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Guest Editors: Bombardieri E.

The Quarterly Journal of Nuclear Medicine 2000 March;44(1):77-87


lingua: Inglese

Role of 131I-metaiodobenzylguanidine (MIBG) in the treatment of neuroendocrine tumours. Experience of the National Cancer Institute of Milan

Castellani M. R., Chiti A., Seregni E., Bombardieri E.

From the Nuclear Medicine Division Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy


Background. 45 ­patients ­with neu­ro­en­do­crine ­tumours (22 neu­ro­blas­to­mas, 10 phae­och­rom­o­cy­to­mas, 3 par­a­gan­gli­o­mas, 6 medul­lary thy­roid car­ci­no­mas and 4 car­ci­noids) under­went 131I-­MIBG ther­a­py.
Methods. All ­patients, ­with the excep­tion of 5 phae­och­rom­o­cy­to­ma cas­es ­with non­op­er­able dis­ease, had pre­vi­ous­ly ­been treat­ed ­with con­ven­tion­al ther­a­pies. Patients had a pre­vi­ous diag­nos­tic scin­tig­ra­phy ­with 131I-­MIBG (activ­ity 20-44.4 MBq) or ­with 123­I-MIBG (activ­ity 74-222 MBq). The ther­a­peu­tic activ­ity for ­adults ­ranged ­from 3.7 to 7.4 GBq of 131I-­MIBG; for chil­dren ­from 2.7 to 5.5 GBq. All treat­ments ­were repeat­ed at not ­less ­than 4-week­ly inter­vals. The neu­ro­blas­to­ma ­patients ­were divid­ed ­into two ­groups: the ­first includ­ed 14 ­patients ­with ­advanced met­a­stat­ic dis­ease not respond­ing to pre­vi­ous treat­ments; the sec­ond includ­ed 8 ­patients ­with doc­u­ment­ed resid­u­al neu­ro­blas­to­ma tis­sue ­that ­could not be sur­gi­cal­ly ­removed ­after ­first-­line ther­a­py.
Results. In neu­ro­blas­to­ma ­patients ­with ­advanced dis­ease resist­ant to pre­vi­ous ther­a­pies 2 out of 14 ­showed a par­tial ­response, 9 ­stable dis­ease and 3 pro­gres­sion of can­cer. In neu­ro­blas­to­ma ­patients ­with resid­u­al dis­ease (7 eval­u­able out of 8) we ­obtained 3 par­tial respons­es; a ­stable ­response was ­observed in 3 ­patients. The ­results of ­MIBG ther­a­py in the ­group of phae­och­rom­o­cy­to­ma ­patients (9 eval­u­able out of 10) con­sist­ed of 3 par­tial respons­es, 5 ­stable dis­ease and 1 pro­gres­sion. Evaluation of the ­response car­ried out on the ­basis of bio­chem­i­cal param­e­ters ­increased the respons­es and ­MIBG ther­a­py ­showed ­good effec­tive­ness in con­trol­ling the func­tion­al symp­toms. In the ­group of par­a­gan­gli­o­ma ­patients we ­observed 1 com­plete, 1 par­tial and 1 ­stable ­response. In ­patients ­with medul­lary thy­roid car­ci­no­ma a par­tial ­response was ­observed in 1 ­patient ­with med­i­as­ti­nal metas­ta­ses and 2 dis­ease sta­bil­isa­tions ­were ­seen in ­another 2 ­patients. Patients ­with car­ci­noids who under­went ­MIBG ther­a­py ­showed 3 dis­ease sta­bil­isa­tions. The over­all tox­ic­ity was accept­able, espe­cial­ly con­sid­er­ing ­that the major­ity of our ­patients had had pre­vi­ous myel­o­tox­ic treat­ments (chem­o­ther­a­py and/or radio­ther­a­py, ­alone or in com­bi­na­tion).
Conclusions. On the ­basis of our expe­ri­ence we can con­clude ­that 131I-­MIBG ther­a­py is effec­tive and ­also ­well tol­er­at­ed.

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