Induction chemotherapy for neuroblastoma

Induction chemotherapy is often the first major phase of treatment for children diagnosed with neuroblastoma. The aim is to shrink the primary tumour and any disease elsewhere in the body, so that surgery and later stages of treatment have the best possible chance of success.

Chemotherapy uses strong medicines to destroy cancer cells. These medicines are usually given into a vein through a central line, which is fitted under general anaesthetic to avoid repeated needles and reduce distress.

What induction chemotherapy involves

Induction chemotherapy is given as a series of treatment cycles over several months. The exact drugs and schedule your child receives will depend on their treatment plan, but in the UK the two most commonly used induction regimens are Rapid COJEC and Modified N7.

Rapid COJEC

Rapid COJEC uses a combination of five chemotherapy medicines: cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide. These are delivered directly into the bloodstream through your child’s central line.

Key features include:

• Eight treatment cycles, each separated by 10‑day intervals
• Treatment course completed within approximately 70 days
• High doses given over a short time period, which may improve outcomes for some children with high‑risk disease.

Modified N7

Modified N7 uses a different combination of chemotherapy medicines: cyclophosphamide, doxorubicin, vincristine, cisplatin, and etoposide.

Key features include:

• Five cycles, each lasting 3–4 days
• A three‑week break between cycles to allow the body to recover
• Daily G‑CSF injection between cycles to help reduce the risk of infection by supporting white blood cell recovery

Stem cell harvest during induction 

During induction chemotherapy, your child will have a stem‑cell harvest. This involves collecting healthy stem cells from their blood before the chemotherapy becomes too intensive. These cells are then frozen and stored. 

Why stem cells are collected: 

• Chemotherapy can damage the bone marrow, where blood cells are made 
• Collecting stem cells early means they can be returned to your child later, following high‑dose chemotherapy which comes later in the treatment pathway 
• This helps the body recover and produce healthy blood cells again after the most intensive treatment phase 

Read more about stem‑cell transplant for neuroblastoma. 

Side effects 

Induction chemotherapy can cause side effects, but each child’s experience is unique. 

Read more about the side effects of induction chemotherapy.

Your child’s clinical team will monitor them closely and support them through any difficulties during treatment. 

What to expect during induction chemotherapy 

Families often want to know what treatment will look like day‑to‑day. While each centre works slightly differently, you can usually expect: 

• Regular hospital stays for chemotherapy cycles 
• Time at home between cycles when your child is monitored for infection, eating difficulties, or fatigue 
• Supportive treatments such as anti‑sickness medicines, nutritional support, and medicines to help the body recover 
• Frequent blood tests and assessments to check how well your child is responding to treatment 

Induction treatment can feel intense and fast‑paced, so your child’s consultant and clinical nurse specialist will explain the schedule and what each step involves.

Nutritional support 

Some children may need extra support with feeding during treatment, especially during chemotherapy where nausea, vomiting, and diarrhea are common side effects. This might be done using a nasogastric (NG) tube, which is a thin, soft tube that goes through the nose, down the throat, and into the stomach.

It allows liquid food or medicines to be given directly into the stomach when a child is not able to eat or drink enough by mouth. Feeds are given through the tube using a syringe or pump, helping make sure your child gets the nutrition they need.

Animated video on induction therapy for high-risk neuroblastoma

This video was produced as part of the SIOPEN High-Risk Neuroblastoma 2 Trial.