Neuroblastoma
Treating children with neuroblastoma takes a team of experts with experience treating childhood cancer. Whether your child has recently been diagnosed or you are seeking advanced therapies for a relapse, Duke Children’s offers the latest treatments for kids. This includes a promising new targeted treatment for relapsed and hard-to-treat neuroblastoma called MIBG therapy. Your child gets comprehensive, personalized care in a compassionate, family-friendly environment. Your family also is supported by a team that specializes in helping children with cancer.
Trusted Care for Neuroblastoma in Children
Neuroblastoma is a type of cancer that affects the nerves of the sympathetic nervous system (responsible for the fight-or-flight response) throughout the body. The disease forms as tumors in the adrenal glands (found above the kidneys) or in the neck, chest, abdomen, or pelvis. When your child is diagnosed with neuroblastoma, it’s comforting to know you’re working with a team of specialists on the leading edge of neuroblastoma treatment.
- Your child’s team includes pediatric oncologists, bone marrow transplant specialists, pediatric surgeons, radiation oncologists, specialized nurses, and nuclear medicine specialists. They work collaboratively with social workers, counselors, and other care professionals to keep you well-informed and supported through every step of your child’s treatment.
- The neuroblastoma specialists who care for your child are also researchers who are seeking better treatments. Our neuroblastoma doctors collaborate with pediatric cancer experts nationally, as part of neuroblastoma committees through the Children's Oncology Group, the world’s largest childhood and adolescent cancer research organization. That means your child has access to the latest treatments, including 131I-MIBG therapy, a promising new treatment for relapsed and hard-to-treat neuroblastoma. Duke Children’s is one of 15 centers in the U.S. to offer the treatment through a clinical trial.
- Most children with neuroblastoma need surgery, and your child is in good hands. Duke Children’s is one of only seven hospitals in the U.S. verified as a level I children's surgery center by the American College of Surgeons. This Level I designation recognizes our commitment to providing the safest and highest-quality surgical care to our young patients.
Diagnosing Neuroblastoma
Doctors diagnose neuroblastoma with blood and urine tests, bone marrow examination, and imaging exams such as ultrasound, CT, MRI, bone scans, and MIBG (metaiodobenzylguanidine) scans. These tests find the location of the tumor and determine whether it's spread in the body. Your child may also have surgery to get a tissue sample or biopsy for diagnosis. These tests allow doctors to personalize treatment and determine the best therapies for your child.
MIGB: Targeted Therapy for Relapsed or Difficult-to-Treat Neuroblastoma
When children have neuroblastoma that has returned or isn’t responding to treatment, your pediatric oncologist will discuss whether 131I-MIBG is a treatment option.
When neuroblastoma is found in multiple places throughout the body, it’s difficult to treat with standard, external-beam radiation therapy, which uses a machine to deliver radiation from outside the body to target a specific area, rather than throughout the body.
MIBG is a substance that is combined with radioactive iodine to target and destroy cancer cells. MIBG is absorbed by neuroblastoma cells, and the iodine releases the radiation to kill the cells. It targets the tumor cells everywhere and destroys them while sparing healthy tissue.
A specially trained nuclear medicine technologist uses an IV to infuse the MIBG into your child’s bloodstream over the course of two hours. It’s done in a lead-lined room that's specifically designed for this type of therapy. Your child will spend a few days in the same room while the radioactive substance is cleared from their body naturally. We take special precautions to protect parents and staff from radiation exposure while they are in the room.
MIBG therapy can be a faster, more effective, and less painful option than other treatments. It requires less time in the hospital, and it’s usually well-tolerated, with fewer side effects than other treatments.
- PATIENT STORYFighting Neuroblastoma Like a Superhero
College student Sarah Smith recalls her treatment for neuroblastoma at Duke Children's.
NEUROBLASTOMA
Treatments
Your child's neuroblastoma treatment will depend on their age, as well as the location and progression of their cancer.
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Surgery removes the tumor and the tissue around it to ensure no cancer cells are left behind. Our highly skilled pediatric surgeons use minimally invasive surgery whenever possible, which requires smaller incisions and a faster recovery.
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Chemotherapy destroys cancer cells or stops them from growing, with the goal of keeping cancer from coming back. Most children receive chemotherapy as part of their treatment. Pediatric medical oncologists provide chemotherapy, usually through an IV infusion.
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External-beam radiation therapy, which is delivered from a machine outside the body, focuses high-energy radiation (X-ray) beams on tumors to kill or stop the growth of cancer cells. It is usually used after chemotherapy, surgery, and autologous transplant to kill any cancer cells that may remain. Our pediatric radiation oncologists use advanced imaging techniques to determine the exact location of the tumor and minimize damage to surrounding tissues.
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Immunotherapy uses the power of the immune system's disease-fighting cells (antibodies) to help fight cancer. Doctors use a specially designed monoclonal antibody, which is a man-made substance that acts like the body's own antibodies, to attack neuroblastoma cells. Immunotherapy is often used in combination with other treatments, such as radiation and chemotherapy. The therapy is delivered through an IV infusion.
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Radiation and chemotherapy destroy healthy stem cells in the bone marrow, which are important for fighting infection. A stem cell transplant allows doctors to harvest your child’s stem cells before treatment begins and store them for use after treatment. Your child receives a high dose of chemotherapy or radiation (or both) to destroy as many cancer cells as possible. This is followed by an IV infusion of stem cells that were set aside earlier, to replace bone marrow and restore healthy blood cells. Because the stem cells are your child’s own cells, there is minimal risk that your child's body will have difficulty with the transplanted cells.
NEUROBLASTOMA
Family and Support Services
We treat the whole child -- not just the disease. Your child receives a personalized treatment and follow-up plan that’s tailored to their needs. You have access to a variety of services that are designed to make your child’s experience as positive as possible and support your family throughout treatment.
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We offer outpatient services -- such as chemotherapy, transfusions, and lab tests -- 12 hours a day, seven days a week at Duke Children’s Valvano Day Hospital. This means your child won't need to be admitted to the hospital just because they feel ill or need treatment on a day when your doctor's office is closed.
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You want your child to be as comfortable as possible during treatment. Our team focuses on managing your child’s symptoms and other aspects of treatment that affect your child’s quality of life. We help with pain management, supportive nutrition, relaxation techniques, and more to help your child get through treatment. We’re here to improve your child’s and your family’s well-being during treatment and hospitalization.
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Teens and young adults are too old to be treated like young kids, but adult care might not be quite right for them either. Our Teen and Young Adult Program brings together the expertise of pediatric and adult cancer specialists to determine what’s best for each person, along with personalized psychological support. We customize treatment and services that consider your child’s unique needs, including support and guidance to help them cope with the ways treatment may affect their high school or college activities or their social life.
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Once treatment is complete, you can count on us for continuing support. We offer long-term follow-up services for preventive health care, including screenings and ongoing surveillance. Our cancer care doctors and nurses work with social workers and child psychologists who can offer support and assistance with school-related or personal issues. In addition, we can help your child transition to adult cancer care services when they’re ready. If your child needs other services related to treatment, we refer you to the appropriate specialists. You’ll have resources and support to ensure your child’s long-term well-being.
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When your child is fighting cancer, it’s difficult for the entire family, so we try to make it a little easier on you. Whether it's explaining a procedure, offering encouragement, or arranging fun activities during therapy or during a hospital stay, your child gets care in a welcoming, kid-friendly environment. And, you and your family can get emotional support and education to help you cope as your child goes through treatment and recovery.
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It’s helpful to have a team on your side to help you manage your child’s care. Our social workers help you navigate the medical system and coordinate the variety of health services your child needs. They can help you work with insurance providers, connect you with resources, and help you manage the details related to your child’s care. Our nurse coordinators can help you schedule appointments for tests, treatments, and other medical visits.
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Enjoy a comfortable place to relax at the hospital. You can grab a light meal, shower, do laundry, or use a computer with internet access. Staffed by volunteers, the family room is here to make your time at the hospital a little more comfortable.