Chemotherapy for neuroblastoma

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is usually used to treat neuroblastoma. Your child's healthcare team will consider the stage and risk group, as well as your child's personal needs, to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.

Most children with intermediate- and high-risk disease will have chemotherapy. Some children with low-risk disease that affects vital organs will be given chemotherapy.

Chemotherapy is given for different reasons. Your child may have chemotherapy to:

• destroy cancer cells in the body
• shrink a tumour before surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and lower the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• relieve pain or control the symptoms of advanced neuroblastoma (called palliative chemotherapy)
• treat spinal cord compression, a cancer-related emergency that neuroblastoma can cause

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the blood to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour. The drugs may be given by mouth or by a needle in a vein (intravenous injection). Sometimes a special device called a central venous catheter may be used to safely give the drugs. It is usually placed during surgery at the start of chemotherapy and left in place until treatment is finished. Find out more about central venous catheter.

The most common chemotherapy drugs used to treat neuroblastoma are:

• cyclophosphamide
• cisplatin
• carboplatin
• vincristine
• doxorubicin
• etoposide
• topotecan
• melphalan
• busulfan
• thiotepa

If neuroblastoma does not respond to drugs used in earlier treatments or if it recurs, these drug combinations may be used:

• topotecan and cyclophosphamide
• irinotecan and temozolomide

Side effects can happen with any type of treatment for neuroblastoma, but every child's experience is different. Some children have many side effects. Other children have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can develop any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child's body seems to handle chemotherapy better than an adult's body. Children usually have less severe side effects and will often recover from them faster than adults.

Side effects of chemotherapy will depend mainly on the type of drug or drugs given, the dose, how the drugs are given and the child's overall health. Some common side effects of chemotherapy drugs used for neuroblastoma are:

• bone marrow suppression
• weakened immune system
• low platelet count
• low white blood cell count
• anemia
• fatigue

• infection

• hair loss

• nausea and vomiting
• sore mouth or throat
• loss of appetite
• diarrhea
• constipation

Other side effects can develop months or years after treatment for neuroblastoma. Find out more about late effects for neuroblastoma.

Tell the healthcare team if your child has side effects you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for your child, ask the healthcare team questions about chemotherapy.