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M. Schmidt, T. Simon, B. Hero, W. Eschner, M. Dietlein, F. Sudbrock, R. Bongartz, F. Berthold, H. Schicha

Is there a benefit of 131I-MIBG therapy in the treatment of children with stage 4 neuroblastoma? A retrospective evaluation of The German Neuroblastoma Trial NB97 and implications for the The German Neuroblastoma Trial NB2004

Keywords: High risk neuroblastoma, stage 4 neuroblastoma, 131I-MIBG therapy

AIM: 131I-meta-iodobenzylguanidine (131I-MIBG) therapy has been used in neuroblastoma treatment for many years but its value in high intensive first line treatment protocols is not exactly known. PATIENTS, METHODS: Stage 4 neuroblastoma patients >1 year with 123I-MIBG positive residual disease (primary tumour and/or metastasis) after complete induction chemotherapy according to the German neuroblastoma trial NB97 were retrospectively analyzed. RESULTS: One-hundred-eleven patients had 123I-MIBG positive residual disease after complete induction chemotherapy. Forty patients received 131I-MIBG therapy using a median activity of 0.44 GBq/kg body weight. By univariate analysis, patients who underwent 131I-MIBG therapy had a better 3-year event free survival (3-y-EFS 46 8%) and 3-year overall survival (3-y-OS 58 9%) than 71 patients without 131I-MIBG therapy (3-y-EFS 19 5%, p = 0.003; 3-y-OS 43 6%, p = 0.037). However, subgroup analysis of 66 patients who underwent high dose chemotherapy with autologous stem cell transplantation (ASCT) during treatment found a very similar outcome with 131I-MIBG therapy (3-y-EFS 49 9%, 3-y-OS 59 10%) and without 131I-MIBG therapy (3-y-EFS 33 9%, p = 0.171; 3-y-OS 59 9%, p = 0.285) due to the dominating effect of ASCT. By multivariate analysis, 131I-MIBG therapy had no impact on EFS (p = 0.494) and OS (p = 0.891). Only ASCT, external beam radiation therapy and MYCN amplification were important for EFS and OS. CONCLUSIONS: An independent advantage of I-131-MIBG therapy could not be proven in this retrospective analysis. The ongoing German Neuroblastoma Trial NB2004 will address the influence of 131I-MIBG therapy with emphasis on tumour dosimetry.

Nuklearmedizin, Schattauer

Print ISSN: 0029-5566
Volume: 45, 01/2006
Pages: 145 - 151

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