Background: Neuroblastoma is one of the most common tumors in children occupying the third place among all malignant neoplasms, trailing only the tumors of the central nervous system and soft tissue sarcomas. Survival in patients with high-risk neuroblastoma remains unsatisfactory. Objective: Improvement of the treatment results in patients with high-risk neuroblastoma. Methods: The study included 32 patients with high-risk neuroblastoma who received treatment at our clinic from 2009 to 2016: 21 (65.6%) boys and 11 (34.4%) girls aged 1.7–15 years (mean age 4.6±3.3 years). The median follow-up time was 19.8 months. Patients were divided into 2 groups depending on the regimens of induction polychemotherapy (PCT): in group I (n=19, 59.4%) patients received chemotherapy including topotecan, cyclophosphamide, vincristine, doxorubicin, cisplatin, etoposide; in group II (n=13; 40.6%) — threosulfan, vincristine, doxorubicin, cyclophosphamide, platidiam, etoposide, carboplatin. In both groups, therapy also included surgical treatment, high-dose CT, radiation therapy (RT), and biotherapy with ATRA. A part of patients from group I (n=4; 21%) who did not attain complete response to induction chemotherapy received systemic radiotherapy with 131I-MIBG. Results: The immediate efficacy (the ratio of the number of complete and partial effects obtained) of induction chemotherapy in the group I was 94.7% (n=18), in the group II — 84.6% (n = 11). Bone marrow sanation during induction chemotherapy was registered in 10 (71.5%) patients of group I after 1 course. In the remaining patients of group I, bone marrow sanation was detected after 2–5 courses of polychemotherapy. Bone marrow sanation after the first course of chemotherapy was revealed only in 4 (30.8%) patients of group II; in 2 (15.4%) patients bone marrow sanation was not detected. 2-year overall survival (OS) of patients with stage 4 in the group I was 65.6±14%, in the group II — 43.1±14.7%. The 2-year event-free survival (EFS) rate in the group I was 33.4±14.5%, in the group II — 23.1±11.7%. When performing single-factor regression analysis, the significant correlation between systemic radiotherapy and the absence of progression or relapse of the disease was revealed. Radical surgery does not affect the prognosis of the disease. Conclusion: The induction regimen used in group I showed a higher efficacy: OS and EFS rates in group I were higher. Patients with an active residual tumor tissue who completed the induction chemotherapy course were indicated a systemic radiotherapy with 131I-MIBG. The surgical treatment should be performed with organ-preservation approach.