Sympathetic and Allied Nervous System Tumors

Treatment options for neuroblastoma are related to age at diagnosis, tumor location, stage of disease, regional lymph node involvement, and tumor biology. Four types of treatment are used, often in combination— surgery, radiation therapy, chemotherapy, and bone marrow transplantation.

Renal Tumors

Choice of treatment for Wilms’ tumor depends on the tumor’s size, stage, histology and the child’s age and general health. The treatment of Wilms’ tumor usually involves surgery to remove the cancer followed by chemotherapy. Other regimens may also include radiotherapy.

Retinoblastoma

Therapeutic approaches to retinoblastoma depend on the extent of the disease within the eye, whether the disease is in one or both eyes, and whether the disease has spread beyond the eye. Treatment options include enucleation (surgery to remove the eye); radiation therapy; cryotherapy (the use of extreme cold to destroy cancer cells); photocoagulation (the use of laser light to destroy blood vessels that supply nutrients to the tumor); thermotherapy (the use of heat to destroy cancer cells); and chemotherapy. Pediatric oncologists have modified treatment to improve survival, to preserve vision and cosmetic appearance, and to reduce second cancers. Chemotherapy is used to shrink tumors so that they can be treated focally, thereby avoiding enucleation or radiation in at least 50 percent of eyes (Friedman et al., 2000). Children who have hereditary retinoblastoma may also be at risk of developing a tumor in the brain while they are being treated for the eye tumor. This is called trilateral retinoblastoma, and patients should be periodically monitored for the possible development of this rare condition during and after treatment.

Hepatic Tumors

Surgery, chemotherapy, radiation therapy, and liver transplantation are all used to treat childhood liver cancers. Surgery may be used to take out the cancer and surrounding tissue. Chemotherapy may be administered before surgery to help reduce the size of the liver cancer and it may be administered after surgery to eliminate any remaining cancer cells. Systemic or direct infusion chemotherapy (drugs injected directly into the blood vessels that go into the liver) may also be administered. Sometimes a



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