131I-metaiodobenzylguanidine (131I-MIBG) therapy for residual neuroblastoma: a mono-institutional experience with 43 patients

Abstract

Incomplete response to therapy may compromise the outcome of children with advanced neuroblastoma. In an attempt to improve tumour response we incorporated 131 I-metaiodobenzylguanidine ( 131 I-MIBG) in the treatment regimens of selected stage 3 and stage 4 patients. Between 1986 and 1997, 43 neuroblastoma patients older than 1 year at diagnosis, 13 with stage 3 (group A) and 30 with stage 4 disease (group B) who had completed the first-line protocol without achieving complete response entered in this study. 131 I-MIBG dose/course ranged from 2.5 to 5.5 Gbq (median, 3.7). The number of courses ranged from 1 to 5 (median 3) depending on the tumour response and toxicity. The most common acute side-effect was thrombocytopenia. Later side-effects included severe interstitial pneumonia in one patient, acute myeloid leukaemia in two, reduced thyroid reserve in 21. Complete response was documented in one stage 4 patient, partial response in 12 (two stage 3, 10 stage 4), mixed or no response in 25 (ten stage 3, 15 stage 4) and disease progression in five (one stage 3, four stage 4) Twenty-four patients (12/13 stage 3, 12/30 stage 4) are alive at 22–153 months (median, 59) from diagnosis. 131 I-MIBG therapy may increase the cure rate of stage 3 and improve the response of stage 4 neuroblastoma patients with residual disease after first-line therapy. A larger number of patients should be treated to confirm these results but logistic problems hamper prospective and coordinated studies. Long-term toxicity can be severe. © 1999 Cancer Research Campaign

I-131 MIBG Therapy for Advanced Stage III & IV Neuroblastoma

“…Our results are different from Garaventa et al, 1999 concerning stage III neuroblastoma, this may be attributed to the fact that stage III disease patients are already advanced from the start, also may be because we used the same doses of MIBG for both groups [20].…”

“…They reported that MIBG therapy showed very good partial response in 4/13 patients with stage III neuroblastoma, 1 patient showed disease progression and 8 patients showed stable disease. Regarding stage IV patients, 1/30 patients showed CR, 10 patients showed PR, 15 patients had no response to MIBG therapy and 4 patients showed progressive disease [20]. They stated the 5-year event-free survival (EFS) of stage III neuroblastoma to be 92% (±0.07) and that of stage IV to be 40% (±0.08) [20].…”

Megatherapy combining I131 metaiodobenzylguanidine and high-dose chemotherapy with haematopoietic progenitor cell rescue for neuroblastoma

“…9,10 However the presence of radioactive compounds in the lungs may worsen a pre-existing immunodeficiency leading to a growth of opportunistic agents. 11 The increased risk of pneumopathy reported in lymphoma patients treated with 131 I-charged monoclonal antibodies could support this hypothesis. 12 Moreover, radioactive compounds are observed in the lungs very early on.…”

Treatment of High-Risk Neuroblastoma

“…Последние десятилетия во многих протоколах лечения нейробластомы, например в NB2004, используется системная радиотерапия 131 I-MIBG, которая показала свою эффективность как у пер-вичных больных, так и у пациентов с рецидивами [19][20][21].…”