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High-dose 131I-metaiodobenzylguanidine therapy in patients with high-risk neuroblastoma in Japan

Annals of Nuclear Medicine volume 34, pages 397–406 (2020)Cite this article

Abstract

Objective

The aim of the study was to investigate the outcomes and prognostic factors of high-dose 131I-metaiodobenzylguanidine (131I-MIBG) therapy in patients with refractory or relapsed neuroblastoma (NBL) in Japan.

Methods

We retrospectively analyzed 20 patients with refractory or relapsed high-risk NBL who underwent 131I-MIBG therapy with an administration dose ranging from 444 to 666 MBq/kg at Kanazawa University Hospital, Japan, between September 2008 and September 2013. We focused on measurements regarding their initial responses, prognostic factors, survivals, and toxicities following 131I-MIBG therapy using our hospital data and questionnaires from the hospitals that these patients were initially referred from. Furthermore, we performed Kaplan–Meier survival analysis to evaluate event-free survival (EFS) and overall survival (OS).

Results

In 19 patients with complete follow-up data, the median age at first 131I-MIBG treatment was 7.9 years (range 2.5–17.7 years). Following 131I-MIBG therapy, 17 of the 19 patients underwent stem-cell transplantations, and their treatment response was either complete (CR) or partial (PR) in three and two cases, respectively. The EFS and OS rates at 1 year following 131I-MIBG therapy were 42% and 58%, respectively, and those at 5 years following 131I-MIBG therapy were 16% and 42%, respectively. Using the two-sample log-rank test, the OS time following 131I-MIBG therapy was significantly longer for < 3-year time interval between the initial diagnosis and 131I-MIBG therapy (p = 0.017), Curie score < 16 just before 131I-MIBG therapy (p = 0.002), without pain (p = 0.002), without both vanillylmandelic acid (VMA) and homovanillic acid (HVA) elevation (p = 0.037) at 131I-MIBG therapy, and with CR or PR following 131I-MIBG therapy (p = 0.015). Although severe hematological toxicities were identified in all 19 patients, severe nonhematological toxicity was not recorded in any patient, except for one patient with grade 3 anorexia and nausea.

Conclusions

High-dose 131I-MIBG therapy in patients with refractory or relapsed high-risk NBL can provide a favorable prognosis without severe nonhematological toxicities. Better prognosis may be anticipated in patients with the initial good response, no pain at 131I-MIBG therapy, no VMA and HVA elevation at 131I-MIBG therapy, low Curie score (< 16) just before 131I-MIBG therapy, and short time interval (< 3 years) between the initial diagnosis and 131I-MIBG therapy.

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Acknowledgements

The authors would like to thank all staffs of East 2 Ward at Kanazawa University Hospital, Japan, for supporting 131I-MIBG therapy.

Funding

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Authors and Affiliations

  1. Department of Nuclear Medicine, Kanazawa University Hospital and Department of Nuclear Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Daiki Kayano, Hiroshi Wakabayashi, Anri Inaki, Ayane Toratani, Norihito Akatani, Takafumi Yamase, Yuji Kunita, Tomo Hiromasa, Aki Takata, Hiroshi Mori, Shintaro Saito, Junichi Taki & Seigo Kinuya

  2. Department of Functional Imaging and Artificial Intelligence, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Kenichi Nakajima & Satoru Watanabe

  3. Department of Pediatrics, Kanazawa University Hospital and Department of Pediatrics, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Rie Kuroda

  4. Department of Radiology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan

    Takafumi Yamase

  5. Department of Pediatrics, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa, Ishikawa, 920-8530, Japan

    Raita Araki

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  1. Daiki Kayano
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Correspondence to Daiki Kayano.

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Conflict of interest

S. K. has a funded research collaboration with FUJIFILM Toyama Chemical Co., Ltd. The remaining authors declare that there is no conflict of interest regarding the publication of this article.

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Kayano, D., Wakabayashi, H., Nakajima, K. et al. High-dose 131I-metaiodobenzylguanidine therapy in patients with high-risk neuroblastoma in Japan. Ann Nucl Med 34, 397–406 (2020). https://doi.org/10.1007/s12149-020-01460-z

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  • DOI: https://doi.org/10.1007/s12149-020-01460-z

Keywords

  • 131I-metaiodobenzylguanidine
  • Refractory neuroblastoma
  • Relapsed neuroblastoma
  • Internal radiation therapy
  • Radionuclide therapy