ENDOCRINOLOGY - II
Therapy 

The Quarterly Journal of Nuclear Medicine 1999 December;43(4):336-43

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Nuclear medicine therapy of neuroblastoma

Hoefnagel C. A.

From the Department of Nuclear Medicine The Netherlands Cancer Institute, Amsterdam, The Netherlands

Specific tar­get­ing of radio­nu­clides to neu­ro­blas­to­ma, a neu­ral ­crest ­tumour occur­ring pre­dom­i­nant­ly in ­young chil­dren and asso­ciat­ed ­with a rel­a­tive­ly ­poor prog­no­sis, may be ­achieved via the meta­bol­ic ­route (­MIBG), recep­tor bind­ing (pep­tides) or immu­no­log­i­cal ­approach (anti­bod­ies). The clin­i­cal ­role of 131I-­MIBG ther­a­py and radio­im­mu­no­ther­a­py in neu­ro­blas­to­ma is dis­cussed. In recur­rent or pro­gres­sive met­a­stat­ic dis­eas­e ­after con­ven­tion­al treat­ment modal­ities ­have ­failed, 131I-­MIBG ther­a­py, ­with an over­all objec­tive ­response ­rate of 35%, is prob­ably the ­best pal­li­a­tive treat­ment, as the inva­sive­ness and tox­ic­ity of ­this ther­a­py com­pare favour­ably ­with ­that of chem­o­ther­a­py, immu­no­ther­a­py and exter­nal ­beam radio­ther­a­py. In ­patients pre­sent­ing ­with inop­er­able ­stage III and IV neu­ro­blas­to­ma, 131I-­MIBG ther­a­py at diag­no­sis is at ­least as effec­tive as com­bi­na­tion chem­o­ther­a­py but is asso­ciat­ed ­with ­much ­less tox­ic­ity. In ­patients ­with recur­rent dis­ease 131I-­MIBG ther­a­py in com­bi­na­tion ­with hyper­bar­ic oxy­gen ther­a­py ­proved fea­sible and encour­ag­ing ­effects on sur­vi­val ­have ­been ­observed. Attempts to inten­si­fy the treat­ment in ­relapsed ­patients by com­bi­na­tion of 131I-­MIBG ther­a­py ­with ­high ­dose chem­o­ther­a­py and/or ­total ­body irra­di­a­tion ­have met ­with con­sid­er­able tox­ic­ity. Developments in ­MIBG ther­a­py aim­ing at improv­ing the ther­a­peu­tic ­index are men­tioned. Early ­results of radio­im­mu­no­ther­a­py ­using 131I-UJ13A or 131I-3F8 mono­clo­nal anti­bod­ies ­have ­shown mod­er­ate objec­tive ­response and con­sid­er­able ­side ­effects in ­patients ­with ­stage IV neu­ro­blas­to­ma, who had ­relapsed or ­failed con­ven­tion­al ther­a­py. New devel­op­ments in radio­im­mu­no­ther­a­py of neu­ro­blas­to­ma ­include the use of chi­maer­ic anti­bod­ies, the enhance­ment of ­tumour ­uptake by mod­ula­tion of anti­gen expres­sion or by increas­ing the ­tumour per­fu­sion/vas­cu­lar­ity/perme­abil­ity, the use of oth­er ­labels and mul­ti­step tar­get­ing tech­niques, e.g. ­using bispe­cif­ic mono­clo­nal anti­bod­ies.