Rose Brian, Matthay Katherine K, Price David, Huberty John, Klencke Barbara, Norton Jeffrey A, Fitzgerald Paul A
Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Cancer. 2003 Jul 15;98(2):239-48. doi: 10.1002/cncr.11518.
131I-Metaiodobenzylguanidine (131I-MIBG) can be used systemically to treat malignant pheochromocytoma. To improve outcome, the authors used higher levels of activity of 131I-MIBG than previously reported. The authors reported the response rates and toxicity levels in patients with malignant pheochromocytoma or paraganglioma who were treated with high-dose 131I-MIBG.
Following debulking surgery and stem cell harvest, 12 patients with malignant pheochromocytoma or paraganglioma were treated with 131I-MIBG. Five had received previous external beam radiation and/or chemotherapy. The median single treatment dose was 800 mCi (37 gigabecquerels; range, 386-866 mCi) or 11.5 mCi/kg (range, 5.6-18.3 mCi/kg). The median cumulative dose was 1015 mCi (range, 386-1690 mCi).
Three patients had a complete response, two of whom had soft tissue and skeletal metastases. Their median follow-up was 45 months (range, 23-101 months). Seven patients had a partial response (PR), with a median follow-up 43 months (range, 6-47 months). Two patients without a response died with progressive disease (PD) and 2 patients with an initial PR died of PD at 13 and 11 months, respectively. Grade 3 thrombocytopenia occurred after 79% (15 of 19) of treatments had been administered. Grade 3 and 4 neutropenia followed 53% (10 of 19) and 19% (4 of 19) of treatments, respectively. One patient required stem cell infusion, and one developed primary ovarian failure.
The single and cumulative doses of 131I-MIBG were approximately 2-3.5 times higher than those used at other centers. Unlike previous reports, two patients with both skeletal and soft tissue metastases had a complete response. Hematologic toxicity was significant but tolerable. High-dose 131I-MIBG may lead to long-term survival in patients with malignant pheochromocytoma.
131I-间碘苄胍（131I-MIBG）可用于全身治疗恶性嗜铬细胞瘤。为改善治疗效果，作者使用了比先前报道更高活度的131I-MIBG。作者报告了接受高剂量131I-MIBG治疗的恶性嗜铬细胞瘤或副神经节瘤患者的缓解率和毒性水平。
在减瘤手术和干细胞采集后，12例恶性嗜铬细胞瘤或副神经节瘤患者接受了131I-MIBG治疗。其中5例曾接受过外照射放疗和/或化疗。单次治疗剂量中位数为800mCi（37GBq；范围386 - 866mCi）或11.5mCi/kg（范围5.6 - 18.3mCi/kg）。累积剂量中位数为1015mCi（范围386 - 1690mCi）。
3例患者完全缓解，其中2例有软组织和骨转移。他们的中位随访时间为45个月（范围23 - 101个月）。7例患者部分缓解（PR），中位随访时间43个月（范围6 - 47个月）。2例无反应患者死于疾病进展（PD），2例初始PR患者分别在13个月和11个月死于PD。79%（19次治疗中的15次）治疗后出现3级血小板减少。3级和4级中性粒细胞减少分别出现在53%（19次治疗中的10次）和19%（19次治疗中的4次）治疗后。1例患者需要干细胞输注，1例发生原发性卵巢功能衰竭。
131I-MIBG的单次和累积剂量比其他中心使用的剂量高约2 - 3.5倍。与先前报道不同，2例同时有骨和软组织转移的患者完全缓解。血液学毒性显著但可耐受。高剂量131I-MIBG可能使恶性嗜铬细胞瘤患者获得长期生存。
