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Treatment options for low-risk neuroblastoma
Source: Neuroblastoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 28, 2025 · Captured 2026-09-09.
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Context: Treatment of Non–High-Risk Neuroblastoma / Low-Risk Neuroblastoma
Surgery, by an experienced surgeon, is the treatment of choice for patients with low-risk, INRG stage L1 tumors. The exception is for patients who are younger than 6 months with isolated adrenal masses with maximum diameter smaller than 3.1 cm if solid, or 5 cm if at least 25% of the mass is cystic. For these patients, observation without biopsy is the recommended approach. If the biology is confirmed to be favorable, residual disease after surgery is not considered a risk factor for relapse and chemotherapy is not indicated. Several studies have shown that patients with favorable biology and residual disease have excellent outcomes, with event-free survival (EFS) rates exceeding 90% and overall survival (OS) rates ranging from 99% to 100%.[2,3]
In patients with INRG stage MS disease who are asymptomatic and have tumors with favorable biology, observation is the preferred approach.
Some patients with presumed neuroblastoma have been observed without biopsy. The COG is studying this strategy further in the ANBL1232 (NCT02176967) trial (closed to accrual).[4,5]
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Treatment options for low-risk neuroblastoma include the following:
Surgery followed by observation (INRG stage L1 or MS).
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Observation with or without biopsy.
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Observation with or without biopsy.
Observation without biopsy (for perinatal neuroblastoma with small adrenal tumors). The COG experience with observation of apparent neuroblastoma without diagnostic biopsy is limited and under investigation.
Observation with or without biopsy.
Observation with biopsy (for infants aged <12 months with INRG stage MS disease without hepatomegaly and MYCN-nonamplified tumors; infants aged <12 months with localized disease, favorable histology and genomics, and MYCN-nonamplified tumors with no segmental chromosomal aberrations).
Chemotherapy with or without surgery (for symptomatic disease or unresectable progressive disease after surgery).
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Radiation therapy (only for emergency therapy).
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Preserved source evidence · Not medical advice