Neuroblastoma
Treatment
The types of treatment used to treat neuroblastoma are:
Surgery
Surgery is used to remove the tumor either at diagnosis or after using chemotherapy or radiation to make the tumor smaller.
Chemotherapy
There are several chemotherapy medications 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 of the tumor (like pressing on an important nerve or the spinal cord, for example).
Stem Cell Transplantation
This involves temporarily removing a portion of a child's healthy blood cells and then 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 are newer therapies used for neuroblastoma which take advantage of what we have learned about the biologic characteristics of neuroblastoma cells. One of the most common biologic therapies used is cis-retinoic acid, which is a drug that is similar to vitamin A. Cis-retinoic acid causes neuroblastoma cells to stop acting like cancer cells when they are grown in a test tube. It is usually given after all other therapy is completed in patients with high-risk neuroblastoma. Other examples of biologic therapies are antibody therapy and tumor vaccines, which are still in the experimental stage.
Risk-adjusted Treatments
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:
Low risk: Patients with low-risk disease 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.
Intermediate risk: 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. Chemotherapy is chosen to try to minimize side effects, both during treatment and in the future.
High risk: Patients with high-risk disease have aggressive disease that is often difficult to cure. These patients therefore are treated with a combination of chemotherapy, surgery, radiation, stem cell transplant and biologic therapy. The Pediatric Stem Cell Transplantation Program at Dana-Farber/Children's Hospital Cancer Care is one of the most established and active in the country.
Ultimately, your child's individual neuroblastoma will determine what treatment options we recommend. Once we determine the type and spread of your child's neuroblastoma, we will discuss these options with you in detail.
