THERAPY RESPONSE IN NUCLEAR MEDICINE
Guest Editor: Bombardieri E. 

The Quarterly Journal of Nuclear Medicine 2003 March;47(1):31-40

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Nuclear medicine procedures and neuroblastoma in childhood. Their value in the diagnosis, staging and assessment of response to therapy

Boubaker A., Bischof Delaloye A.

Nuclear Medicine Department, University Hospital, Lausanne, Switzerland

Neuroblastoma is a fre­quent ­tumor of child­hood and ­remains a lead­ing ­cause of ­death ­despite treat­ment inten­sifi­ca­tion. Many clin­i­cal, bio­log­i­cal and genet­ic fac­tors ­have ­been iden­ti­fied and are asso­ciat­ed ­with prog­no­sis and out­come ­after treat­ment. Initial stag­ing ­plays a ­major ­role for deter­min­ing the ther­a­peu­tic strat­e­gy. Radioiodinated met­a­iod­o­ben­zyl­gua­ni­dine (­MIBG) scin­tig­ra­phy is a high­ly sen­si­tive and spe­cif­ic meth­od for diag­nos­ing, stag­ing and ­also mon­i­tor­ing ­response to ther­a­py. In chil­dren ­with ­high-­risk neu­ro­blas­to­ma, ­relapse may ­occur any ­time ­after remis­sion has ­been ­obtained. 123I-­MIBG scin­tig­ra­phy is a reli­able meth­od to fol­low-up ­those chil­dren and ­allows ear­ly detec­tion of recur­rence. As far as out­come is con­cerned, ­MIBG scin­tig­ra­phy has not prov­en to ­have any prog­nos­tic val­ue. Other radio­lab­eled trac­ers, ­such as pen­tet­re­o­tide, mono­clo­nal anti­bod­ies, and ses­ta­mi­bi ­have ­been com­pared ­with ­MIBG. Up to now, no meth­od has dem­on­strat­ed a reli­able prog­nos­tic val­ue, ­even ­though neu­ro­blas­to­ma ­that ­express som­a­tos­ta­tin recep­tor ­seem to ­have a bet­ter clin­i­cal out­come and sur­vi­val ­rate. Positron emis­sion tomog­ra­phy (PET) ­with 18F-flu­o­rod­e­ox­y­glu­cose has ­been ­used suc­cess­ful­ly in stag­ing and mon­i­tor­ing ­response to treat­ment of ­MIBG neg­a­tive ­tumors. 11C-hydrox­ye­phe­drine has ­shown prom­is­ing ­results in stag­ing neu­ro­blas­to­ma, but is not as wide­ly avail­able as ­MIBG. With ­respect to bio­log­i­cal and genet­ic fac­tors, nucle­ar med­i­cine pro­ce­dures ­play a ­major ­role in ­initial diag­no­sis and stag­ing of neu­ro­blas­to­ma. At the ­moment, ­MIBG scin­tig­ra­phy is cer­tain­ly the ­most sen­si­tive and spe­cif­ic meth­od for ­initial stag­ing of the dis­ease, as ­well as mon­i­tor­ing the ­response to treat­ment and detect­ing ear­ly ­relapse.