Future Directions

Greater reliance on biologic findings, including some not currently used in risk-stratification schemas, combined with less emphasis on precise stage, may further the decade-long trend towards reduction of cytotoxic therapy. This may lead to an increased number of patients currently classified as having intermediate-risk disease being managed with surgery or observation alone, rather than with chemotherapy or radiotherapy (see the present chapter). Improvements in prognostication are foreseen for the very small subsets of patients with MYCN-amplified stage-1 or stage-2 disease and for adolescents with stage-2 tumor via refinements in biologic characterization of neuroblastomas.

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