# COG P9641: surgery alone or with restricted chemotherapy for low-risk neuroblastoma

Source: https://onco.cc/key-papers/paper-p9641-low-risk-neuroblastoma-strother-jco-2012/  
OnCo record `paper-p9641-low-risk-neuroblastoma-strother-jco-2012` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the largest low-risk neuroblastoma trial, surgery alone cured almost all children with stage 1 and most with stage 2 disease, with chemotherapy reserved for symptoms or unfavourable features, confirming that many children need no drug treatment.

## Summary

Children's Oncology Group phase 3 study of 915 children with low-risk neuroblastoma (stage 1, asymptomatic stage 2 and 4S with favourable biology) treated with surgery alone, with chemotherapy only for symptomatic, unresectable or progressive disease.

Five-year event-free survival was 89 percent and overall survival 97 percent; outcomes were excellent for stage 1 and for stage 2 with favourable biology, and lower in stage 2 with unfavourable histology or diploidy in children over 18 months.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Journal of Clinical Oncology
- Year: 2012
- DOI: 10.1200/JCO.2011.37.9990
- Authors: Strother DR, London WB, Schmidt ML, et al.
- Findings: Five-year overall survival 97 percent; event-free survival 89 percent.; Stage 1: event-free survival 93 percent with surgery alone.
- What it means: Surgery alone, or observation, is standard for low-risk neuroblastoma, with chemotherapy limited to those with symptoms or unfavourable biology.
- Caveats: Non-randomised risk-adapted design.

## Sources

- J Clin Oncol 2012: https://doi.org/10.1200/JCO.2011.37.9990
- PubMed: https://pubmed.ncbi.nlm.nih.gov/22529259/

## Connected records

- cancers: [Low-risk neuroblastoma (INRG very low and low risk, including stage MS)](https://onco.cc/cancers/neuroblastoma-low-risk/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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