How do you approach isolated CNS recurrence in previously treated neuroblastoma?

As with other pediatric cancers, the CNS can be a sanctuary site for relapse given the poor CNS penetration of many conventional therapeutics used in the front line setting. As such, there has been an increasing frequency of CNS failures which can occur as early as a year to as late as 5-10 years in some reports (PMID: 9185208, PMID: 11301399). This trend is only expected to continue with the incorporation of Dinutuximab, tandem transplant and 131I-MIBG into front line therapy.

Much of the same problems which confound the management of metastatic spread to the CNS are amplified in the recurrent setting as salvage rates are typically lower than in the upfront setting given that the disease has been exposed to most of the active agents prior t...