The role of radiation therapy in the treatment of neuroblastoma continues to evolve. Past investigations have taught us that the majority of patients with low-risk and intermediate-risk disease do well without radiation therapy. There are several important exceptions where the option of radiotherapy must be considered, such as infants with stage-4S disease requiring rapid reversal of respiratory or gastrointestinal compromise.

Conversely,the majority of patients with high-risk disease do benefit from the addition of radiation therapy to the combined modality treatment paradigm. Cooperative group- and single-institution experiences indicate that this group of patients have excellent local control when the primary site is managed with complete surgical resection followed by approximately 21 Gy; however, this dose of radiation does not appear to be adequate if complete resection is not achieved. Going forward, more aggressive attempts at surgical resection or higher radiation doses must be investigated.

Radiation therapy is an indispensable tool in the management of neuroblastoma metastases, either as part of initial therapy or as palliation. Techniques and fractionation schedules can be tailored to the clinical situation of each individual patient. New technologies that allow highly conformal therapy are often applicable to patients with neuroblastoma; however, survivors must be monitored well into adulthood for potential late effects of therapy.

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