New Review Offers Roadmap for Managing Childhood Neuroblastoma

Neuroblastoma, the most common solid tumor outside the brain in children under five, presents a daunting challenge due to its unpredictable nature. A new narrative review, published in the World Journal of Pediatric Surgery, offers a comprehensive framework for managing this complex disease. The review, authored by specialists from the Royal Hospital for Children in Glasgow and the University of Liverpool, synthesizes current evidence on diagnosis, risk classification, and treatment, emphasizing that outcomes depend on a combination of factors including age, histology, chromosomal changes, and molecular features like MYCN amplification. For low-risk patients, observation or surgery alone may suffice, while high-risk cases require intensive multimodal therapy. The review highlights that five-year survival exceeds 90% for low- and intermediate-risk disease but drops below 60% for high-risk cases, underscoring the need for tailored approaches.

The article details the role of the International Neuroblastoma Risk Group Staging System (INRGSS) and image-defined risk factors (IDRFs) in guiding treatment decisions. It also discusses emerging therapies such as GD2-targeting monoclonal antibodies and chimeric antigen receptor T-cell therapy, as well as the importance of long-term survivorship care, including monitoring for fertility, hearing, endocrine health, and secondary cancers. The authors stress that surgery should be viewed as part of a coordinated pathway, not an isolated goal, and call for standardized surgical reporting to improve trial comparisons. With a 10-year event-free survival of 94.7% in carefully selected infants observed without immediate intervention, the review supports a risk-adapted strategy that avoids overtreatment while optimizing outcomes.