemotherapy or radiation to make the tumor smaller.
- Chemotherapy: Several chemotherapy medications are known to be effective in killing neuroblastoma cells. Chemotherapy is used to decrease the size of the tumor, kill tumor that has spread and prevent further tumor spread.
- Radiation: Radiation is used to kill neuroblastoma cells left behind after chemotherapy and/or surgery. It is also sometimes used for patients who need immediate shrinkage of the tumor to prevent or treat a complication (such as the tumor pressing on an important nerve or the spinal cord).
- Stem cell transplant: This involves temporarily removing some of a child’s healthy blood cells and giving them very high doses of chemotherapy and, in some cases, radiation therapy to overwhelm and destroy the neuroblastoma. The child is then given back his or her own stored healthy blood cells to promote normal body and organ function once treatment is done.
- Biologic therapy: These therapies include antibody therapy and a medicine called isotretinoin, which take advantage of what we have learned about the biologic characteristics of neuroblastoma cells. The objective of biologic therapy is to kill any remaining microscopic tumor cells.
These different types of treatments are used alone or in combination depending on the neuroblastoma risk group. In general, recommended treatment for the three neuroblastoma risk groups is:
Patients with low-risk neuroblastoma usually require only surgery and/or observation. Occasionally, a patient with a low-risk tumor will need chemotherapy (or radiation treatment) to shrink a tumor before it is removed.
Patients with intermediate-risk disease are treated with chemotherapy to shrink the tumor (and/or its sites of spread), before the tumor can be surgically removed. The actual medications used are chosen to try to minimize side effects, both during treatment and in the future.
High-risk neuroblastoma is an aggressive disease that is treated with a combination of therapies including chemotherapy, surgery, radiation, stem cell transplant and biologic therapy.
What treatments are available for relapsed or refractory neuroblastoma?
If your child’s neuroblastoma has recurred, she may receive a specialized treatment known as metaiodobenzylguanidine (MIBG) therapy.
- MIBG therapy, which uses a radioactive isotope that is readily absorbed by most neuroblastomas, can be used to detect neuroblastoma in the body or to deliver radiation in order to kill the neuroblastoma cells.
- In general, about 40 percent of patients respond to MIBG therapy.
- Dana-Farber/Boston Children’s has a specialized MIBG room where children receive therapy.
- MIBG therapy takes one to two hours to administer, but because MIBG is radioactive, your child may need to stay in the hospital for three to four days until radiation levels are reduced.
- The major side effect of therapy is low blood cell counts.
We are currently investigating ways to further improve the effectiveness of MIBG therapy.
Other treatments for relapsed neuroblastoma. For children whose disease has recurred or not responded to initial therapy, we offer innovative clinical trials. Some of these were launched by our own physicians, while others are available through our participation in the New Approaches to Neuroblastoma Therapy (NANT) consortium and the Pediatric Oncology Experimental Therapeutics Investigators' Consortium (POETIC).
What is the long-term outlook for my child?
Your child’s prognosis (chance of recovery) and treatment options depend on a number of different factors:
- the extent of the disease
- the size and location of the tumor
- the tumor's characteristics when examined under a microscope
- the presence or absence of metastasis
- the tumor's response to therapy
- the age and overall health of your child
- your child's tolerance of specific medications, procedures or therapies
- new developments in treatment
In general, low- and intermediate-risk neuroblastomas tend to be more treatable. High-risk neuroblastomas are more difficult to treat and require more aggressive therapy. Prompt medical attention and appropriate therapy are important for the best prognosis.
Continual follow-up care is essential if your child has neuroblastoma. Side effects of radiation and chemotherapy, as well as recurrence of the disease, can occur in survivors of neuroblastoma.