Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Treatment and prognosis of neuroblastoma

Jason M Shohet, MD, PhD
Jed G Nuchtern, MD, FACS, FAAP
Section Editor
Julie R Park, MD
Deputy Editor
Sadhna R Vora, MD


The term neuroblastoma is commonly used to refer to a spectrum of neuroblastic tumors (including neuroblastomas, ganglioneuroblastomas, and ganglioneuromas) that arise from primitive sympathetic ganglion cells, and like paraganglioma and pheochromocytomas, have the capacity to synthesize and secrete catecholamines. (See "Clinical presentation and diagnosis of pheochromocytoma" and "Paragangliomas: Epidemiology, clinical presentation, diagnosis, and histology".)

Neuroblastomas, which account for 97 percent of all neuroblastic tumors, are clinically heterogeneous, varying in location, histopathologic appearance, and biologic characteristics [1]. They are most remarkable for their broad spectrum of clinical behavior, which can range from spontaneous regression, to maturation to a benign ganglioneuroma, or aggressive disease with metastatic dissemination leading to death [2]. Clinical diversity correlates closely with numerous clinical and biological factors, although its molecular basis remains largely unknown. For example, most infants with disseminated disease have a favorable outcome after treatment with chemotherapy and surgery, while the majority of children over the age of 18 months who have advanced neuroblastoma die from progressive disease despite intensive multimodality therapy.

The treatment and prognosis of neuroblastoma will be reviewed here. The epidemiology, clinical presentation, and diagnosis of neuroblastoma are presented separately, as is a discussion of neuroblastomas arising in the olfactory epithelium. (See "Epidemiology, pathogenesis, and pathology of neuroblastoma" and "Clinical presentation, diagnosis, and staging evaluation of neuroblastoma" and "Olfactory neuroblastoma (esthesioneuroblastoma)".)


Neuroblastomas are diverse in their clinical behavior. Certain factors influence the biologic behavior of these tumors and are helpful in predicting outcome; some are patient-related (eg, age at the time of diagnosis), while the majority are tumor-related (disease stage, tumor histology, molecular and cytogenetic features).

Tumor stage — The extent of metastatic spread at presentation is the most important factor in determining outcome for patients with neuroblastoma [3-5]. Although regional spread to lymph nodes attached or adjacent to the primary tumor does not significantly affect outcome, distant metastatic disease (eg, bone marrow involvement) confers a much worse prognosis.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: Jun 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Goodman MT, Gurney JG, Smith MA, Olshan AF. Sympathetic nervous system tumors. In: Cancer Incidence and Survival among Children and Adolescents: United States SEER Program, 1975-1995, Ries, LA, Smith, MA, Gurney, JG, et al (Eds), National Cancer Institute, Bethesda, MD 1999. p.35.
  2. Brodeur GM, Hogarty MD, Mosse YP, Maris JM. Neuroblastoma. In: Principles and Practice of Pediatric Oncology, Pizzo PA, Poplack DG (Eds), Lippincott Williams & Wilkins, Philadelphia 2011. p.886.
  3. Castleberry RP, Shuster JJ, Smith EI. The Pediatric Oncology Group experience with the international staging system criteria for neuroblastoma. Member Institutions of the Pediatric Oncology Group. J Clin Oncol 1994; 12:2378.
  4. Haase GM, Atkinson JB, Stram DO, et al. Surgical management and outcome of locoregional neuroblastoma: comparison of the Childrens Cancer Group and the international staging systems. J Pediatr Surg 1995; 30:289.
  5. Cohn SL, Pearson AD, London WB, et al. The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. J Clin Oncol 2009; 27:289.
  6. Brodeur GM, Pritchard J, Berthold F, et al. Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment. J Clin Oncol 1993; 11:1466.
  7. Monclair T, Brodeur GM, Ambros PF, et al. The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report. J Clin Oncol 2009; 27:298.
  8. Woods WG, LaQuaglia MP. The drama of the gifted disease. J Clin Oncol 2009; 27:172.
  9. Katzenstein HM, Bowman LC, Brodeur GM, et al. Prognostic significance of age, MYCN oncogene amplification, tumor cell ploidy, and histology in 110 infants with stage D(S) neuroblastoma: the pediatric oncology group experience--a pediatric oncology group study. J Clin Oncol 1998; 16:2007.
  10. D'Angio GJ, Evans AE, Koop CE. Special pattern of widespread neuroblastoma with a favourable prognosis. Lancet 1971; 1:1046.
  11. Nickerson HJ, Matthay KK, Seeger RC, et al. Favorable biology and outcome of stage IV-S neuroblastoma with supportive care or minimal therapy: a Children's Cancer Group study. J Clin Oncol 2000; 18:477.
  12. DuBois SG, Kalika Y, Lukens JN, et al. Metastatic sites in stage IV and IVS neuroblastoma correlate with age, tumor biology, and survival. J Pediatr Hematol Oncol 1999; 21:181.
  13. Rosen EM, Cassady JR, Frantz CN, et al. Stage IV-N: a favorable subset of children with metastatic neuroblastoma. Med Pediatr Oncol 1985; 13:194.
  14. Morgenstern DA, London WB, Stephens D, et al. Metastatic neuroblastoma confined to distant lymph nodes (stage 4N) predicts outcome in patients with stage 4 disease: A study from the International Neuroblastoma Risk Group Database. J Clin Oncol 2014; 32:1228.
  15. Toren A, Mandel M, Passwell J, et al. Lack of N-myc-amplification and normal karyotype in stage IV-N neuroblastoma. Acta Oncol 1996; 35:496.
  16. Evans AE, D'Angio GJ, Propert K, et al. Prognostic factor in neuroblastoma. Cancer 1987; 59:1853.
  17. Matthay KK, Perez C, Seeger RC, et al. Successful treatment of stage III neuroblastoma based on prospective biologic staging: a Children's Cancer Group study. J Clin Oncol 1998; 16:1256.
  18. London WB, Castleberry RP, Matthay KK, et al. Evidence for an age cutoff greater than 365 days for neuroblastoma risk group stratification in the Children's Oncology Group. J Clin Oncol 2005; 23:6459.
  19. Schmidt ML, Lal A, Seeger RC, et al. Favorable prognosis for patients 12 to 18 months of age with stage 4 nonamplified MYCN neuroblastoma: a Children's Cancer Group Study. J Clin Oncol 2005; 23:6474.
  20. George RE, London WB, Cohn SL, et al. Hyperdiploidy plus nonamplified MYCN confers a favorable prognosis in children 12 to 18 months old with disseminated neuroblastoma: a Pediatric Oncology Group study. J Clin Oncol 2005; 23:6466.
  21. Gaspar N, Hartmann O, Munzer C, et al. Neuroblastoma in adolescents. Cancer 2003; 98:349.
  22. Shimada H, Chatten J, Newton WA Jr, et al. Histopathologic prognostic factors in neuroblastic tumors: definition of subtypes of ganglioneuroblastoma and an age-linked classification of neuroblastomas. J Natl Cancer Inst 1984; 73:405.
  23. Shimada H, Ambros IM, Dehner LP, et al. The International Neuroblastoma Pathology Classification (the Shimada system). Cancer 1999; 86:364.
  24. Shimada H, Umehara S, Monobe Y, et al. International neuroblastoma pathology classification for prognostic evaluation of patients with peripheral neuroblastic tumors: a report from the Children's Cancer Group. Cancer 2001; 92:2451.
  25. Navarro S, Amann G, Beiske K, et al. Prognostic value of International Neuroblastoma Pathology Classification in localized resectable peripheral neuroblastic tumors: a histopathologic study of localized neuroblastoma European Study Group 94.01 Trial and Protocol. J Clin Oncol 2006; 24:695.
  26. Attiyeh EF, London WB, Mossé YP, et al. Chromosome 1p and 11q deletions and outcome in neuroblastoma. N Engl J Med 2005; 353:2243.
  27. Ho PT, Estroff JA, Kozakewich H, et al. Prenatal detection of neuroblastoma: a ten-year experience from the Dana-Farber Cancer Institute and Children's Hospital. Pediatrics 1993; 92:358.
  28. Saylors RL 3rd, Cohn SL, Morgan ER, Brodeur GM. Prenatal detection of neuroblastoma by fetal ultrasonography. Am J Pediatr Hematol Oncol 1994; 16:356.
  29. Acharya S, Jayabose S, Kogan SJ, et al. Prenatally diagnosed neuroblastoma. Cancer 1997; 80:304.
  30. Yamamoto K, Hanada R, Kikuchi A, et al. Spontaneous regression of localized neuroblastoma detected by mass screening. J Clin Oncol 1998; 16:1265.
  31. Holgersen LO, Subramanian S, Kirpekar M, et al. Spontaneous resolution of antenatally diagnosed adrenal masses. J Pediatr Surg 1996; 31:153.
  32. Sauvat F, Sarnacki S, Brisse H, et al. Outcome of suprarenal localized masses diagnosed during the perinatal period: a retrospective multicenter study. Cancer 2002; 94:2474.
  33. Nishihira H, Toyoda Y, Tanaka Y, et al. Natural course of neuroblastoma detected by mass screening: s 5-year prospective study at a single institution. J Clin Oncol 2000; 18:3012.
  34. Yoneda A, Oue T, Imura K, et al. Observation of untreated patients with neuroblastoma detected by mass screening: a "wait and see" pilot study. Med Pediatr Oncol 2001; 36:160.
  35. Oue T, Inoue M, Yoneda A, et al. Profile of neuroblastoma detected by mass screening, resected after observation without treatment: results of the Wait and See pilot study. J Pediatr Surg 2005; 40:359.
  36. Tanaka M, Kigasawa H, Kato K, et al. A prospective study of a long-term follow-up of an observation program for neuroblastoma detected by mass screening. Pediatr Blood Cancer 2010; 54:573.
  37. Nuchtern JG, London WB, Barnewolt CE, et al. A prospective study of expectant observation as primary therapy for neuroblastoma in young infants: a Children's Oncology Group study. Ann Surg 2012; 256:573.
  38. Hero B, Simon T, Spitz R, et al. Localized infant neuroblastomas often show spontaneous regression: results of the prospective trials NB95-S and NB97. J Clin Oncol 2008; 26:1504.
  39. Perez CA, Matthay KK, Atkinson JB, et al. Biologic variables in the outcome of stages I and II neuroblastoma treated with surgery as primary therapy: a children's cancer group study. J Clin Oncol 2000; 18:18.
  40. Alvarado CS, London WB, Look AT, et al. Natural history and biology of stage A neuroblastoma: a Pediatric Oncology Group Study. J Pediatr Hematol Oncol 2000; 22:197.
  41. Rubie H, Hartmann O, Michon J, et al. N-Myc gene amplification is a major prognostic factor in localized neuroblastoma: results of the French NBL 90 study. Neuroblastoma Study Group of the Société Francaise d'Oncologie Pédiatrique. J Clin Oncol 1997; 15:1171.
  42. Bowman LC, Castleberry RP, Cantor A, et al. Genetic staging of unresectable or metastatic neuroblastoma in infants: a Pediatric Oncology Group study. J Natl Cancer Inst 1997; 89:373.
  43. De Bernardi B, Mosseri V, Rubie H, et al. Treatment of localised resectable neuroblastoma. Results of the LNESG1 study by the SIOP Europe Neuroblastoma Group. Br J Cancer 2008; 99:1027.
  44. Kushner BH, Cheung NK, LaQuaglia MP, et al. International neuroblastoma staging system stage 1 neuroblastoma: a prospective study and literature review. J Clin Oncol 1996; 14:2174.
  45. Evans AE, Silber JH, Shpilsky A, D'Angio GJ. Successful management of low-stage neuroblastoma without adjuvant therapies: a comparison of two decades, 1972 through 1981 and 1982 through 1992, in a single institution. J Clin Oncol 1996; 14:2504.
  46. Strother DR, London WB, Schmidt ML, et al. Outcome after surgery alone or with restricted use of chemotherapy for patients with low-risk neuroblastoma: results of Children's Oncology Group study P9641. J Clin Oncol 2012; 30:1842.
  47. Rubie H, Coze C, Plantaz D, et al. Localised and unresectable neuroblastoma in infants: excellent outcome with low-dose primary chemotherapy. Br J Cancer 2003; 89:1605.
  48. Rubie H, Plantaz D, Coze C, et al. Localised and unresectable neuroblastoma in infants: excellent outcome with primary chemotherapy. Neuroblastoma Study Group, Société Française d'Oncologie Pédiatrique. Med Pediatr Oncol 2001; 36:247.
  49. Leclair MD, Hartmann O, Heloury Y, et al. Localized pelvic neuroblastoma: excellent survival and low morbidity with tailored therapy--the 10-year experience of the French Society of Pediatric Oncology. J Clin Oncol 2004; 22:1689.
  50. Strother D, van Hoff J, Rao PV, et al. Event-free survival of children with biologically favourable neuroblastoma based on the degree of initial tumour resection: results from the Pediatric Oncology Group. Eur J Cancer 1997; 33:2121.
  51. Strother D, Shuster JJ, McWilliams N, et al. Results of pediatric oncology group protocol 8104 for infants with stages D and DS neuroblastoma. J Pediatr Hematol Oncol 1995; 17:254.
  52. Baker DL, Schmidt ML, Cohn SL, et al. Outcome after reduced chemotherapy for intermediate-risk neuroblastoma. N Engl J Med 2010; 363:1313.
  53. Mullassery D, Farrelly P, Losty PD. Does aggressive surgical resection improve survival in advanced stage 3 and 4 neuroblastoma? A systematic review and meta-analysis. Pediatr Hematol Oncol 2014; 31:703.
  54. Rubie H, De Bernardi B, Gerrard M, et al. Excellent outcome with reduced treatment in infants with nonmetastatic and unresectable neuroblastoma without MYCN amplification: results of the prospective INES 99.1. J Clin Oncol 2011; 29:449.
  55. Laprie A, Michon J, Hartmann O, et al. High-dose chemotherapy followed by locoregional irradiation improves the outcome of patients with international neuroblastoma staging system Stage II and III neuroblastoma with MYCN amplification. Cancer 2004; 101:1081.
  56. Matthay KK, Villablanca JG, Seeger RC, et al. Treatment of high-risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid. Children's Cancer Group. N Engl J Med 1999; 341:1165.
  57. Pritchard J, Cotterill SJ, Germond SM, et al. High dose melphalan in the treatment of advanced neuroblastoma: results of a randomised trial (ENSG-1) by the European Neuroblastoma Study Group. Pediatr Blood Cancer 2005; 44:348.
  58. Berthold F, Boos J, Burdach S, et al. Myeloablative megatherapy with autologous stem-cell rescue versus oral maintenance chemotherapy as consolidation treatment in patients with high-risk neuroblastoma: a randomised controlled trial. Lancet Oncol 2005; 6:649.
  59. Yalçin B, Kremer LC, Caron HN, van Dalen EC. High-dose chemotherapy and autologous haematopoietic stem cell rescue for children with high-risk neuroblastoma. Cochrane Database Syst Rev 2013; :CD006301.
  60. Haase GM, O'Leary MC, Ramsay NK, et al. Aggressive surgery combined with intensive chemotherapy improves survival in poor-risk neuroblastoma. J Pediatr Surg 1991; 26:1119.
  61. Chamberlain RS, Quinones R, Dinndorf P, et al. Complete surgical resection combined with aggressive adjuvant chemotherapy and bone marrow transplantation prolongs survival in children with advanced neuroblastoma. Ann Surg Oncol 1995; 2:93.
  62. McGregor LM, Rao BN, Davidoff AM, et al. The impact of early resection of primary neuroblastoma on the survival of children older than 1 year of age with stage 4 disease: the St. Jude Children's Research Hospital Experience. Cancer 2005; 104:2837.
  63. Zwaveling S, Tytgat GA, van der Zee DC, et al. Is complete surgical resection of stage 4 neuroblastoma a prerequisite for optimal survival or may >95 % tumour resection suffice? Pediatr Surg Int 2012; 28:953.
  64. von Allmen D, Davidoff AM, London WB, et al. Impact of Extent of Resection on Local Control and Survival in Patients From the COG A3973 Study With High-Risk Neuroblastoma. J Clin Oncol 2017; 35:208.
  65. Kiely EM. The surgical challenge of neuroblastoma. J Pediatr Surg 1994; 29:128.
  66. Simon T, Häberle B, Hero B, et al. Role of surgery in the treatment of patients with stage 4 neuroblastoma age 18 months or older at diagnosis. J Clin Oncol 2013; 31:752.
  67. Haas-Kogan DA, Swift PS, Selch M, et al. Impact of radiotherapy for high-risk neuroblastoma: a Children's Cancer Group study. Int J Radiat Oncol Biol Phys 2003; 56:28.
  68. Marcus KJ, Shamberger R, Litman H, et al. Primary tumor control in patients with stage 3/4 unfavorable neuroblastoma treated with tandem double autologous stem cell transplants. J Pediatr Hematol Oncol 2003; 25:934.
  69. Kreissman SG, Villablanca JG, Seeger RC, et al. A randomized phase III trial of myeolablative autologous peripheral blood stem cell transplant for high-risk neuroblastoma employing immunomagnetic purged versus unpurged PBSC: A Children's Oncology Group study (abstract #10011). J Clin Oncol 2008; 26:541s.
  70. Matthay KK, Reynolds CP, Seeger RC, et al. Long-term results for children with high-risk neuroblastoma treated on a randomized trial of myeloablative therapy followed by 13-cis-retinoic acid: a children's oncology group study. J Clin Oncol 2009; 27:1007.
  71. Shusterman S, London WB, Gillies SD, et al. Antitumor activity of hu14.18-IL2 in patients with relapsed/refractory neuroblastoma: a Children's Oncology Group (COG) phase II study. J Clin Oncol 2010; 28:4969.
  72. Yu AL, Gilman AL, Ozkaynak MF, et al. Anti-GD2 antibody with GM-CSF, interleukin-2, and isotretinoin for neuroblastoma. N Engl J Med 2010; 363:1324.
  73. Pasqualini C, Dufour C, Goma G, et al. Tandem high-dose chemotherapy with thiotepa and busulfan-melphalan and autologous stem cell transplantation in very high-risk neuroblastoma patients. Bone Marrow Transplant 2016; 51:227.
  74. Grupp SA, Stern JW, Bunin N, et al. Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma. J Clin Oncol 2000; 18:2567.
  75. Kletzel M, Katzenstein HM, Haut PR, et al. Treatment of high-risk neuroblastoma with triple-tandem high-dose therapy and stem-cell rescue: results of the Chicago Pilot II Study. J Clin Oncol 2002; 20:2284.
  76. von Allmen D, Grupp S, Diller L, et al. Aggressive surgical therapy and radiotherapy for patients with high-risk neuroblastoma treated with rapid sequence tandem transplant. J Pediatr Surg 2005; 40:936.
  77. George RE, Li S, Medeiros-Nancarrow C, et al. High-risk neuroblastoma treated with tandem autologous peripheral-blood stem cell-supported transplantation: long-term survival update. J Clin Oncol 2006; 24:2891.
  78. Ladenstein R, Pötschger U, Pearson AD, et al. Busulfan and melphalan versus carboplatin, etoposide, and melphalan as high-dose chemotherapy for high-risk neuroblastoma (HR-NBL1/SIOPEN): an international, randomised, multi-arm, open-label, phase 3 trial. Lancet Oncol 2017; 18:500.
  79. Park JR, Kreissman SG, London WB, Naranjo A. A phase III randomized clinical trial (RCT) of tandem myeloablative autologous stem cell transplant (ASCT) using peripheral blood stem cell (PBSC) as consolidation therapy for high-risk neuroblastoma (HR-NB): A Children's Oncology Group (COG) study. J Clin Oncol 2016; ASCO: LBA3.
  80. Grupp SA, Prak EL, Boyer J, et al. Adoptive transfer of autologous T cells improves T-cell repertoire diversity and long-term B-cell function in pediatric patients with neuroblastoma. Clin Cancer Res 2012; 18:6732.
  81. Louis CU, Savoldo B, Dotti G, et al. Antitumor activity and long-term fate of chimeric antigen receptor-positive T cells in patients with neuroblastoma. Blood 2011; 118:6050.
  82. Rousseau RF, Haight AE, Hirschmann-Jax C, et al. Local and systemic effects of an allogeneic tumor cell vaccine combining transgenic human lymphotactin with interleukin-2 in patients with advanced or refractory neuroblastoma. Blood 2003; 101:1718.
  83. Bowman L, Grossmann M, Rill D, et al. IL-2 adenovector-transduced autologous tumor cells induce antitumor immune responses in patients with neuroblastoma. Blood 1998; 92:1941.
  84. Morales La Madrid A, Campbell N, Smith S, et al. Targeting ALK: a promising strategy for the treatment of non-small cell lung cancer, non-Hodgkin's lymphoma, and neuroblastoma. Target Oncol 2012; 7:199.
  85. Lovat PE, Di Sano F, Corazzari M, et al. Gangliosides link the acidic sphingomyelinase-mediated induction of ceramide to 12-lipoxygenase-dependent apoptosis of neuroblastoma in response to fenretinide. J Natl Cancer Inst 2004; 96:1288.
  86. Russell HV, Groshen SG, Ara T, et al. A phase I study of zoledronic acid and low-dose cyclophosphamide in recurrent/refractory neuroblastoma: a new approaches to neuroblastoma therapy (NANT) study. Pediatr Blood Cancer 2011; 57:275.
  87. Wilson JS, Gains JE, Moroz V, et al. A systematic review of 131I-meta iodobenzylguanidine molecular radiotherapy for neuroblastoma. Eur J Cancer 2014; 50:801.
  88. Cairo MS, Coiffier B, Reiter A, et al. Recommendations for the evaluation of risk and prophylaxis of tumour lysis syndrome (TLS) in adults and children with malignant diseases: an expert TLS panel consensus. Br J Haematol 2010; 149:578.
  89. Katzenstein HM, Kent PM, London WB, Cohn SL. Treatment and outcome of 83 children with intraspinal neuroblastoma: the Pediatric Oncology Group experience. J Clin Oncol 2001; 19:1047.
  90. De Bernardi B, Pianca C, Pistamiglio P, et al. Neuroblastoma with symptomatic spinal cord compression at diagnosis: treatment and results with 76 cases. J Clin Oncol 2001; 19:183.
  91. Simon T, Niemann CA, Hero B, et al. Short- and long-term outcome of patients with symptoms of spinal cord compression by neuroblastoma. Dev Med Child Neurol 2012; 54:347.
  92. Plantaz D, Rubie H, Michon J, et al. The treatment of neuroblastoma with intraspinal extension with chemotherapy followed by surgical removal of residual disease. A prospective study of 42 patients--results of the NBL 90 Study of the French Society of Pediatric Oncology. Cancer 1996; 78:311.
  93. Russo C, Cohn SL, Petruzzi MJ, de Alarcon PA. Long-term neurologic outcome in children with opsoclonus-myoclonus associated with neuroblastoma: a report from the Pediatric Oncology Group. Med Pediatr Oncol 1997; 28:284.
  94. De Grandis E, Parodi S, Conte M, et al. Long-term follow-up of neuroblastoma-associated opsoclonus-myoclonus-ataxia syndrome. Neuropediatrics 2009; 40:103.
  95. Telander RL, Smithson WA, Groover RV. Clinical outcome in children with acute cerebellar encephalopathy and neuroblastoma. J Pediatr Surg 1989; 24:11.
  96. Koh PS, Raffensperger JG, Berry S, et al. Long-term outcome in children with opsoclonus-myoclonus and ataxia and coincident neuroblastoma. J Pediatr 1994; 125:712.
  97. Robison LL, Mertens AC, Boice JD, et al. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol 2002; 38:229.
  98. Rudnick E, Khakoo Y, Antunes NL, et al. Opsoclonus-myoclonus-ataxia syndrome in neuroblastoma: clinical outcome and antineuronal antibodies-a report from the Children's Cancer Group Study. Med Pediatr Oncol 2001; 36:612.
  99. Petruzzi MJ, de Alarcon PA. Neuroblastoma-associated opsoclonus-myoclonus treated with intravenously administered immune globulin G. J Pediatr 1995; 127:328.
  100. Battaglia T, De Grandis E, Mirabelli-Badenier M, et al. Response to rituximab in 3 children with opsoclonus-myoclonus syndrome resistant to conventional treatments. Eur J Paediatr Neurol 2012; 16:192.
  101. Pranzatelli MR, Tate ED, Verhulst SJ, et al. Pediatric dosing of rituximab revisited: serum concentrations in opsoclonus-myoclonus syndrome. J Pediatr Hematol Oncol 2010; 32:e167.
  102. Kushner BH, Cheung NK, LaQuaglia MP, et al. Survival from locally invasive or widespread neuroblastoma without cytotoxic therapy. J Clin Oncol 1996; 14:373.
  103. Nitschke R, Smith EI, Shochat S, et al. Localized neuroblastoma treated by surgery: a Pediatric Oncology Group Study. J Clin Oncol 1988; 6:1271.
  104. Vo KT, Matthay KK, Neuhaus J, et al. Clinical, biologic, and prognostic differences on the basis of primary tumor site in neuroblastoma: a report from the international neuroblastoma risk group project. J Clin Oncol 2014; 32:3169.
  105. van Santen HM, de Kraker J, van Eck BL, et al. High incidence of thyroid dysfunction despite prophylaxis with potassium iodide during (131)I-meta-iodobenzylguanidine treatment in children with neuroblastoma. Cancer 2002; 94:2081.
  106. van Santen HM, de Kraker J, Vulsma T. Endocrine late effects from multi-modality treatment of neuroblastoma. Eur J Cancer 2005; 41:1767.
  107. Kushner BH, Cheung NK, Kramer K, et al. Neuroblastoma and treatment-related myelodysplasia/leukemia: the Memorial Sloan-Kettering experience and a literature review. J Clin Oncol 1998; 16:3880.
  108. Rubino C, Adjadj E, Guérin S, et al. Long-term risk of second malignant neoplasms after neuroblastoma in childhood: role of treatment. Int J Cancer 2003; 107:791.
  109. Hoover M, Bowman LC, Crawford SE, et al. Long-term outcome of patients with intraspinal neuroblastoma. Med Pediatr Oncol 1999; 32:353.
  110. Paulino AC, Fowler BZ. Risk factors for scoliosis in children with neuroblastoma. Int J Radiat Oncol Biol Phys 2005; 61:865.
  111. Carpentieri, SC, Diller, L . Neuropsychological and psychosocial resiliency in children treated for neuroblastoma. Adv Neuroblastoma Res 2002; Conference 2 AD:PC.
  112. Bossi G, Lanzarini L, Laudisa ML, et al. Echocardiographic evaluation of patients cured of childhood cancer: a single center study of 117 subjects who received anthracyclines. Med Pediatr Oncol 2001; 36:593.
  113. Johnson GL, Moffett CB, Geil JD, et al. Late echocardiographic findings following childhood chemotherapy with normal serial cardiac monitoring. J Pediatr Hematol Oncol 1996; 18:72.
  114. Parsons SK, Neault MW, Lehmann LE, et al. Severe ototoxicity following carboplatin-containing conditioning regimen for autologous marrow transplantation for neuroblastoma. Bone Marrow Transplant 1998; 22:669.
  115. Simon T, Hero B, Dupuis W, et al. The incidence of hearing impairment after successful treatment of neuroblastoma. Klin Padiatr 2002; 214:149.
  116. Berg AL, Spitzer JB, Garvin JH Jr. Ototoxic impact of cisplatin in pediatric oncology patients. Laryngoscope 1999; 109:1806.
  117. Landier W, Knight K, Wong FL, et al. Ototoxicity in children with high-risk neuroblastoma: prevalence, risk factors, and concordance of grading scales--a report from the Children's Oncology Group. J Clin Oncol 2014; 32:527.
  118. Laverdière C, Liu Q, Yasui Y, et al. Long-term outcomes in survivors of neuroblastoma: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2009; 101:1131.