Cancers and Tumors

Neuroblastoma Treatment

Your child's neuroblastoma treatment will depend on whether their disease is low-risk, intermediate-risk or high-risk. Your child's doctor can explain your child's risk level.

Treatments by Risk Level

Here are the most common treatments based on risk level. All of them are offered through Seattle Children's.

Low-risk

Most children with low-risk neuroblastoma have surgery to remove their primary tumor. Some have chemotherapy or radiation, too.

Some children with a certain form of low-risk disease have tumors that go away on their own. For children with this form, doctors may suggest "watchful waiting." This refers to the practice of closely tracking the child's cancer, without treatment, to see whether it changes.

Intermediate-risk

Children at this risk level most often have surgery and chemotherapy. Some have radiation, too.

High risk

Treatment for high-risk neuroblastoma most often involves some mix of surgery, chemotherapy, radiation, hematopoietic cell transplant and new treatments.

Neuroblastoma Treatment Options

Surgery

Children with neuroblastoma usually have surgery . The first surgery your child has may be a biopsy , in which doctors remove a small sample of tumor cells to check for cancer.

The standard surgical treatment is for doctors to remove as much of the tumor as they can. In about half of the children with neuroblastoma, this is done during the same surgery as the biopsy.

In the remaining children with neuroblastoma, the tumor has spread to other sites in the body or is too large to remove safely when the biopsy is done. In these cases, after the biopsy and diagnosis the patient receives chemotherapy to help control the tumor and later has surgery to remove as much tumor as possible.

Doctors sometimes use chemotherapy or radiation before or after surgery. Used before, these treatments may help shrink a tumor so that it's easier to remove.

Even when doctors can remove the entire tumor, they may suspect or know that cancer cells are still in the child's body, so they often use chemotherapy, radiation or both to kill any cancer cells that remain.

Chemotherapy

Chemotherapy means giving medicines that go throughout your child's body to kill cancer cells.

Your child's doctors may suggest chemotherapy as the main treatment or they may suggest using it before, during or after other treatments. These medicines spread around the body through the bloodstream.

They can help kill cancer cells that are in the blood and bone marrow as well as those that may have spread to other sites.

The exact mix of medicines and how long they are given depend on the type of neuroblastoma your child has. Researchers are studying new mixes of medicines to find which work best against each type of the disease.

Our childhood neuroblastoma patients receive chemotherapy at our hospital's main campus in Seattle - most often during a stay in the hospital (as inpatients) but sometimes in a clinic (as outpatients), depending on the type of medicines they need.

Radiation therapy

Your child's doctors may suggest using radiation therapy, too.

For low-risk or intermediate-risk disease, doctors may use radiation when a child has tumors that cause severe problems - such as blocking breathing, blood flow or organ function - and treatment with the medicines isn't helping quickly enough.

All children with high-risk neuroblastoma receive radiation to the site of the first tumor and sometimes to places where the tumor has spread.

Most children with neuroblastoma get external radiation. This means a machine sends a dose of radiation through the outer structures, such as the skin and the skull, into deeper parts of the body. Radiation uses strong X-rays to kill cancer cells and reduce the size of tumors.

Radiation can cause unpleasant side effects, such as nausea, sore throat or mild skin burning, or long-term problems, such as infertility or second cancers. Radiation also can affect the way a child develops.

Researchers are looking for ways to give it in smaller doses or to smaller areas or to use other treatments instead.

Our patients receive radiation through our partner  UW Medicine .

Children with high-risk neuroblastoma that has come back after treatment or that does not respond well to initial treatment may be able to have a newer type of radiation therapy, I-131-MIBG therapy . This is a way to get radiation inside your child's body and into their cancer cells via the bloodstream.

Learn more about Children's Radiation Therapy Service .

Hematopoietic cell transplant, or stem cell transplant

Children with high-risk neuroblastoma may have high doses of chemotherapy medicines combined with a hematopoietic cell, or stem cell, transplant.

The medicines are designed to kill cancer cells that remain in the child's body. Such high doses damage the bone marrow so it cannot make new stem cells that would become blood cells.

To rescue a child from the damaging effects of high-dose chemotherapy, doctors then give the child bone marrow or stem cells through a vein. This is called an infusion .

Doctors remove the stem cells from the child before chemotherapy, then freeze and store the cells until they can be returned to the child's body. This is called an autologous stem cell transplant.

Our patients who have a hematopoietic cell, or stem cell, transplant receive this care through Children's Hospital and our partner Fred Hutchinson Cancer Research Center . Learn more about the Pediatric Blood and Marrow Transplant Program .

New Treatments for Neuroblastoma

Researchers are running studies to find better treatments for children with neuroblastoma. They are looking for the best combinations of chemotherapy medicines and ways to use radiation and transplants with better results. They are also looking for new types of cancer treatments.

Many of our patients with neuroblastoma take part in clinical trials. These research studies give children the chance to get the very latest treatment options being studied – options that are not offered at all treatment centers.

The cancer doctors at Seattle Children's are active members of the Children's Oncology Group (COG). COG is an international organization of childhood cancer specialists who conduct clinical trials on many forms of childhood cancer.

Dr. Julie R. Park leads the COG neuroblastoma committee’s efforts to understand how the disease works, develop new treatment programs and reduce later effects of the disease and treatments.

Seattle Children’s doctors also take part in the New Approaches to Neuroblastoma Therapy (NANT) consortium. NANT works to find new treatment options for children with neuroblastoma whose disease has not responded well to frontline therapy or has grown back during treatment or after treatment is completed.

One new treatment Seattle Children's doctors and researchers are working on is immunotherapy. Immunotherapy is a new cancer treatment that stimulates a patient's own immune system to better fight disease.

Park is currently enrolling patients in a Phase 1 clinical trial to test T-cell therapy, a form of immunotherapy, in children and adolescents with recurrent or refractory neuroblastoma. This trial is known as Engineered Neuroblastoma Cellular Immunotherapy (ENCIT)-01. It is based on promising results from previous trials using immunotherapy for recurrent leukemia. Learn more.

Your child's doctor will talk with you in detail about any new treatment that might be a match for your child. Then you can decide whether you want to try this option.

Read more about research at Seattle Children's and about follow-up after treatment ends.