Schmidt M, Simon T, Hero B, Eschner W, Dietlein M, Sudbrock F, Bongartz R, Berthold F, Schicha H
Department of Nuclear Medicine, University of Cologne, Kerpener Strasse 62, 50937 Köln, Germany.
Nuklearmedizin. 2006;45(4):145-51; quiz N39-40.
(131)I-meta-iodobenzylguanidine ((131)I-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 (123)I-MIBG positive residual disease (primary tumour and/or metastasis) after complete induction chemotherapy according to the German neuroblastoma trial NB97 were retrospectively analyzed.
One-hundred-eleven patients had (123)I-MIBG positive residual disease after complete induction chemotherapy. Forty patients received (131)I-MIBG therapy using a median activity of 0.44 GBq/kg body weight. By univariate analysis, patients who underwent (131)I-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 (131)I-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 (131)I-MIBG therapy (3-y-EFS 49 +/- 9%, 3-y-OS 59 +/- 10%) and without (131)I-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, (131)I-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.
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 (131)I-MIBG therapy with emphasis on tumour dosimetry.
碘-131间碘苄胍（(131)I-MIBG）治疗已用于神经母细胞瘤治疗多年，但其在高强度一线治疗方案中的价值尚不完全清楚。
患者、方法：回顾性分析了根据德国神经母细胞瘤试验NB97进行完全诱导化疗后，年龄大于1岁且(123)I-MIBG阳性残留病灶（原发肿瘤和/或转移灶）的4期神经母细胞瘤患者。
111例患者在完全诱导化疗后有(123)I-MIBG阳性残留病灶。40例患者接受了(131)I-MIBG治疗，中位活度为0.44GBq/kg体重。单因素分析显示，接受(131)I-MIBG治疗的患者3年无事件生存率（3-y-EFS 46±8%）和3年总生存率（3-y-OS 58±9%）优于71例未接受(131)I-MIBG治疗的患者（3-y-EFS 19±5%，p = 0.003；3-y-OS 43±6%，p = 0.037）。然而，对66例在治疗期间接受高剂量化疗联合自体干细胞移植（ASCT）的患者进行亚组分析发现，接受(131)I-MIBG治疗（3-y-EFS 49±9%，3-y-OS 59±10%）和未接受(131)I-MIBG治疗（3-y-EFS 33±9%，p = 0.171；3-y-OS 59±9%，p = 0.285）的患者结局非常相似，这是由于ASCT的主导作用。多因素分析显示，(131)I-MIBG治疗对无事件生存率（p = 0.494）和总生存率（p = 0.891）无影响。只有ASCT、外照射放疗和MYCN扩增对无事件生存率和总生存率有重要影响。
在这项回顾性分析中未能证实I-131-MIBG治疗的独立优势。正在进行的德国神经母细胞瘤试验NB2004将着重探讨(131)I-MIBG治疗的影响，重点是肿瘤剂量测定。
