A major aim in the management of intermediate-risk neuroblastoma is to reduce acute and late toxicity risks while maintaining the current high rate of cure. It is noteworthy that while metastatic involvement of bones or bone marrow denotes a dismal prognosis for most children older than 1 year of age with neu-roblastoma, infants with a similar clinical picture of neuroblastoma have an excellent outlook with modest doses of chemotherapy. Also worthy of note is the excellent prognosis when local-regional neuroblas-toma cannot be entirely excised by surgery or completely sterilized by radiotherapy, i.e., long-term survival ensues despite the presence of residual disease. Neuroblastoma is one of the rare, well-defined oncologic entities that regresses or remains quiescent without further treatment when disease is left behind after surgery, or when the disease process involves multiple sites (stage 4S); yet, current group-wide studies call for additional chemotherapy and/or radiotherapy for residual disease, an approach that might entail more risk (toxicity) than benefit (antitumor effect).

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