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

Abstract

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.

Tandem high-dose chemotherapy with thiotepa and busulfan–melphalan and autologous stem cell transplantation in very high-risk neuroblastoma patients

“…One case of S. epidermidis septicaemia occurred. The median duration of antibiotherapy was 15 days (range [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Viral infections were identified in 7/24 patients (5/7 herpes zoster, 2/7 HSV) after a median interval of 9.8 months (range 1.4-66.2) after ASCT.…”

“…CR and PR were obtained in 3/26 and 23/26 patients, respectively. The mIBG scan was positive in 18/26 children, with a median SIOPEN score of 2 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Three patients still exhibited hepatic metastasis, and seven patients had a positive bone marrow biopsy.…”

“…Disease extent was assessed by mIBG scan using the SIOPEN scoring system. 19 Two biopsies and four aspirates were obtained for morphological evaluation of bone marrow.…”

Individualized therapy in neuroblastoma

“…Поздняя санация метайодбензилгуанидин (МЙБГ)-позитивных очагов во время индукционной ХТ была определена как прогноз плохого исхода по ретроспективным дан-ным [50,51]. Прогностическое значение наличия оста-точных МЙБГ-позитивных очагов во время или после индукционной ХТ было увеличено благодаря приме-нению полуоценочных систем, таких как системы Кю-ри и SIOPEN [51][52][53]. В дополнение ответ первичной опухоли также был определен как прогностический фактор исхода у пациентов с 4-й стадией НБ, так же как и у пациентов с амплификацией MYCN вне зави-симости от стадии.…”

Semi-quantitative scoring of skeletal metastases by 123I-mIBG scintigraphy in high-risk neuroblastoma

“…In North America, the Children's Oncology Group (COG) also runs clinical trials in neuroblastoma. Both groups have used semi-quantitative scoring in their studies, and several similar scales have been developed [14]. They both have similarities in that the body is divided into a number of parts, and each part is given a numerical score depending on how much mIBG-avid neuroblastoma can be seen on planar scintigraphy.…”