Neuroblastoma: Therapy

General measures

Nicotine restriction (refraining from tobacco use).
Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
Preservation of normal weight strive!Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
- Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.

The following vaccinations are advised:

Flu vaccination
Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to 12 months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.

Regular follow-up examinations for early detection of recurrence (recurrence of the disease).

Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
- Consume only limited energy-rich foods.
- Moderate total fat intake
- Little red meat (pork, beef, lamb, veal) and sausages.
- Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grains, vegetables).
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
- Refrain from polluted foods such as offal and wild mushrooms.
- Do not eat moldy food
Observe the following special dietary recommendations:
- Diet rich in:
  - Vitamins (A, C, D, E, folic acid).
  - Minerals
  - Trace elements (selenium, zinc)
  - Omega-3 fatty acids
  - Secondary plant compounds (e.g. carotenoids, polyphenols).
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Stress management, if necessary
Detailed information on psychosomatics (including stress management) can be obtained from us.

The following procedures may be used as complementary treatments, if appropriate:

MIBG therapy – 131Iodine-labeled metaiodobenzylguanidine (131I-MIBG) therapy; option for patients with metastatic pheochromocytoma, neuroblastoma, or paraganglioma.
High-dose chemotherapy with autologous stem cell transplantation (more precisely, hematopoietic stem cell transplantation; HSCT; blood stem cell transplantation).
Retinoic acid therapy (vitamin A derivative).