# Neuroblastoma — GCMD Library living collection

Updated: n/a · 5 episodes · 106 cited statements

## Episodes
### Tools
- [Neuroblastoma PDQ](https://library.globalcastmd.com/watch/neuroblastoma-pdq-10946) — article · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-pdq-10946.md)

### High-Yield Summaries
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-1620.md)
- [Topics in 10: Neuroblastoma](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md)

### In-depth Review
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-2534) — video · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-2534.md)

### Work-up and Treatment

### Test Your Knowledge
- [Did you Know: Storycasts](https://library.globalcastmd.com/watch/did-you-know-storycasts-4083) — video · [machine version](https://library.globalcastmd.com/watch/did-you-know-storycasts-4083.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=0) Introduction and Prenatal Diagnosis Approach (Ep 2)
- [4:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=240) Postnatal Workup and Observation Strategy (Ep 2)
- [9:07](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=547) Surveillance Protocol and Long-term Follow-up (Ep 2)
- [11:03](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=663) Surgical Approach and Stage MS Disease (Ep 2)
- [14:44](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=884) Workup of Older Child with Abdominal Mass (Ep 2)
- [21:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1310) Tissue Biopsy Techniques and Adequacy (Ep 2)
- [30:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1817) Risk Stratification and Staging (Ep 2)
- [36:54](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2214) Central Line Selection and Timing (Ep 2)
- [41:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2509) Timing of Surgical Resection (Ep 2)
- [47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860) Surgical Philosophy and Extent of Resection (Ep 2)
- [53:13](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3193) Immunotherapy Advances (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0) Introduction and Overview (Ep 3)
- [0:38](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=38) Clinical Presentation and Initial Workup (Ep 3)
- [2:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=131) MIBG Accuracy and Pre-Biopsy Staging (Ep 3)
- [3:53](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=233) Surgical Approach for Localized Disease (Ep 3)
- [5:08](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=308) Biopsy Results and Risk Stratification (Ep 3)
- [6:48](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=408) Treatment for Intermediate and Low Risk Disease (Ep 3)
- [7:50](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=470) Management of Metastatic and MS Disease (Ep 3)
- [9:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=540) Clinical Pearls and Conclusion (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=0) Prenatal Diagnosis and Observation (Ep 4)
- [10:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=639) Surveillance Protocol and Indications for Surgery (Ep 4)
- [15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908) Stage MS Disease with Liver Involvement (Ep 4)
- [21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) Workup of Large Abdominal Mass in Older Child (Ep 4)
- [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) Tissue Acquisition Strategies (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress — Daniel von Allmen (clinical) [Ep 4 · 2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131)
- Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly — Daniel von Allmen (clinical) [Ep 4 · 2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131)
- Familial neuroblastoma occurs in about 1% of patients — Tony Sandler (epidemiological) [Ep 4 · 4:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=279)
- For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen — Todd Ponsky (guideline) [Ep 4 · 5:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=307)
- CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated — Tony Sandler (guideline) [Ep 4 · 5:34](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=334)
- MIBG scan is the next step if catecholamines are elevated — Daniel von Allmen (guideline) [Ep 4 · 6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362)
- Radiologists are quite good at identifying adrenal hemorrhage on ultrasound — Daniel von Allmen (opinion) [Ep 4 · 6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362)
- In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes — Daniel von Allmen (clinical) [Ep 4 · 8:14](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=494)
- Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance — Daniel von Allmen (guideline) [Ep 4 · 8:44](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=524)
- Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference — Tony Sandler (epidemiological) [Ep 4 · 10:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=639)
- Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma — Erika Newman (epidemiological) [Ep 4 · 11:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=667)
- First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year — Erika Newman (guideline) [Ep 4 · 11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697)
- After one year, surveillance becomes every six months, then yearly — Erika Newman (guideline) [Ep 4 · 11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697)
- Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma — Daniel von Allmen (clinical) [Ep 4 · 12:27](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=747)
- 5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses — Tony Sandler (guideline) [Ep 4 · 14:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=876)
- Volume increase of more than 50% is criterion for considering surgery — Todd Ponsky (guideline) [Ep 4 · 15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908)
- 50% increase in VMA or HVA prompts consideration of surgery — Todd Ponsky (guideline) [Ep 4 · 15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908)
- Laparoscopic approach is reasonable for masses less than 6 centimeters — Erika Newman (guideline) [Ep 4 · 16:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=967)
- Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor — Daniel von Allmen (clinical) [Ep 4 · 16:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=996)
- Biology of neuroblastoma is more important than lymph node status for treatment decisions — Erika Newman (clinical) [Ep 4 · 17:00](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1020)
- Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology — Erika Newman (clinical) [Ep 4 · 17:30](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1050)
- Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise — Daniel von Allmen (clinical) [Ep 4 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Stage MS without distress can be treated with aggressive observation — Erika Newman (guideline) [Ep 4 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy — Erika Newman (guideline) [Ep 4 · 17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078)
- Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy — Daniel von Allmen (opinion) [Ep 4 · 19:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1146)
- Liver biopsy in newborns is difficult because bleeding is hard to control — Erika Newman (clinical) [Ep 4 · 19:52](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1192)
- If NMYC is amplified in stage MS, staging changes from MS to M — Todd Ponsky (clinical) [Ep 4 · 20:40](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1240)
- VIP secretion can cause severe diarrhea in neuroblastoma — Erika Newman (clinical) [Ep 4 · 21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265)
- Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid — Erika Newman (guideline) [Ep 4 · 21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265)
- Ultrasound is important for Wilms tumor to assess venous extension — Tony Sandler (clinical) [Ep 4 · 22:56](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1376)
- Large mass encasing aorta and celiac axis with microcalcifications represents L2 INRG classification — Tony Sandler (clinical) [Ep 4 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430)
- Complete staging workup includes bone marrow biopsy, MIBG scan, chest CT to rule out metastasis, and head CT if clinical symptoms present — Tony Sandler (guideline) [Ep 4 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430)
- 10% of neuroblastomas are not MIBG avid — Daniel von Allmen (epidemiological) [Ep 4 · 25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506)
- PET scan may detect metastases in MIBG-negative neuroblastomas — Daniel von Allmen (clinical) [Ep 4 · 25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506)
- PET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar — Erika Newman (guideline) [Ep 4 · 26:03](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1563)
- Open retroperitoneal biopsy provides adequate tissue size for pathology and biology studies — Tony Sandler (opinion) [Ep 4 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Transperitoneal laparoscopic biopsy may not allow adequate bleeding control for large tumors — Tony Sandler (opinion) [Ep 4 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Multiple percutaneous biopsies may not provide adequate tissue for biology studies — Tony Sandler (opinion) [Ep 4 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- NMYC amplification can be obtained from bone marrow, but additional biology studies require tumor tissue — Tony Sandler (clinical) [Ep 4 · 27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630)
- Biology studies beyond NMYC include ALK mutation and ploidy status — Tony Sandler (clinical) [Ep 4 · 28:28](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1708)
- In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass. — Daniel von Allmen (clinical) [Ep 3 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression. — Daniel von Allmen (clinical) [Ep 3 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor. — Daniel von Allmen (clinical) [Ep 3 · 1:07](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI. — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study. — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease. — Daniel von Allmen (clinical) [Ep 3 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- About 10% of neuroblastomas are MIBG negative. — Daniel von Allmen (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease. — Daniel von Allmen (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed. — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M. — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin. — Daniel von Allmen (guideline) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient. — Daniel von Allmen (guideline) [Ep 3 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- The prior neuroblastoma staging system required tissue diagnosis before assigning a stage. — Daniel von Allmen (guideline) [Ep 3 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy. — Daniel von Allmen (clinical) [Ep 3 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor. — Daniel von Allmen (opinion) [Ep 3 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist. — Daniel von Allmen (clinical) [Ep 3 · 4:44](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status. — Daniel von Allmen (clinical) [Ep 3 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue. — Daniel von Allmen (clinical) [Ep 3 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk. — Daniel von Allmen (clinical) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk. — Daniel von Allmen (epidemiological) [Ep 3 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma. — Daniel von Allmen (clinical) [Ep 3 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy. — Daniel von Allmen (clinical) [Ep 3 · 6:11](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have. — Daniel von Allmen (clinical) [Ep 3 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection. — Daniel von Allmen (clinical) [Ep 3 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation. — Daniel von Allmen (clinical) [Ep 3 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure. — Daniel von Allmen (clinical) [Ep 3 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- In patients with MS disease, simple observation can be the treatment path. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated. — Daniel von Allmen (clinical) [Ep 3 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- You can biopsy the skin lesions in MS disease and that will give you the diagnosis. — Daniel von Allmen (clinical) [Ep 3 · 8:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)
- Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress — Daniel von Allmen (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- Familial neuroblastoma occurs in approximately 1% of patients — Tony Sandler (epidemiological) [Ep 2 · 3:27](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery — Daniel von Allmen (clinical) [Ep 2 · 7:24](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival — Tony Sandler (clinical) [Ep 2 · 9:09](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly — Erika Newman (guideline) [Ep 2 · 9:58](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA — Erika Newman (guideline) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma — Tony Sandler (opinion) [Ep 2 · 12:43](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=763)
- Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor — Daniel von Allmen (clinical) [Ep 2 · 14:21](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly — Erika Newman (clinical) [Ep 2 · 14:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=890)
- Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy — Erika Newman (clinical) [Ep 2 · 15:42](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful — Daniel von Allmen (clinical) [Ep 2 · 22:12](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status — Tony Sandler (clinical) [Ep 2 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma — Erika Newman (epidemiological) [Ep 2 · 26:56](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment — Erika Newman (clinical) [Ep 2 · 28:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1684)
- Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor — Erika Newman (clinical) [Ep 2 · 28:55](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1735)
- Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy — Erika Newman (clinical) [Ep 2 · 29:45](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1785)
- NMEC amplification automatically means high-risk neuroblastoma regardless of other factors — Tony Sandler (clinical) [Ep 2 · 31:38](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category — Erika Newman (clinical) [Ep 2 · 33:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months) — Tony Sandler (guideline) [Ep 2 · 35:25](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant — Erika Newman (clinical) [Ep 2 · 37:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy — Tony Sandler (clinical) [Ep 2 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies — Daniel von Allmen (clinical) [Ep 2 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect — Erika Newman (clinical) [Ep 2 · 42:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2560)
- COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients) — Daniel von Allmen (clinical) [Ep 2 · 44:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival — Daniel von Allmen (clinical) [Ep 2 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection — Daniel von Allmen (epidemiological) [Ep 2 · 46:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2770)
- Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes — Tony Sandler (clinical) [Ep 2 · 46:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2810)
- High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence — Tony Sandler (clinical) [Ep 2 · 47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed — Daniel von Allmen (clinical) [Ep 2 · 50:54](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3054)
- There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings — Daniel von Allmen (clinical) [Ep 2 · 51:30](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3090)
- Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction — Tony Sandler (clinical) [Ep 2 · 53:13](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60% — Tony Sandler (clinical) [Ep 2 · 53:44](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor — Tony Sandler (clinical) [Ep 2 · 54:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old. — Rae Hanke summarizes what Dr. Daniel von Allmen said [Ep 3 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)

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