High-dose 131I-metaiodobenzylguanidine therapy for 12 patients with malignant pheochromocytoma.
BACKGROUND
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Rose
Brian
B
Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Matthay
Katherine K
KK
Price
David
D
Huberty
John
J
Klencke
Barbara
B
Norton
Jeffrey A
JA
Fitzgerald
Paul A
PA
D019797:3-Iodobenzylguanidine / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010235:Paraganglioma / Q000532:radiotherapy* / Q000556:secondary; D010673:Pheochromocytoma / Q000532:radiotherapy* / Q000556:secondary; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D019797:3-Iodobenzylguanidine