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Radiation therapy uses high-energy rays or particles to kill cancer cells.
Radiation therapy is sometimes a necessary part of treatment, but because of the possible long-term side effects in young children, doctors avoid using it when possible.
Most children with neuroblastoma will not need radiation therapy. It is most commonly used in children with high-risk neuroblastoma, typically after a stem cell transplant. It might also be used for children with low- and intermediate-risk neuroblastoma, if a child has life-threatening symptoms and needs emergency treatment to shrink the tumor.
Two types of radiation therapy can be used to treat children with neuroblastoma:
External radiation therapy uses a machine to focus a beam of radiation on the cancer from a radiation source outside the body. This type of treatment might be used:
When radiation is aimed at the whole body, it is known as total body irradiation (TBI). This was used in the past for children with high-risk neuroblastoma before a stem cell transplant, but now it's more common for radiation only to be given after a stem cell transplant, and only to the primary tumor site and any other areas of the body that might have active neuroblastoma cells.
Before the radiation treatments start, the radiation team will take careful measurements with imaging tests such as MRI scans to determine the correct angles for aiming the radiation beams and the proper dose of radiation.
Your child might also be fitted with a plastic mold resembling a body cast to keep them in the same position during each treatment so that the radiation can be aimed more accurately.
The number of radiation treatments given depends on the situation.
For each treatment session, your child lies on a special table while a machine delivers the radiation from a precise angle. Radiation therapy is much like getting an x-ray, but the dose of radiation is much higher. The treatment is not painful. Each actual treatment lasts only a few minutes, but the setup time – getting your child into place for treatment – usually takes longer. Young children may be given medicine to make them sleep so they will not move during the treatment.
Radiation therapy is sometimes an important part of treatment, but young children’s bodies are very sensitive to it, so doctors try to use as little radiation as possible to help avoid or limit any problems. Radiation can cause both short-term and long-term side effects, which depend on the dose of radiation and where it is aimed.
Radiation can also make the side effects of chemotherapy worse. Talk with your child’s doctor about the possible side effects because there are ways to relieve some of them.
Close follow-up with doctors is important as children grow older so that any problems can be found and treated as soon as possible. For more on the possible long-term effects of treatment, see Late and Long-term Effects of Neuroblastoma and Its Treatment.
As described in Tests for Neuroblastoma, MIBG is a chemical similar to norepinephrine, which is made by sympathetic nerve cells. A slightly radioactive form of MIBG is sometimes injected into the blood as part of an imaging test to look for neuroblastoma cells in the body. This is called an MIBG scan.
A more highly radioactive form of MIBG can also be used to treat some children with advanced neuroblastoma, often along with other treatments. Once injected into the blood, the MIBG goes to neuroblastoma cells anywhere in the body and delivers its radiation. (This type of radiation travels only a very short distance, so it doesn’t affect most healthy cells in the body.)
The child will need to stay in a special hospital room for a few days after the injection until most of the radiation has left the body. Most of the radiation leaves the body in the urine, so younger children might need to have a catheter in the bladder to help urine leave the body, usually for a couple of days.
Most of the radiation from MIBG therapy stays in the area of the neuroblastoma, so most children don't have serious side effects from this treatment. MIBG therapy can sometimes cause mild nausea and vomiting. It can also make some children feel tired or sluggish. Some children might have swollen cheeks from the MIBG treatment because it can affect the salivary glands. Rarely, it might cause high blood pressure for a short period of time.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Dome JS, Rodriguez-Galindo C, Spunt SL, Santana VM. Chapter 92: Pediatric solid tumors. In: Neiderhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA. Elsevier; 2020.
National Cancer Institute. Neuroblastoma Treatment (PDQ). 2020. Accessed at https://www.cancer.gov/types/neuroblastoma/hp/neuroblastoma-treatment-pdq on April 9, 2021.
Park JR, Hogarty MD, Bagatell R, et al. Chapter 23: Neuroblastoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Principles and Practice of Pediatric Oncology. 8th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2021.
Pinto NR, Applebaum MA, Volchenboum SL, et al. Advances in risk classification and treatment strategies for neuroblastoma. J Clin Oncol. 2015: 30;3008-3017.
Shohet JM, Lowas SR, Nuchtern JG. Treatment and prognosis of neuroblastoma. UpToDate. 2021. Accessed at https://www.uptodate.com/contents/treatment-and-prognosis-of-neuroblastoma on April 9, 2021.
Last Revised: April 28, 2021
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