One hundred and forty-four patients with advanced neuroblastoma were entered in this study between January 1985 and August 1990. The eligible patients included infants younger than 12 months of age with stage IVA disease and patients aged 12 months or older with stage III or IV disease. The patients first received six cyclic course of regimen A1, and surgical removal was performed some time during these first six cycles. Survival rates were greatly improved; 81% in stage III and 54% in stage IV at 2 years, and 75% in stage III and 45% in stage IV at 3 years. The overall survival rates for those who achieved CR were 79% and 74% at 2 years and 3 years, respectively; while the rates for those associated with PR were much lower: 23% and 9% at 2 years and 3 years, respectively. Gross complete resection of primary tumor and regional lymph nodes was feasible in 89% of the patients with stage III disease and in 79% of the patients with stage IV disease. Patients in whom the ipsilateral kidney was preserved at surgery had an outcome superior to those with associated nephrectomy (p less than 0.05).