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Treatment by risk group for neuroblastoma

Treatment for neuroblastoma depends on the risk group. This means if there is a low, medium or high risk of the cancer coming back after treatment.

We have detailed information on how children with neuroblastoma are grouped according to their risk of neuroblastoma coming back.

Most children with neuroblastoma need to have treatment. They might have:

  • surgery
  • chemotherapy
  • radiotherapy
  • combination of two of the above, or all of them

Remember, this is just a guide. Your child’s specialist team will go through their treatment plan with you. Make sure you ask as many questions as you need to about what to expect.

Risk factor groups

Doctors use imaging tests such as CT scans, to look for particular risk factors. If your child has any of these risk factors it is a sign that it is more difficult to treat, for example they will look at whether the tumour is wrapped around an organ. These changes are called image defined risk factors.

Low risk

Babies with low-risk neuroblastoma, such as those who have no image defined high risk changes and no symptoms may not need much treatment, or any treatment at all. This is stage MS or 4S.

This kind of neuroblastoma can sometimes disappear on its own. Doctors always keep a close eye on children who have had neuroblastoma, so they will have hospital appointments for some years.

Treatment for low risk neuroblastoma, which isn’t stage 4S or MS, is usually:

  • just surgery alone
  • chemotherapy and surgery

Intermediate risk

Children with intermediate risk neuroblastoma usually have chemotherapy and surgery. They might also need radiotherapy.

High risk

Treatment for high risk disease has 4 parts:

Induction treatment

The first treatment children with high risk neuroblastoma have is chemotherapy. This is to either get rid of or reduce the cancer that has spread.

Local control treatment

The second part of treatment is an operation to remove the main tumour. This is followed by radiotherapy to where the tumour was. The aim is to kill any remaining cells and reduce the likelihood of the cancer coming back.

Consolidation treatment

This is the third treatment. It is high dose chemotherapy with a stem cell transplant.

Maintenance treatment

After consolidation treatment there is still a small chance the cancer could come back. This is because there could be neuroblastoma cells that haven’t been killed by the other treatments.

Doctors call this minimal residual disease or MRD. Left alone, they could develop into another tumour. Research has shown that having maintenance treatment can help reduce the chance of this happening.

A substance related to vitamin A, called 13-cis-retinoic acid (isotretinoin) is taken as a capsule about 6 months. The standard dose is twice a day for 2 weeks and then 2 weeks off before starting again. Side effects include:

  • skin changes including dry, cracked lips
  • dry eyes
  • nosebleeds
  • muscle and joint pain


This treatment helps the immune system to find and kill any mature neuroblastoma cells. It is a type of immunotherapy called monoclonal antibody treatment. The treatment is called anti GD2.


Researchers are still looking into what the best maintenance treatment is. So, your child’s doctor might ask you if your child will take part in a trial to look into different treatments.

More information on treatment

We have more information on all the treatments, including the chemotherapy drugs, your child might have for neuroblastoma and the possible side effects.

Last reviewed: 
16 May 2018
  • Cancer Research UK Clinical Trials Database

    Accessed January 2018

  • Electronic Medicines Compendium

    Accessed January 2018

  • Cancer in Children: clinical management (6th edition)

    MCG Stevens, HN Caron and A Biondi (Editors)

    Oxford University Press, 2012

  • Overview and recent advances in the treatment of neuroblastoma

    SB Whittle and others

    Expert Review of Anticancer Therapy, 2017

    Volume 17, Number 4

  • Dinutuximab beta for treating neuroblastoma

    National Institute for Health and Care Excellence, August 2018