What is the treatment for high-risk neuroblastoma? 

High‑risk neuroblastoma is treated with an intensive combination of therapies. The exact plan for your child depends on several factors, including the stage of the cancer, tumour biology, where the cancer is in the body, and your child’s age and overall health. Because neuroblastoma behaves differently in each child, treatment pathways can vary. Your child’s team will discuss the treatment approach that is safest and most appropriate for your child’s situation. High‑risk neuroblastoma treatment usually includes the following stages: 

Induction chemotherapy 

Treatment usually begins with several cycles of induction chemotherapy. The aim is to shrink the main tumour and reduce any cancer that has spread elsewhere in the body. Different chemotherapy combinations may be used depending on your child’s situation or the clinical trial they are offered. 

Read more about induction chemotherapy for neuroblastoma.

Surgery to remove the primary tumour 

If the primary tumour can be safely removed, a specialist surgeon will operate after induction chemotherapy. The goal is to remove as much of the tumour as possible while avoiding damage to nearby organs, blood vessels, or nerves. Not all tumours can be removed completely, and this does not stop children moving on to the next treatment stage. 

Read more about surgery for neuroblastoma.

High‑dose chemotherapy and stem cell rescue 

This stage uses more intensive chemotherapy to destroy remaining cancer cells. Because this treatment also damages the bone marrow, your child receives a stem cell rescue (also called a stem cell transplant) using their own previously collected stem cells. Some children receive one high‑dose treatment; others may receive two, depending on their individual treatment plan or whether they are enrolled in a clinical trial. 

Read more about high-dose chemotherapy for neuroblastoma. 

Radiotherapy 

Radiotherapy is usually given to the area where the main tumour started. In some cases, radiotherapy may also be used for small areas of remaining cancer. Both photon radiotherapy and proton beam therapy are used in the UK. Your child’s radiotherapy team will explain which option is most suitable. 

Read more about radiotherapy for neuroblastoma.

Immunotherapy 

After high‑dose chemotherapy and radiotherapy, most children receive immunotherapy. This treatment helps the immune system recognise and destroy any remaining neuroblastoma cells. It is often given alongside other medicines that support the immune response and manage symptoms. 

Read more about immunotherapy for high-risk neuroblastoma. 

Why treatment can vary between children 

Even within the high‑risk group, there is a lot of variation in how the disease behaves. This means the order of treatments may differ, some children may receive additional therapies, some may be offered a clinical trial, and some treatments may be adapted depending on how the cancer responds. Your child’s team will always explain what the plan looks like for your child and why. 

Is treatment for high‑risk neuroblastoma difficult? 

Treatment for high‑risk neuroblastoma is demanding and can cause significant short‑term side effects. Some treatments may also lead to long‑term or late effects. Your child’s medical team will monitor them closely, manage symptoms, and support you through each stage. You can speak to your treatment team at any time if you have concerns. 

Read more about the side effects of neuroblastoma treatment.