Treatment for neuroblastoma in children varies significantly based on the risk for relapse classification of the disease. It is estimated that as many as 50-60% of children with high-risk neuroblastoma will eventually suffer a relapse. In children with intermediate- or low-risk neuroblastoma, relapses occur in only 5-15% of cases. If neuroblastoma is going to relapse at all, it usually does so within the first two years after the end of treatment. The likelihood of relapse continues to decline as more and more time passes after treatment is complete. Relapses occurring more than five years after the completion of therapy are rare. Treatment varies depending on the risk of relapse.
Patients with disease classified as low risk have tumors that:
- Are localized to one area
- Can be mostly or completely removed by a surgeon
- Have features which indicate that the tumor is unlikely to spread or come back
In certain circumstances, very young infants may be observed closely for signs of tumor progression without treatment. Sometimes their tumors spontaneously regress or go away and the potential risks of surgery to remove the tumor are not needed.
Your doctor will order blood, urine, and imaging tests at scheduled times to follow the disease. If a low-risk tumor recurs or begins to grow, your doctor may recommend treatment with surgery and/or chemotherapy.
Patients with disease classified as intermediate risk of relapse have tumors that:
- Are not easy to remove completely with surgery
- Have mixed tumor cell characteristics
- May create symptoms related to the tumor compressing other organs
In these cases, moderately intensive chemotherapy is given initially to shrink the tumor and make it easier for the surgeon to remove. Chemotherapy drugs known to work in neuroblastoma will be combined and given in 3 week cycles. Some patients are treated with chemotherapy alone and others require chemotherapy and surgery. Radiation treatment is generally not used for intermediate-risk disease.
After every few cycles of chemotherapy, the healthcare team will perform appropriate radiology examinations and tests of the bone marrow, blood and urine to determine how your child’s tumor is responding to therapy. Your healthcare team will determine the next steps based on the results of these evaluations. The number of chemotherapy cycles will be determined by how the tumor shrinks in response to therapy. When the treatment is completed, your doctor will plan periodic evaluations (which may include CT/MRI and MIBG scans, as well as urine, blood and bone marrow tests) to look for any signs of disease recurrence.