pediatrics
Neuroblastoma
Treatment of Neuroblastoma
Surgical resection Usually chemotherapy Sometimes high-dose chemotherapy followed by stem cell transplantation Sometimes radiation therapy Cis-retinoic acid for maintenance therapy in high-risk disease Immunotherapy Treatment of neuroblastoma is based on the risk category (see also the National Cancer Institute'sNeuroblastoma Treatment—Health Professional Version). Surgical resection is important for low-risk and intermediate-risk disease. It is often delayed until adjuvant chemotherapy is given to improve the chance of adequate surgical resection. Chemotherapy (typical drugs includevincristine,cyclophosphamide,doxorubicin,cisplatin,carboplatin,ifosfamide, andetoposide) is usually necessary for children with intermediate-risk or high-risk disease. In addition, high-dose chemotherapy with stem cell transplantation and cis-retinoic acid are also frequently used for children with high-risk disease. Radiation therapy is sometimes needed for children with intermediate-risk disease or for children with inoperable tumors and is a standard part of treatment for local control of high-risk disease. Immunotherapy using monoclonal antibodies against neuroblastoma antigens (GD2) combined with cytokines is used as maintenance therapy in high-risk disease. In a recent study of relapsed/refractory neuroblastoma, a combination of immunotherapy with chemotherapy led to impressive clinical responses ( Treatment reference ). 1.Mody R, Naranjo A, Van Ryn C, et al:Irinotecan-temozolomidewithtemsirolimusordinutuximabin children with refractory or relapsed neuroblastoma (COG ANBL1221): An open-label, randomised, phase 2 trial.Lancet Oncol18(7):946–957, 2017. doi: 10.1016/S1470-2045(17)30355-8 