Lam Marnix G E H, Lips Cornelis J M, Jager Pieter L, Dullaart Robin P F, Lentjes Eef G W M, van Rijk Peter P, de Klerk John M H
University Medical Center Utrecht, Department of Nuclear Medicine, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
J Clin Endocrinol Metab. 2005 Oct;90(10):5888-95. doi: 10.1210/jc.2004-2290. Epub 2005 Jul 26.
Approximately 10% of pheochromocytomas are malignant with a 5-yr survival rate of less than 40%. Promising results have been published on single high-dosage [131I]metaiodobenzylguanidine ([131I]MIBG) treatment for malignant pheochromocytoma. We present our experience with multiple intermediate-dosage [131I]MIBG therapy instead of single high-dosage therapy.
The study took place at University Medical Centers and included two patients (one male, 36 yr of age, and one female, 43 yr of age) with widely spread metastatic pheochromocytoma and bad prognosis because of liver and lung metastases.
Instead of a single high dosage, these two patients were treated with multiple intermediate dosages of [131I]MIBG. The first patient received 37 GBq (1 Ci) [131I]MIBG in five sessions [7400 MBq (200 mCi) each; interval range, 2-11 months]; the second patient received 66.6 GBq (1.8 Ci) [131I]MIBG in 12 sessions [5550 MBq (150 mCi) each; interval range, 2-14 months].
We measured efficacy, toxicity, and survival.
Both patients had a complete symptomatic response and a partial tumor volume response. The first patient had a partial biochemical response, the second a complete biochemical response. In both cases, toxicity has been confined to nausea during treatment. Hematological toxicity was minimal, and both patients stayed euthyroid. The survival (so far) of these patients was 5 yr (clinical case 1) and 16 yr (clinical case 2) after initial diagnosis.
Repeated intermediate-dosage [131I]MIBG treatment appears to be a reliable and well-tolerated radionuclide therapy and might be a useful adjunct in patients with malignant pheochromocytoma, providing longstanding palliation and prolonged survival.
约10%的嗜铬细胞瘤为恶性，其5年生存率低于40%。关于单次高剂量[131I]间碘苄胍（[131I]MIBG）治疗恶性嗜铬细胞瘤已发表了有前景的结果。我们介绍了我们采用多次中等剂量[131I]MIBG治疗而非单次高剂量治疗的经验。
该研究在大学医学中心进行，纳入了两名患者（一名36岁男性和一名43岁女性），他们患有广泛转移的嗜铬细胞瘤，因肝肺转移预后不良。
这两名患者未采用单次高剂量治疗，而是接受了多次中等剂量的[131I]MIBG治疗。第一名患者分五次接受37 GBq（1 Ci）[131I]MIBG（每次7400 MBq（200 mCi）；间隔范围为2 - 11个月）；第二名患者分12次接受66.6 GBq（1.8 Ci）[131I]MIBG（每次5550 MBq（150 mCi）；间隔范围为2 - 14个月）。
我们测量了疗效、毒性和生存率。
两名患者均有完全的症状缓解和部分肿瘤体积缩小。第一名患者有部分生化反应，第二名患者有完全生化反应。在两种情况下，毒性均局限于治疗期间的恶心。血液学毒性极小，两名患者甲状腺功能均保持正常。这些患者自初次诊断后的生存时间（目前）分别为5年（临床病例1）和16年（临床病例2）。
重复中等剂量[131I]MIBG治疗似乎是一种可靠且耐受性良好的放射性核素治疗方法，可能是恶性嗜铬细胞瘤患者的一种有用辅助治疗手段，可提供长期缓解并延长生存期。
