Anatomic staging systems for neurobalstoma are important in determining tumor distribution, intensity of therapy required and patient prognosis. Classic staging has utilized two approaches: one defines the initial anatomic distribution of disease at diagnosis; the second includes considerations for degree of resectability of the primary tumor. Many currently used systems are generally incompatible and unable to distinguish patients in the intermediate prognastic groups. A new International Neuroblastoma Staging System (INSS) is proposed which combines components of initial distribution of disease as well as surgical resectability. Uniform evaluation of response to therapy is also part of the INSS. Biologic staging neuroblastoma may become important in the future and the INSS proposal allows enough flexibility to incorporate this into a more standardized classification system.