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Treatment of Neuroendocrine Tumours (Neuroblastoma Stage III or IV, Metastatic Pheochromocytoma, Etc.) with 131I-mIBG

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Clinical Nuclear Medicine

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Abstract

This chapter describes radionuclide I-131-metaiodobenzylguanidine (I-131-mIBG) treatment in a variety of mostly rare tumour entities with focus on high-risk neuroblastoma and metastatic pheochromocytoma. I-131-mIBG was developed by Dr. Donald Wieland, Ann Arbor, Michigan, in 1979 and was primarily intended as a scintigraphic agent to allow imaging of the adrenal medulla. Several transporters have been described being responsible for mIBG uptake. For therapeutic purposes, the pathophysiologic basis for I-131-mIBG therapy is the expression of the norepinephrine transporter on the tumour cell membrane.

In neuroblastoma, 131I-mIBG therapy can be used in case of persistent mIBG-avid lesions at the end of induction chemotherapy, in case of tumour progression or disease relapse or refractory disease or as palliative treatment for pain relief. Mean objective tumour response rate is about 32%.

In metastatic or inoperable malignant pheochromocytoma, there is usually no curative therapy option and 131I-mIBG is a palliative first-line therapy. In pheochromocytoma, indication for 131I-mIBG therapy is usually non-resectable, progressive pheochromocytoma or paraganglioma. Rare indications include metastatic carcinoid tumours and metastatic medullary thyroid carcinomas.

Patient preparation including practical aspects such as thyroid protection and side effect management are presented. Dosimetry is a controversial issue, but may help in treatment decisions in individual patients. Future developments address aspects of I-131-mIBG in multimodality treatment protocols.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany

    Matthias Schmidt

  2. Department of Nuclear Medicine, University Hospital of Frankfurt, Frankfurt, Germany

    Frank Grünwald

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  1. Matthias Schmidt
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  2. Frank Grünwald
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Correspondence to Matthias Schmidt .

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Editors and Affiliations

  1. Department of Nuclear Medicine, Klinikum Westfalen - Knappschaftskrankenhaus Academic teaching hospital of the Ruhr University, Dortmund, Nordrhein-Westfalen, Germany

    Hojjat Ahmadzadehfar

  2. Department of Nuclear Medicine, Beta Klinik Bonn, Bonn, Germany

    Hans-Jürgen Biersack

  3. Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Leonard M. Freeman

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Lionel S. Zuckier

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Schmidt, M., Grünwald, F. (2020). Treatment of Neuroendocrine Tumours (Neuroblastoma Stage III or IV, Metastatic Pheochromocytoma, Etc.) with 131I-mIBG. In: Ahmadzadehfar, H., Biersack, HJ., Freeman, L., Zuckier, L. (eds) Clinical Nuclear Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-39457-8_33

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