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Treatment of advanced neuroblastoma with I-131 meta-iodobenzylguanidine
A Garaventa1, P Guerra, A Arrighini
1Department of Pediatric Hematology-Oncology, Giannina Gaslini Children's Hospital, Genova, Italy.
Insights
This study investigated iodine-131 meta-Iodobenzylguanidine (131-MIBG) for advanced neuroblastoma. While effective in some cases, particularly with residual primary tumors, further research is needed to confirm its role in treatment.
Area of Science:
- Pediatric Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Neuroblastoma is a common childhood cancer.
- Advanced or relapsed neuroblastoma presents significant treatment challenges.
- 131-I meta-Iodobenzylguanidine (131-MIBG) is a targeted radiopharmaceutical for neuroblastoma.
Purpose of the Study:
- To evaluate the efficacy and toxicity of 131-MIBG in children with advanced, pretreated neuroblastoma.
- To identify patient subgroups that may benefit most from 131-MIBG therapy.
Main Methods:
- Retrospective analysis of 31 children with advanced neuroblastoma treated with 131-MIBG.
- Doses ranged from 2.8 to 6.0 GBq (median 3.7 GBq) over 72 courses.
- Evaluation of treatment response and adverse events, primarily thrombocytopenia.
Main Results:
- Six major responses (two complete) and two minor responses were observed.
- Responses were more frequent in patients with residual primary tumors or disseminated relapse without bone marrow infiltration.
- Thrombocytopenia was the most common toxicity, occurring after 19 of 60 evaluable courses.
Conclusions:
- 131-MIBG shows potential therapeutic benefit in select neuroblastoma patients.
- Further investigation is warranted to optimize its use in neuroblastoma treatment protocols.
- Patient selection criteria, such as tumor burden and prior treatment, may influence response rates.
Abstract:
From February 1986 to December 1988, 31 children with advanced pretreated neuroblastoma were treated with 131-I meta-Iodobenzylguanidine (131-MIBG). Thirteen children had been resistant to first-line therapy, three had suffered a local relapse, and fourteen had suffered a disseminated relapse without over bone marrow infiltration. One child was treated initially because of resistance to first-line therapy, and subsequently for a local relapse. A total of 72 courses of 131-MIBG was administered, with doses ranging from 2.8 to 6.0 GBq (median, 3.7 GBq). One child received five courses, two four courses, 13 three courses, four two courses, and 12 one course of 131-MIBG. The most common toxic effect was thrombocytopenia, with a platelet level of less than 50,000/cmm occurring after 19 of 60 evaluable courses. A leukocyte count less than 1000/cmm was seen only once. There were six major responses (two complete) lasting 4 to 9 months, and two minor responses lasting longer than 38 and 44 months. Responses were seen more commonly in children whose only lesion was a residual primary tumor and in children who had not been pretreated who experienced disseminated relapse. Further studies of the role of 131-I meta-Iodobenzylguanidine in treatment of neuroblastoma are needed.