Pediatric Neuroblastoma

Pediatric Neuroblastoma

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Summary

Neuroblastoma is the most common pediatric solid tumor occurring outside the brain and it is the most common cancer in infants. The tumor is still relatively rare, however. Only about 700 cases are diagnosed each year in the United States, according to the American Cancer Society.

Expanded Overview

If a neuroblastoma is diagnosed in a young patient, or a possible tumor is detected in a fetus before birth, pediatric tumor specialists can help manage the complex cancer. Neuroblastomas usually form in nerve tissue of the adrenal glands, abdomen, neck, chest, pelvis or spinal cord. This aggressive tumor often has metastasized by the time it is diagnosed.

Each year, 15 children with neuroblastoma are treated in the Gill Center. Our multidisciplinary approach to develop treatment plans ensures that each child receives the best possible care.

The Neuroblastoma Program team is led by Tanya Watt, M.D., a pediatric oncologist with specialized interest in the care of children with neuroblastoma. The team also includes pediatric surgeons with expertise in removing these tumors, as well as pediatric pathologists and pediatric radiologists.

Tests and Diagnosis 

Neurological and physical exams can detect the effects of a neuroblastoma on spinal cord or nerve function, such as the gait, reflexes or senses. Urine catecholamine analysis may detect presence of the acids from catecholamine breakdown, and a blood chemistry analysis may detect increased levels of dopamine or norepinephrine.

An MIBG scan can detect uptake of radioactive iodine by the neuroblastoma. Other imaging exams include positron emission tomography, ultrasonography, nuclear bone scans, computed tomography scans and magnetic resonance. A biopsy confirms the diagnosis, and bone marrow aspiration and biopsy can confirm whether the neuroblastoma has metastasized to the child’s bones.

Treatment 

Despite its aggressive nature, neuroblastoma is treatable, and outcomes have improved. Children who are younger generally have more positive prognoses, and the 5-year survival rate for those younger than 12 months at diagnosis is 90 percent. Ensuring that your patient receives a rapid diagnosis and treatment from a multidisciplinary team of specialists who have experience caring for children with neuroblastoma can improve the outlook. We coordinate and provide care for infants, children and adolescents who need high-level attention from multiple subspecialists.

After a patient is admitted to Children’s Health, the team quickly biopsies the tumor to determine a diagnosis and then develops a treatment plan that relies typically on chemotherapy and surgery. Surgeons play a critical role in treating neuroblastoma, because some lower-stage tumors (those that have not metastasized) can be treated solely with surgical resection. Most of the pediatric surgeons are members of the Children’s Oncology Group (COG).

Oftentimes children with aggressive forms of neuroblastoma require stem cell transplants. In fact, the majority of autologous stem cell transplants performed at Children’s Health are patients with neuroblastoma. The Gill Center’s Stem Cell Transplant Program provides advanced transplant services from highly experienced staff in our state-of-the-art, 12-bed unit.

To help provide care for families of children with these tumors both during and after transplant, the team provides continuity of care for families of children with these tumors both during and after transplant. 

Research

We continue to participate in research to develop new targeted and biologic therapies to treat neuroblastoma and other complex pediatric tumors. Our surgeons are board certified in pediatric surgery, along with either general surgery or a surgical subspecialty.

Metabolomics Study

Children younger than 18 months with neuroblastoma tumors tend to have much higher survival rates than older children. Led by Drs. Watt and Dinesh Rakheja, this UT Southwestern study is investigating the metabolism of neuroblastoma tumors with the objective of identifying targetable variances in tumors from younger and older patients.

ALK-Inhibitor Study

We are able to offer many options for children with relapsed or refractory neuroblastoma. We participate in consortiums to offer clinical trials, including a trial through the NMTRC with DFMO. DFMO has been demonstrated in early studies to prolong remission and decrease risk of relapse. Through participating in SPOC, we offer other trials, including one using fenretinide, a strong version of accutane. This trial combines an oral medicine, fenretinide with vincristine and has success in the children who have relapsed or progressed through many other therapies. Finally, we are able to provide MIBG therapy. We have a comprehensive team in place to help ensure that all these therapies are well tolerated, both for the patient and their families.  

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