How Neuroblastoma Is Treated

Neuroblastoma is one of the more common types of childhood cancer, but it is still rare—affecting about 1 out of every 100,000 children. This type of cancer develops in immature nerve cells in the adrenal glands, neck, chest, or spinal cord.

The recommended treatment for neuroblastoma depends on a child’s age and the size and location of the tumor. Observation, surgery, chemotherapy, radiation, immunotherapy, stem cell transplant, or a combination of these methods can be used to treat neuroblastoma.

Here is an overview of the different treatment options available for neuroblastoma.

Pediatrician with face mask and toddler in medical practice

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Observation

The tumors in neuroblastoma sometimes resolve on their own. If a tumor is less than 5 centimeters and a child is younger than 18 months, an observational approach might be taken because there is a good chance that the tumor will not progress.

Imaging is usually done every six to eight weeks to monitor whether the tumor is growing.

Surgery

Surgical resection is done to remove the tumor and some of the surrounding healthy tissue. If the tumor has not spread, the surgery might be able to remove all the cancer cells.

If cancer has spread, surgery is sometimes recommended to remove part of the cancer cells. Then another type of treatment, such as chemotherapy, can be used to destroy the other cancer cells.

The cancer cells in the tumor that are removed during surgery can be tested to determine the type of tumor. That information can be used to guide treatment.

Sometimes the size or location of the tumor can make surgery too risky. For example, if the tumor is near the lungs or attached to the spinal cord, then treatment other than surgery is usually recommended.

The side effects of surgery will depend on the location of the tumor. Any surgery can cause reactions to anesthesia and pain.

Chemotherapy

Chemotherapy drugs target and destroy cancer cells. They also help prevent cancer cells from growing and dividing and can shrink a tumor. Chemo drugs can be taken orally, injected into the muscle, or given through an IV placed in a vein.

Chemotherapy can be recommended before or after surgery. When it is given before surgery, it can help shrink the tumor, which makes it easier for a surgeon to remove. After surgery, chemotherapy helps to clean up any remaining cancer cells.

Your child’s pediatric oncologist will recommend the best chemotherapy options for the specific type and location of the tumor.

The symptoms of chemo may include fatigue, weakened immune system, nausea, vomiting, hair loss, low appetite, and diarrhea.

Immunotherapy

Immunotherapy drugs boost the immune system to help fight off cancer cells. One drug that is used to treat high-risk neuroblastoma is a monoclonal antibody agent called dinutuximab. It is sometimes used with drugs that manipulate the immune system as part of immunotherapy.

Dinutuximab works by attaching to the surface of neuroblastoma cells, which flags the cancer cells and triggers the immune system to destroy them.

Neuropathic pain and peripheral neuropathy are significant side effects of dinutuximab (in fact, there is a Black Box Warning on the drug for these reactions). Other common side effects include skin rash, flu-like symptoms, weight change, and diarrhea. Allergic reactions to dinutuximab can also occur.

Stem Cell Transplant

Stem cell transplants can be used with chemotherapy to treat high-risk cancer. Large doses of chemotherapy can destroy stem cells and other healthy cells in the body.

Having a stem cell transplant after chemo provides fresh stem cells to help the body rebuild healthy cells and recover more quickly.

For many children, their own stem cells can be collected and used for the transplant. A stem cell transplant can also be completed using stem cells donated by another person.

Collecting Stem Cells

Stem cells can be collected with a process called apheresis. A medication is given before the procedure to cause the stem cells that are already in the bone marrow to travel outside the bone marrow and into the bloodstream. When enough cells are circulating in the blood to collect, a type of central venous catheter is placed.

Next, the child’s blood is run through a machine that filters the stem cells out of the blood. Then the blood flows back into their body.

It can take a few hours to complete the procedure, and it might need to be completed over multiple days. The stem cells are frozen until after chemotherapy, when the transplant will be needed.

While the process minimizes the risk of a child's body rejecting the stem cells, there is still a risk that some of the cancerous neuroblastoma cells could be in the bone marrow or blood. If this is the case, the cancerous cells could be collected along with the stem cells, then later reinfused back into a patient.

Radiation Therapy

Radiation therapy uses high-energy beams, like X-rays, to destroy cancer cells. The most common form of radiation therapy is external-beam radiation therapy. It uses a machine to aim a beam of radiation at the tumor from outside the body.

Typically, radiation therapy in young children is avoided, and it's not typically part of a treatment plan for neuroblastoma.

The possible side effects of radiation therapy include fatigue, skin rash, upset stomach, and diarrhea. It can also interfere with normal growth in children.

Summary

Neuroblastoma sometimes goes away on its own. When it does not, there are many ways that it can be treated. If your child has been diagnosed with neuroblastoma, their doctor will explain which types of treatment might work for them.

These treatments might include chemotherapy, surgery, or simply "watching and waiting" if their doctor thinks the tumor might go away on its own.

A Word From Verywell

When your child is diagnosed with cancer, it can be an overwhelming and frightening experience for your entire family. With the support of their healthcare team, you will learn about your child's options for treatment, as well as be guided through the process of making decisions about their care.

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  1. American Cancer Society. What Is Neuroblastoma?. Updated April 28, 2021.

  2. Meany HJ. Non-High-Risk Neuroblastoma: Classification and Achievements in TherapyChildren (Basel). 2019;6(1):5. Published 2019 Jan 8. doi:10.3390/children6010005

  3. American Cancer Society. Neuroblastoma Surgery. Updated April 28, 2021.

  4. Bansal D, Totadri S, Chinnaswamy G, et al. Management of neuroblastoma. Indian J Pediatr. 2017;84(6):446-455. doi:10.1007/s12098-017-2298-0.

  5. Keyel ME, Reynolds CP. Spotlight on dinutuximab in the treatment of high-risk neuroblastoma: development and place in therapy. Biologics. 2018;13:1-12. doi:10.2147/BTT.S114530

  6. Park JR, Kreissman SG, London WB, et al. Effect of tandem autologous stem cell transplant vs single transplant on event-free survival in patients with high-risk neuroblastoma: a randomized clinical trial. JAMA. 2019;322(8):746-755. doi:10.1001/jama.2019.11642

  7. American Cancer Society. High-dose Chemotherapy and Stem Cell Transplant for Neuroblastoma. Updated April 28, 2021.

  8. American Cancer Society. Radiation Therapy for Neuroblastoma. Updated April 28, 2021.