The main aim of induction chemotherapy is to reduce the size of the primary tumour to make it easier to remove as much of it as possible during surgery. 

Chemotherapy uses drugs to kill cancer cells. It's delivered through a central line - a tube that feeds into one of the large veins in the chest. This will be fitted under general anaesthetic to minimise the distress caused by intravenous injections. 

There are different chemotherapy regimens used in the induction phase but the most common in the UK are: 

Rapid COJEC 

This is a combination of five agents (cisplatin, vincristine, carboplatin, etoposide and cyclophosphamide) that is delivered directly into your child’s bloodstream through their central line 

This therapy is administered in eight cycles, separated by intervals of ten days and is completed within 70 days of the first treatment 

In high-risk patients, the use of Rapid COJEC is to give high doses of chemotherapy over a shorter time which may improve survival. 

Modified N7 

Modified N7 uses the drugs cyclophosphamide, doxorubicin, vincristine, cisplatin and etoposide. 

One cycle lasts three-four days every three weeks, and there are five cycles. 

Your child will also be given a 'growth factor' known as G-CSF as an injection, given daily between chemotherapy cycles to reduce the risk of infection. 

During induction chemotherapy, your child will have some of their 'peripheral haematopoietic stem cells' taken from their blood. These are cells that can develop into any of the different types of blood cells and so are very important for carrying oxygen, fighting infection, and preventing bleeding. 

During chemotherapy, these cells can get damaged and this can limit the amount of therapy your child can have as it takes some time for the blood to recover and for blood counts to improve. Taking some cells while they are healthy (known as stem cell harvest) and storing them during the induction phase means that these cells can be replaced later, therefore improving your child’s ability to make new blood cells. 

Side-effects 

Chemotherapy damages cancer cells that divide often with the aim of destroying them. But other types of cells also divide, like skin, hair and nail cells. Damaged other cells can repair and recover.  

Some side-effects of chemotherapy are: 

  • Tiredness/weakness 
  • Sore mouth 
  • Hair loss 
  • Feeling sick/being sick 
  • Diarrhoea 
  • Loss of appetite- in some cases your child may need a nasogastric (NG) tube to provide nutrition directly to the stomach if they are unable to eat. 
  • Increased chance of infection 

These problems are temporary and steps can be taken to manage them as best as possible with support from your healthcare provider. 

Following induction chemotherapy, your child is likely to have surgery. Read more about neuroblastoma surgery.