Neuroblastoma Treatment : High-Risk Disease
Advanced stage tumors are usually treated initially with neoadjuvant chemotherapy followed 3-4 months later by surgery. Chemotherapy shrinks the tumor and makes it firmer, reducing the risk of rupture and hemorrhage during surgery. Myelosuppression caused by high-dose chemotherapy has been overcome by increased used of autologous bone marrow transplantation. Tumor debulking before autologous bone marrow transplantation is achieved by external beam radiation therapy. The patients who develop the autoimmune paraneoplastic phenomenon opsoclonus-myoclonus-ataxia syndrome are treated with a combination of high-dose steroids, IV gammaglobulins and cyclophosphamide. The image shows bizarre, multinucleated neuroblasts that are seen in rare cases (anaplastic/pleomorphic neuroblastoma).