Most patients with low-risk neuroblastoma are cured with surgery alone, while a subset of low-risk infants with small adrenal tumors can be safely observed without surgery or other treatment. The excellent outcome is due, in part, to a high incidence of spon taneous tumor regression observed with this group of tumors. The identification of biologic markers associated with favorable prognosis has facilitated treatment reduction for ever greater numbers of neu-roblastoma patients. While gross total resection of a localized neuroblastoma remains the current treatment recommendation for most patients, it is now well recognized that such a procedure is not justified if it entails acute risks such as loss of a major organ (e.g., kidney) or damage to important nerves (e.g., brachial or sacral plexus) as the residual biologically favorable disease will likely remain stable or even regress spontaneously. Ongoing biologic studies will hopefully lead to a refinement in the risk-group schema as additional factors may identify the rare patient, currently classified as low risk, who is destined to fail treatment with surgery alone.

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