Treatment of Recurrent Neuroblastoma

For information about the treatments listed below, see the Treatment Option Overview section.

Patients First Treated for Low-Risk Neuroblastoma

Treatment for recurrent neuroblastoma that comes back in the area where the cancer first formed may include:

• surgery followed by observation or chemotherapy
• chemotherapy that may be followed by surgery

Treatment for recurrent neuroblastoma that comes back in other parts of the body or that has not responded to treatment may include:

• observation
• chemotherapy
• surgery followed by chemotherapy
• treatment as for newly diagnosed high-risk neuroblastoma, for children older than 18 months

Patients First Treated for Intermediate-Risk Neuroblastoma

Treatment for recurrent neuroblastoma that comes back in the area where the cancer first formed may include:

• surgery that may be followed by chemotherapy
• radiation therapy for children whose disease has gotten worse after chemotherapy and second-look surgery

Treatment for recurrent neuroblastoma that comes back in other parts of the body may include:

• Treatment as for newly diagnosed high-risk neuroblastoma.

Patients First Treated for High-Risk Neuroblastoma

There is no standard treatment for recurrent neuroblastoma in patients first treated for high-risk neuroblastoma. Treatment may include:

• Combination chemotherapy with monoclonal antibody therapy (dinutuximab).
• Iodine 131-MIBG therapy to relieve symptoms and improve quality of life. It may be given alone or in combination with chemotherapy, or followed by stem cell rescue.
• Chemotherapy.
• Targeted therapy with crizotinib, lorlatinib, or adavosertib, for patients with changes in the ALK gene.

Because there is no standard treatment, patients first treated for high-risk neuroblastoma may want to consider a clinical trial. For information about clinical trials, please see the NCI website.

Patients with Recurrent CNS Neuroblastoma

Treatment for neuroblastoma that recurs (comes back) in the central nervous system (CNS; brain and spinal cord) may include:

• surgery to remove the tumor in the CNS followed by radiation therapy
• chemotherapy, surgery, and radiation therapy

Treatments Being Studied for Progressive/Recurrent Neuroblastoma

Some of the treatments being studied in clinical trials for neuroblastoma that recurs (comes back) or progresses (grows, spreads, or does not respond to treatment) include:

• Chemotherapy and targeted therapy (dinutuximab with or without eflornithine).
• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.
• A clinical trial of targeted therapy (pembrolizumab).
• A clinical trial of CAR T-cell therapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.