Treatment

Treatment options for neuroblastoma vary depending on the diagnosis and may include surgery, observation, chemotherapy, stem cell transplant, radiation therapy and immunotherapy. 

Treatment and care of children with cancer is usually provided by a team of health professionals called a multidisciplinary team. Members of this team are specialists in children’s cancers – they understand the differences between children’s cancer and adult cancer, and each team member brings different skills in managing care to meet the needs of both you and your child.

The team will be led by a childhood cancer specialist (paediatric oncologist). Other members of the team depend on the age of your child and their type of disease, and may change over time as your child’s needs change. A list of team members who might make up the multidisciplinary team can be found in The treatment team. 

Treatment for neuroblastoma depends on the age of your child, the stage of the disease, the biological features of the cancer and other factors identified during diagnosis. Treatment will be tailored to your child’s particular situation, and may involve one or more of the following (see How is cancer treated for more detail).

Surgery

Your child is likely to have surgery to remove all or part of the tumour. If the entire tumour can be removed and it has not spread to other parts of the body, your child may not need any other treatment.

Chemotherapy

Chemotherapy uses anti-cancer medicines to destroy cancer cells. It is often given as a combination of medicines to try to prevent the cancer cells from becoming resistant to just one or two medicines. Chemotherapy medicines are given together in courses, often over a few days. Once the body has recovered from the side effects, the next course is given. Most children receive multiple courses of chemotherapy.

Chemotherapy may be used:

• before surgery (to shrink the tumour and make it easier to remove)
• after surgery (to destroy any remaining cancer cells) 
• as the main treatment (if the cancer has spread to other parts of the body, or if surgery is not a good option )
• to relieve symptoms of neuroblastoma.

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy X-rays or other types of radiation to destroy cancer cells or stop them from growing. Radiation therapy is commonly used to treat children with high-risk neuroblastoma. If radiation therapy is included in your child’s treatment, special care will be taken to reduce the risks. Radiation therapy can be used to relieve symptoms of neuroblastoma, usually after other treatments have been tried.

Stem cell transplant

Some children with high-risk neuroblastoma may be treated using a stem cell transplant (also known as a bone marrow transplant), in combination with high-dose chemotherapy or radiation therapy. After the transplant, your child will be given additional treatment known as maintenance therapy to destroy any remaining cancer cells. Maintenance therapy is given for 6 months and may include:a vitamin-like medicine that slows the cancer's ability to make more cancer cells antibodies and other compounds to stimulate the body’s immune system to destroy any remaining cancer cells.

Immunotherapy

Immunotherapy is a treatment that uses certain parts of a person's immune system (a collection of organs, special cells and substances that help protect from infections and some other diseases) to fight cancer. Immunotherapies are thought to work by slowing the growth and spread of cancer cells, and by helping the immune system destroy existing cancer cells.

Types

The main types of immunotherapy can be divided into treatments using monoclonal antibodies, nonspecific immunotherapies, and cancer vaccines.

Antibodies are naturally produced by the body when it detects harmful viruses, bacteria and other substances that cause disease. Antibodies fight infection or disease by targeting parts of cancer cells to alter their growth. Monoclonal antibodies (mAbs) are made in a laboratory to work in the same way. They are usually given intravenously.

Monoclonal antibodies may be designed to change cancer cells in different ways:

• Antibodies can attach to cancer cells to ‘flag’ your immune system to destroy that cell.
• Antibodies can slow the growth of cancer cells by blocking parts of the cell that enable them to grow.
• Radioimmunotherapy uses antibodies to deliver radiotherapy to cancer cells without damaging healthy cells. This is done by attaching radioactive molecules to antibodies in a medical laboratory. These kinds of antibodies can also be used to diagnose some cancers by flagging where cancer cells exist in the body.
• The antibody may carry medicine, such as chemotherapy, directly to cancer cells.

Nonspecific immunotherapies refer to the use of cytokines (proteins produced by white blood cells to control immune responses) to help the body’s immune system destroy cancer cells. Nonspecific immunotherapies are typically given in combination with other cancer treatments, such as chemotherapy or radiation therapy

Types of cytokines that are made in a laboratory to treat cancer include:

• interferons, which can help the immune system to slow the growth of cancer cells
• interleukins, which can increase the production white blood cells and antibodies to fight cancer
• hematopoietic growth factors, which may be used to counteract some side effects of chemotherapy.

Cancer vaccines are medicines that trigger the body’s immune system to detect cancer cells. There are 2 types of cancer vaccines. Preventive (prophylactic) vaccines may prevent cancer cells from developing; they are only useful for cancer known to be caused by infections. Treatment (therapeutic) vaccines prompt the immune system to fight existing cancer cells. Clinical trials continue into different types of therapeutic vaccines (source of this information is Cancer Australia).

Dinutuximab Beta - QARZIBA

Recently, an immunotherapy treatment called dinutuximab beta (brand name QARZIBA) has been introduced and approved for children with high risk neuroblastoma. It is a monoclonal antibody. Neuroblastomas express an antigen called disialoganglioside 2 (GD2). An anti-body called ch14.18 was found to kill cells expressing GD2. A leaflet explaining the treatment produced by EUSA Pharma, who make the antibody, can be downloaded here. It also explains the side effects of the treatment. Dinutuximab beta is sometimes also given with interleukin-2 (IL2).

(above paragraph has been added by Neuroblastoma Australia)

Careful observation

For a few carefully selected patients, specific treatment may not be needed. If your child has a tumour that is not growing or spreading, they might be monitored closely but not given any treatment until they develop symptoms, or until their symptoms change. In some children (especially very young children), a neuroblastoma will disappear by itself, and no treatment is needed.

Support

Diagnosis of cancer in a child is a very difficult time for the child, their family and their friends. You might feel overwhelmed, scared, anxious or angry. These are all normal feelings. It is very important to seek support from family, friends, health professionals or other services to help you, your child and your family cope with cancer.

Talk to your child’s treatment team if you are having difficulties coping.

Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment. There is also a page with helpful links on where to find support.

The Cancer Council in your state or territory can give you general information about cancer, as well as information on resources and support groups in your local area. Call the Cancer Council Helpline from anywhere in Australia for the cost of a local call on 13 11 20 .

For additional specific information about childhood cancer, contact any of the major children’s hospitals and networks in your state or territory.

Chance of cure

Many children with cancer are cured of the disease. Children’s bodies have great capacity for healing. Also, huge improvements have been made in the treatment of childhood cancer in the past few decades. In the 1980s, around 65% of children diagnosed with cancer were alive more than 5 years after their diagnosis. Today, around 83% of children are successfully treated and become long-term survivors. Long-term survival (also called the outlook or prognosis) and treatment options depend on a range of factors, including:

• age of your child at diagnosis 
• extent or stage of the cancer 
• appearance of the cancer cells under the microscope (the shape, function and structure of the cells)
• how the cancer responds to treatment cancer or tumour biology, which includes: 
• the patterns of the cancer cells 
• how different the cancer cells are from normal cells 
• how fast the cancer cells are growing.

Talk to your child’s doctor about your child’s individual disease, treatment options and outlook.

Information above is reproduced with permission of Cancer Australia and you can download the full Cancer Australia’s Neuroblastoma Fact Sheet here.

Read next: Clinical Trials

More information:

If your child has been diagnosed with neuroblastoma, your child's treatment team will discuss the options with you. It’s important to weigh the benefits of each treatment option against the possible risks and side effects. Visit our related support services page for organisations that can help during this time and our 'living with neuroblastoma area' for helpful tips from other neuroblastoma families.

We also have a helpful guide for parents that aims to help parents and carers following their child’s diagnosis and give specific information about neuroblastoma, its treatment and possible side effects. You can access the guide below. If you would like a hard copy of the guide, please email us at [email protected]

Parent's Guide to Neuroblastoma

Below are links to more information regarding treatments and their side-effects:

• The Royal Hospital Melbourne’s Fact Sheets 
• Treatments - Cancer Australia
• Treatment and side effects downloadable PDF American Cancer Society
• Treating neuroblastoma - American Cancer Society
• Treatment of neuroblastoma by risk group - American Cancer Society
• Preparing for a treatment - American Cancer Society
• Treatment option overview - PDQ Neuroblastoma Treatment
• Treatment side effects - PDQ Neuroblastoma Treatment