Well I don't know if I have any answers but I can help you with some pointers. As I am sure you already know this is a pretty unique situation. I can tell you that the resection is the first order of business and, yes, the pathology will hopefully shed light on the situation. I would also guess that this should be potentially followed with radiation, if possible. Where are the tumors?
The pointers that I have are more about process than specific recommendations. I am a little unclear on how his OMS will effect his eligibility for various trials. I just am not knowledgeable enough in that area. I don't know what it will preclude Braeden from participating in and, secondly, given the fact that he has neuroblastoma associated with OMS, whether he would be considered high risk enough for trials such as MIBG or other phase 1 trials. I am guessing that the pathology will help in that area. Regardless, there are two things that you need to be aware of in making your decisions.
First, eleigibility for many trials is dependent upon the presence of measureable disease. Once he has been resected (assuming he has no other disease) he will no longer qualify for many trials. This is obviously good and bad. He no longer has disease but he is also no longer eligible for many therapies that could potentially help to keep him in remission. If this is the case you will be limited to drugs that are available off trial. Many of these are chemotherapeutic in nature but there are some that may be appropriate. Furthermore, it does come at an out of the pocket cost but there are labs that will test Braednes tumor to see what agents it is susceptible to. Finally, trials that he might be eligible for without measurable disease he may not be elibigible for given the OMS. Antibodies and vaccine therapies come to mind although I would definitely ask the questions.
The second thing that should be considered by nearly everyone who has a child with relapsed disease is in regards to the management of toxicities. There is a risk reward tradeoff with every therapy. It is my opinion that, when choosing a particular relapse therapy, you should not only consider the toxicities of the therapy itself but also what happens next. What happens if the therapy fails? What happens if it succeeds? What will happen next? What will they be able to tolerate after this therapy if it fails? How long will it be before they can start another therapy? These questions are important to ask considering the response rates of many of these therapies. With many response rates in the neighborhood of 30% (at best) I believe we have to strongly consider the cost. You may also keep in mind that sometimes you can change the order in which you try many therapies to help reduce the risks associated with failed therapies. For example, drugs X and Y may both work. However, drug X may keep you from doing drug Y (either due to toxicities, timing, eligibility criteria, etc.) However, if you do drug Y first you may be able to follow it with drug X. Always keep this in mind and make sure to ask lots and lots of questions.
I hope this helps and doesn't just make your path more confusing. Please feel free to write or cal anytime.