Mastrangelo R, Tornesello A, Riccardi R, Lasorella A, Mastrangelo S, Mancini A, Rufini V, Troncone L
Divisione di Oncologia Pediatrica, Università Cattolica, Rome, Italy.
Eur J Cancer. 1995;31A(4):606-11. doi: 10.1016/0959-8049(95)00048-n.
The outlook for disseminated neuroblastoma (NB) continues to be dismal. NB is a radiosensitive tumour. Owing to its high concentration in NB lesions, [131I]meta-iodobenzylguanidine [131I]MIBG has the potential for specifically delivering very large radiation doses to the malignant cells. Encouraging results have been reported with [131I]MIBG used alone in patients resistant to conventional therapy and at diagnosis. We report the first attempt to explore the integration of this new treatment modality with chemotherapy. Among the drugs effective in NB, cisplatin was chosen because of its high degree of activity against NB, its mild haematological toxicity and the known synergism between cisplatin and radiation. 4 patients, 3 with relapsed, heavily pre-treated, progressive stage IV NB, and 1 with stage IV NB at diagnosis, all with a good [131I]MIBG uptake, were investigated with combined therapy (CO-TH). Two complete remissions and one partial remission were observed in these patients 4-6 weeks following only a single course of both cisplatin and [131I]MIBG at "standard" dosage. The only toxicity was haematological, which was significant and relatively long-lasting, but was not associated with any serious infections or bleeding tendency. The general condition of these patients during the entire study period was excellent. The fourth patient, investigated at diagnosis with a modified less intensive treatment, obtained a partial remission with mild haematological toxicity. During the subsequent courses of intensive multidrug chemotherapy, this patient showed haematological toxicity comparable with that experienced by patients treated with an identical drug combination, but without previous treatment with CO-TH. The provisional conclusion of this ongoing study is that this new form of CO-TH appears most effective in obtaining a rapid and excellent response in heavily pretreated relapsed patients with progressive disease, and should be further investigated in earlier stages of the disease.
播散性神经母细胞瘤（NB）的预后仍然不容乐观。NB是一种对放疗敏感的肿瘤。由于[131I]间碘苄胍（[131I]MIBG）在NB病灶中浓度较高，它有可能将非常大的辐射剂量特异性地传递给恶性细胞。已有报道称，单独使用[131I]MIBG治疗对传统治疗耐药及初诊的患者取得了令人鼓舞的结果。我们报告了首次探索这种新治疗方式与化疗联合应用的尝试。在对NB有效的药物中，选择顺铂是因为它对NB具有高度活性、血液学毒性轻微且已知顺铂与放疗之间存在协同作用。4例患者，3例为复发的、经过大量前期治疗的进展期IV期NB，1例为初诊IV期NB，所有患者[131I]MIBG摄取良好，接受了联合治疗（CO - TH）。仅给予一个疗程“标准”剂量的顺铂和[131I]MIBG后4 - 6周，这些患者中观察到2例完全缓解和1例部分缓解。唯一的毒性反应是血液学方面的，较为显著且持续时间相对较长，但未伴有任何严重感染或出血倾向。在整个研究期间，这些患者的一般状况良好。第四例患者在初诊时接受了改良的强度较低的治疗，获得了部分缓解，血液学毒性轻微。在随后的强化多药化疗疗程中，该患者表现出的血液学毒性与接受相同药物组合但未接受过CO - TH前期治疗的患者相当。这项正在进行的研究初步结论是，这种新的CO - TH形式在获得快速且良好的反应方面，对经过大量前期治疗的复发进展期患者似乎最为有效，并且应该在疾病的早期阶段进行进一步研究。
