Neuroblastoma

Monitoring requirements depend on the patient's risk stratification.

Low-risk patients:

Observation is recommended for:[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

• Low-risk MS disease that is asymptomatic with favorable biology; these patients have a high rate of spontaneous regression

• Infants <6 months with L1 disease with a small isolated adrenal mass (<5 cm diameter); tumor enlargement in these patients warrants surgery

Observation is accompanied by serial ultrasound (e.g., at 3-6 week intervals, or as clinically indicated), and should continue at increasing intervals over a 2-year period.

Low-risk patients who underwent surgical resection:[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

• Ultrasound of the primary site every 3 months for the first year, then every 6-12 months for the next 2 years.

Intermediate-risk patients:

• CT or MRI of the primary site every 3 months for the first year, then every 6 months for the second year, then annually for the third year.[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

• Functional imaging is recommended if positive at diagnosis and at completion of treatment. Monitoring continues until a negative scan, or for a period of 36 months following completion of treatment (every 3-6 months for the first year, then annually for the next 2 years).[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

  • Metaiodobenzylguanidine (MIBG) scintigraphy is recommended for MIBG avid tumors in patients with stage M disease at diagnosis (MIBG may not be used for routine surveillance in some countries).

  • 18-Fluorodeoxyglucose (FDG)-PET is recommended for MIBG nonavid tumors.

• Audiologic assessment may be appropriate to assess for treatment-related ototoxicity.[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

High-risk patients:

• CT or MRI of the primary site every 3-6 months for the first year, then every 6 months for the second year, then annually for the third year.[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

• Functional imaging every 3-6 months for the first year, then every 6 months for the second year, then annually for the third year.

  • MIBG scintigraphy is recommended for MIBG avid tumors (MIBG may not be used for routine surveillance in some countries).

  • 18-Fluorodeoxyglucose (FDG)-PET is recommended for MIBG nonavid tumors.[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1

• Audiologic assessment is recommended annually for up to 5 years.

• Echocardiography is recommended every 2-5 years if normal at completion of treatment, with frequency depending on risk of treatment-related cardiotoxicity.[36]National Comprehensive Cancer Network. Neuroblastoma [internet publication]. https://www.nccn.org/guidelines/category_1