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The treatment of neuroblastoma with [131I]MIBG at diagnosis
1Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Insights
Iodine-131 meta-iodobenzylguanidine ([131I]MIBG) therapy shows promise for treating pediatric neuroblastoma (NB). Combining [131I]MIBG with cisplatin may enhance treatment efficacy in advanced neuroblastoma cases.
Area of Science:
- Pediatric Oncology
- Nuclear Medicine
- Radiopharmaceutical Therapy
Background:
- Neuroblastoma (NB) is a challenging pediatric cancer.
- Inoperable and untreated cases require effective therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of Iodine-131 meta-iodobenzylguanidine ([131I]MIBG) therapy in children with untreated, inoperable neuroblastoma.
- To assess the potential benefit of combining [131I]MIBG with cisplatin.
Main Methods:
- Six children (10 months-5 years) with neuroblastoma were treated at diagnosis.
- [131I]MIBG therapy was administered alone or preceded by cisplatin.
- Doses ranged from 2.9 to 6.1 GBq for single [131I]MIBG treatments, with one case receiving 9.1 GBq in two courses combined with cisplatin.
Main Results:
- Initial responses included 1 complete, 1 partial, 1 minor response, and 2 stabilizations.
- The treatment was generally well-tolerated with minimal toxicity.
- While one patient achieved a durable complete response, others relapsed; however, combination therapy with cisplatin showed a very good partial response in a patient with widespread metastases.
Conclusions:
- [131I]MIBG therapy is a potentially effective and low-toxicity treatment for neuroblastoma at diagnosis.
- Integration with cisplatin may improve the efficacy of [131I]MIBG therapy, particularly in advanced or metastatic neuroblastoma.
Abstract:
The potential role [131I]MIBG therapy in untreated, inoperable cases of neuroblastoma (NB) in children was evaluated. Six children, aged 10 months-5 years, were treated at diagnosis. Five (4 stage III and 1 stage IV NB) underwent [131I]MIBG treatment alone (single doses ranging from 2.9 to 6.1 GBq of high specific activity [131I]MIBG. In one case (stage IV NB) [131I]MIBG was preceded by Cisplatin administration (20 mg/m2/day) given over a 5 day period. The results obtained in the first 5 cases were as follows: 1 complete response still lasting after 5 years; 1 partial and 1 minor response allowing further surgery and chemotherapy; 2 stabilization of the disease. The treatment was well tolerated with minimal toxicity. However, apart from the first case all these children relapsed and subsequently died. Therefore [131I]MIBG therapy (9.1 GBq given in 2 courses) combined with Cisplatin as a "radiosensitizer" was used in the sixth case, a patient with widespread bone metastases and massive bone marrow involvement. A very good partial response was obtained in this case. Further surgery (of the primary NB) and multidrug chemotherapy was then possible. In conclusion, [131I]MIBG therapy at diagnosis appears to be effective, low toxic treatment of NB; when integrated with Cisplatin its efficacy seems to improve even more.