Biodistribution of post‐therapeutic versus diagnostic <sup>131</sup>I‐MIBG scans in children with neuroblastoma

Hickeson, Marc; Charron, Martin; Maris, John M.; Brophy, Patricia; Kang, Tammy I.; Zhuang, Hongming; Khan, Jehanzeb; Nevrotski, Teresa

doi:10.1002/pbc.10454

Cited by 32 publications

(15 citation statements)

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“…There was no effect of 131 I-MIBG or AT dose on response or toxicity with the only non-hematologic >grade 2 toxicity observed in the patient who received 6/10 doses of 0.25mg/kg/day AT. Post-therapy scans showed excellent targeting of 131 I-MIBG therapy to lesions and similar to previous reports,(31) revealing additional lesions not detected on pre-therapy 123 I-MIBG scans. However, response rates for resistant NB were not improved when compared to historical data with single-agent high-dose 131 I-MIBG, suggesting that AT did not have a radiosensitizing or other beneficial effect for 131 I-MIBG therapy.…”

Section: Discussionsupporting

confidence: 89%

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

et al. 2016

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Arsenic trioxide has in vitro and in vivo radiosensitizing properties. We hypothesized that Arsenic trioxide would enhance the efficacy of the targeted radiotherapeutic agent 131I-metaiodobenzylguanidine (131I-MIBG), and tested the combination in a phase II clinical trial. Methods Patients with recurrent or refractory stage 4 neuroblastoma or metastatic paraganglioma/pheochromocytoma (MP) were treated on an institutional review board-approved protocol (Clinicaltrials.gov identifier NCT00107289). Planned treatment was 131I-MIBG (444 or 666MBq/kg) intravenously on day 1 plus arsenic trioxide (0.15 or 0.25mg/m2) intravenously on days 6–10 and 13–17. Toxicity was evaluated using National Cancer Institute Common Toxicity Criteria version 3.0. Response was assessed by International NB response criteria or (for MP) by changes in 123I-MIBG or PET scans. Results Twenty-one patients were treated: 19 with neuroblastoma and 2 with MP. Fourteen patients received 131I-MIBG and AT both at maximal dosages, 2 patients received a 444MBq/kg dose of 131I-MIBG plus a 0.15mg/kg/dose dose of arsenic trioxide; and 3 patients received a 666MBq/kg dose of 131I-MIBG plus a 0.15mg/kg/dose dose of arsenic trioxide. One did not receive arsenic trioxide because of transient central line-induced cardiac arrhythmia and another received only 6 of 10 planned doses of arsenic trioxide because of grade 3 diarrhea and vomiting with concurrent grade 3 hypokalemia and hyponatremia. Nineteen patients experienced myelosuppression higher than grade 2, most frequently, thrombocytopenia (n=18), though none required autologous stem cell rescue. 12 of 13 evaluable patients experienced hyperamylasemia higher than grade 2 from transient sialoadenitis. By International Neuroblastoma Response Criteria, 12 NB patients had no response and 7 had progressive disease, including 6 of 8 entering the study with progressive disease. Objective improvements in semiquantitative 131I-MIBG scores were observed in 6 patients. No response was seen in MP. Seventeen of 19 neuroblastoma patients continued on further chemotherapy or immunotherapy. Mean 5-year overall survival (±SD) for neuroblastoma was 37±11%. Mean blood absorbed dose of 131I-MIBG to blood was 0.134 cGy/mCi 131I-MIBG, well below myeloablative levels in all patients. Conclusion 131I-MIBG plus arsenic trioxide was well tolerated with an adverse event profile similar to that of 131I-MIBG therapy alone. The addition of arsenic trioxide to 131I-MIBG did not significantly improve response rates when compared to historical data with 131I-MIBG alone.

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Section: Discussionsupporting

confidence: 89%

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

et al. 2016

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“…The gamma emission energy of 159 keV from The sensitivity of detection with mIBG increases with increased activity injected, as shown for both 131 I-mIBG and 123 I-mIBG pretherapy diagnostic scans compared with immediate post-treatment 131 I-mIBG scans (Parisi et al, 1992;Hickeson et al, 2004). Furthermore, in the high-risk neuroblastoma patient group the radiation hazard is far less than the risk resulting from falsenegative or false-positive scanning results (Stabin and Gelfand, 1998).…”

Section: Radiopharmaceuticalmentioning

confidence: 85%

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

et al. 2010

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BACKGROUND: Neuroblastoma is an embryonic tumour of the sympathetic nervous system, metastatic in half of the patients at diagnosis, with a high preponderance of osteomedullary disease, making accurate evaluation of metastatic sites and response to therapy challenging. Metaiodobenzylguanidine (mIBG), taken into cells via the norepinephrine transporter, provides a sensitive and specific method of assessing tumour in both soft tissue and bone sites. The goal of this report was to develop consensus guidelines for the use of mIBG scans in staging, response assessment and surveillance in neuroblastoma. METHODS: The International Neuroblastoma Risk Group (INRG) Task Force, including a multidisciplinary group in paediatric oncology of North and South America, Europe, Oceania and Asia, formed a subcommittee on metastatic disease evaluation, including expert nuclear medicine physicians and oncologists, who developed these guidelines based on their experience and the medical literature, with approval by the larger INRG Task Force. RESULTS: Guidelines for patient preparation, radiotracer administration, techniques of scanning including timing, energy, specific views, and use of single photon emission computed tomography are included. Optimal timing of scans in relation to therapy and for surveillance is reviewed. Validated semi-quantitative scoring methods in current use are reviewed, with recommendations for use in prognosis and response evaluation. CONCLUSIONS: Metaiodobenzylguanidine scans are the most sensitive and specific method of staging and response evaluation in neuroblastoma, particularly when used with a semi-quantitative scoring method. Use of the optimal techniques for mIBG in staging and response, including a semi-quantitative score, is essential for evaluation of the efficacy of new therapy.

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“…Metastatic spread to the CPA has been reported to arise from primary neoplasms of the lungs, breast, prostate, and melanomas. 3,4,13 Other rare lesions reported to involve the CPA are malignant fibrous xanthoma, craniopharyngioma, teratomas, and chondrosarcoma. 13,14 The rapid progression of the cochleovestibular and facial symptoms in our case alerted us to the possibility of an unusual lesion of the CPA, yet the tumor's preoperative imaging studies were consistent with undifferentiated mesenchymal tumors such as osteosarcoma, rhabdomyosarcoma, and fibrosarcoma, which share certain similarities such as homogeneous enhancement of a solid tumor, predominantly young patients, and the frequently osteolytic nature of the lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Metastases to the CPA are rare, representing only 0.2% to 2.0% of all CPA lesions, and are known to arise from primary neoplasm of the colon, breast, and melanoma. [1][2][3][4] Differentiation of these neoplasms from other less common lesions of the CPA is difficult due to the similarity of presenting signs and symptoms. However, distinguishing among lesions is essential for determining prognosis and formulating an appropriate therapeutic protocol.…”

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confidence: 99%

Retroperitoneal Neuroblastoma Metastatic to the Cerebellopontine Angle

Yamakawa¹,

Tamakawa²,

Endo

et al. 2015

Neurosurgery Quarterly

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Neuroblastoma is the most common extracranial solid tumor in children. Survival rates have improved because of advances in treatment with aggressive chemotherapy and autologous bone marrow transplantation. Usual sites of recurrence and/or metastases include the site of the primary tumor, residual gross disease, bones, bone marrow, liver, and lungs. Central nervous system metastases have been regarded as uncommon; however, it is being increasingly diagnosed due to prolonged overall survival rates. Herein, we describe a 3-year-old boy with stage 4 primary adrenal gland neuroblastoma that metastasized to the pyramidal bone and rapidly extended into the cerebellopontine cistern while he was in the course of therapy for idiopathic thrombocytopenic purpura. He underwent an emergent debulking surgery, and the cerebellopontine angle metastatic lesion almost completely resolved after radical chemotherapy. Although our case is only the fourth case report of the metastatic cerebellopontine angle neuroblastoma in the literature, all clinicians involved in the treatment of pediatric neoplasms need to take this rare disease into consideration as a potential differential diagnosis.Key Words: metastatic neuroblastoma, rapid growth, cerebellopontine angle tumor (Neurosurg Q 2015;25:267-270) C erebellopontine angle (CPA) tumors comprise about 8% to 10% of all intracranial tumors. The majority of these tumors are vestibular schwannoma, followed in predominance by meningioma and epidermoid cyst. Metastases to the CPA are rare, representing only 0.2% to 2.0% of all CPA lesions, and are known to arise from primary neoplasm of the colon, breast, and melanoma. 1-4 Differentiation of these neoplasms from other less common lesions of the CPA is difficult due to the similarity of presenting signs and symptoms. However, distinguishing among lesions is essential for determining prognosis and formulating an appropriate therapeutic protocol. In contrast, neuroblastoma originates from neural crest cells of the adrenal medulla or sympathetic ganglia and is the most common solid extracranial tumor in children, accounting for approximately 7% of all pediatric cancers. 5,6 Over 70% of neuroblastoma patients have progressed to disseminated disease by the time of diagnosis, and these patients have a poor prognosis. 6 Common sites of distant metastases are the bone marrow, bony cortex, liver, lymph nodes, subcutaneous tissue, and intraorbital space. 7,8 Central nervous system metastasis occurs rarely, in only 1% to 16% of cases. Furthermore, metastatic neuroblastoma presenting as a CPA mass is quite rare. Herein, we report a case with intra-abdominal neuroblastoma that unexpectedly spreaded to the CPA. CASE DESCRIPTIONA 3-year-old boy with 1-year therapeutic history for idiopathic thrombocytopenic purpura (ITP) suddenly developed left facial palsy. Before this symptom, he had 4-months history of swaying to the left accompanied by progressive left facial nerve palsy. Headache and somnolence were present for a week before facial palsy developed. Neur...

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Biodistribution of post‐therapeutic versus diagnostic ¹³¹I‐MIBG scans in children with neuroblastoma

Abstract: The biodistribution of (131)I-MIBG is different using therapeutic doses as compared to pre-therapy doses. (131)I-MIBG imaging following high therapeutic doses often reveals sites of occult metastatic disease that may be clinically relevant.

Cited by 32 publications

References 27 publications

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

Retroperitoneal Neuroblastoma Metastatic to the Cerebellopontine Angle

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Biodistribution of post‐therapeutic versus diagnostic 131I‐MIBG scans in children with neuroblastoma

Abstract: The biodistribution of (131)I-MIBG is different using therapeutic doses as compared to pre-therapy doses. (131)I-MIBG imaging following high therapeutic doses often reveals sites of occult metastatic disease that may be clinically relevant.

Cited by 32 publications

References 27 publications

Arsenic Trioxide as a Radiation Sensitizer for 131I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

Arsenic Trioxide as a Radiation Sensitizer for 131I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

Criteria for evaluation of disease extent by 123I-metaiodobenzylguanidine scans in neuroblastoma: a report for the International Neuroblastoma Risk Group (INRG) Task Force

Retroperitoneal Neuroblastoma Metastatic to the Cerebellopontine Angle

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Biodistribution of post‐therapeutic versus diagnostic ¹³¹I‐MIBG scans in children with neuroblastoma

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study

Arsenic Trioxide as a Radiation Sensitizer for ¹³¹I-Metaiodobenzylguanidine Therapy: Results of a Phase II Study