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Surgical removal of the tumor may be all that is necessary for children with low-risk disease. Your healthcare team will determine whether chemotherapy and radiation are necessary.
Very young infants, in certain circumstances, 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.
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. Radiation treatment is generally not used for intermediate-risk disease.
The majority of high-risk treatment protocols use some combination of the following procedures:
In some cases the process may be repeated with a different combination of very high dose chemotherapy drugs and a second stem cell transplant. Most doctors agree that using autologous (from the patient) peripheral blood stem cells is preferable to using either autologous bone marrow or allogeneic (from a matched donor) bone marrow in the transplant process. Research has shown that the body more rapidly "engrafts," or goes to work restoring the immune system when peripheral blood stem cells are used. In addition, there is less risk of tumor cell contamination. However, in cases where the patients’ own stem cells cannot be harvested from their blood, bone marrow may be used.
The following are currently being used in the treatment of children with high-risk neuroblastoma:
About 2-4% of children who develop neuroblastoma also have symptoms of a rare neurological condition called OMA. Children with OMA develop symptoms that include walking and balance problems (ataxia), uncontrollable eye movements (opsoclonus), and body jerking, especially of the feet and legs (myoclonus). The cause of OMA is not completely understood, but it occurs when the auto-antibodies (disease-fighting proteins) that attack the cancer for some reason begin attacking the brain and central nervous system. OMA is usually associated with a less aggressive form of neuroblastoma.
Doctors and researchers currently DO NOT know what causes neuroblastoma. The only known factor is that Caucasian babies are more likely than African American babies to develop neuroblastoma. However, at older ages, Caucaian and African American children have similar chances of developing neuroblastoma.
The majority of children with cancer participate in research studies. This high rate of participation has been essential to improving the cure rates for children’s cancer.
Researchers design various studies to improve treatment and advance the understanding of cancer and its causes. Clinical trials are carefully reviewed and must be approved through a formal scientific process before anyone can be enrolled. If there is a research study “open” that your child is “eligible for,” you may be asked to allow your child to participate. It is also possible that your child will be asked to participate in more than one study.
Whether an individual is eligible for a particular study may depend on age, location of the cancer, the extent of the disease and other information. Researchers usually must limit their study to some of these characteristics to have a scientifically valid study. Further, researchers must follow exactly the same restrictions throughout the study.
If your child is eligible to participate in one or more study, your doctor will discuss these with you during an initial treatment conference (also called informed consent conference). The doctor will describe the study, potential risks of participation, and other information you need to decide whether or not you would like your child to participate in the study. You always have the choice to participate or not in research studies.
If you do choose to have your child participate in a study, you doctor will explain what type of information you will receive about the results of the study. The overall results of the research study will be published to inform the public and other researchers. No study will publish any information that identifies an individual.
Visit the Clinical Trials section of this website to learn more about the various kinds of research studies.
About NeuroblastomaJust Diagnosed with NeuroblastomaAfter Treatment for Neuroblastoma