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In the largest low-risk neuroblastoma trial, surgery alone cured almost all children with stage 1 and most with stage 2 disease, with chemotherapy reserved for symptoms or unfavourable features, confirming that many children need no drug treatment.
Children's Oncology Group phase 3 study of 915 children with low-risk neuroblastoma (stage 1, asymptomatic stage 2 and 4S with favourable biology) treated with surgery alone, with chemotherapy only for symptomatic, unresectable or progressive disease.
Five-year event-free survival was 89 percent and overall survival 97 percent; outcomes were excellent for stage 1 and for stage 2 with favourable biology, and lower in stage 2 with unfavourable histology or diploidy in children over 18 months.
Surgery alone, or observation, is standard for low-risk neuroblastoma, with chemotherapy limited to those with symptoms or unfavourable biology.
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