Treatment is determined according to the stage of the tumor, its location and the patient’s general health. Standard treatment and clinical trial options are available and should be discussed with the cancer care team.

Of the children diagnosed with neuroblastoma, about 70 percent have metastasis (spreading) of the disease. The extent of the spread of the cancer is determined by staging of the cancer, which is critical to planning treatment.

Treatment methods for neuroblastoma may include:

• Surgery. Removal of a part or complete area of cancerous cell growth. Optimally, all of the tumor should be removed but this may not be possible if there is metastasis. Risks include bleeding, blood vessel damage and damage to organs or nerves. This is the primary treatment for low-risk tumors.
  
  
• Chemotherapy. The use of powerful drugs for killing cancer cells. It is typically administered before surgery to shrink the tumor, when the whole tumor cannot be excised or when there is metastasis. Childhood cancers tend to respond well to chemotherapy.
  
  
• Radiation. Use of high-energy x-rays to destroy cancer cells. Internal radiation involves placing the substance directly in the area of the cancer. External radiation involves the use of a machine outside the body to direct the precise beams of radiation to the cancer site. This type of therapy is usually reserved for tumors that cannot be removed surgically and do not respond to chemotherapy.
  
  
• Retinoid therapy. Medications related to vitamin A. These substances are known to mature the cells into normal cells. Use of 13-cis-retinoic acid for six months is generally considered for neuroblastoma.
  
  
• Bone marrow transplant. A surgical procedure used to replace cancerous bone marrow with healthy bone marrow. The bone marrow may come from the patient for a matched donor, although neuroblastoma is confined to transplant from the patient.  For children with high-risk neuroblastoma and a poor prognosis, bone marrow transplant and/or retinoid medication have successfully induced remission.

One or more of these treatments may be used for neuroblastoma, depending on the stage and assessed risk for the child. Both chemotherapy and radiation have been shown to have a risk of long-term side effects for childhood cancer patients and may increase the risk of developing another cancer later in life. Research is continuing into the potential use of biological therapy drugs such as monoclonal antibodies or vaccines for neuroblastoma. These agents have shown promise for treating recurrent neuroblastoma.

Several factors are considered when determining treatment of the recurrence, including initial treatment and new growth factors. Surgery, chemotherapy, high-dose chemotherapy and/or  biological agents may be used as treatment.