Castellani M R, Seghezzi S, Chiesa C, Aliberti G L, Maccauro M, Seregni E, Orunesu E, Luksch R, Bombardieri E
Nuclear Medicine Division, National Cancer Institute, Milan, Italy.
Q J Nucl Med Mol Imaging. 2010 Feb;54(1):100-13.
Since the second half of the 1980s, (131)I-MIBG has been widely used for treatment of patients with malignant pheochromocytoma. In 1991, at the International Meeting in Rome, it was agreed that (131)I-MIBG therapy induces significant tumor responses in about 30-50% of cases, long-term stabilization of disease in several cases and significant reduction of cathecolamine-related symptoms in almost all patients. Nevertheless, more than 20 years later, its therapeutic use in malignant phaeochromocytoma has not yet been standardized. Aim of the present study was to compare the use of low versus intermediate activity of MIBG to achieve better results in a shorter time with higher activities.
Two different modalities of (131)I-MIBG therapy were performed: before 2001, 12 patients (Group 1) received a fixed activity of 5.55 GBq/session. From 2001 to 2009, 16 patients (Group 2) were treated with 9.25-12.95 GBq/session.
As expected, the overall response rate in Group 2 are slightly better. The most important result of increasing the single session activity was the shorter median time to achieve a significant response (7 versus 19 months), which was obtained with a lower median cumulative activity (11 versus 22 GBq) in a lower median number of sessions (2 versus 7).
We demonstrated that intermediate single session activity shortened to one third the global treatment time, with similar efficacy and a moderate increment of toxicity. Consequently, the increase of (131)I-MIBG activity, without reaching myeloablative levels, can be recommended for standard treatment of pheochromocytoma and paraganglioma patients.
自20世纪80年代后半期以来，碘-131间碘苄胍（¹³¹I-MIBG）已广泛用于治疗恶性嗜铬细胞瘤患者。1991年，在罗马召开的国际会议上达成共识，¹³¹I-MIBG治疗在约30%-50%的病例中可诱导显著的肿瘤反应，在一些病例中可实现疾病的长期稳定，并且几乎所有患者的儿茶酚胺相关症状都有显著减轻。然而，20多年后，其在恶性嗜铬细胞瘤中的治疗应用仍未标准化。本研究的目的是比较低活度与中活度MIBG的使用情况，以期在更短时间内以更高活度取得更好的效果。
进行了两种不同方式的¹³¹I-MIBG治疗：2001年之前，12例患者（第1组）每次接受固定活度5.55 GBq。2001年至2009年，16例患者（第2组）每次接受9.25-12.95 GBq的治疗。
正如预期的那样，第2组的总体反应率略好。增加单次治疗活度的最重要结果是达到显著反应的中位时间更短（7个月对19个月），这是在更低的中位累积活度（11 GBq对22 GBq）和更少的中位治疗次数（2次对7次）下实现的。
我们证明，中等单次治疗活度可将总体治疗时间缩短至三分之一，疗效相似且毒性有适度增加。因此，对于嗜铬细胞瘤和副神经节瘤患者的标准治疗，推荐增加¹³¹I-MIBG活度，但不达到骨髓消融水平。
