title: Iodine-131-metaiodobenzylguanidine as initial induction therapy in stage 4 neuroblastoma patients over 1 year of age.
abstract: OBJECTIVE
  To determine the response to radionuclide targeted therapy with I-131-metaiodobenzylguanidine ((131)I-MIBG) as induction therapy in high-risk neuroblastoma patients.
  
  
  METHODS
  The protocol dictated at least two cycles of (131)I-MIBG with a fixed dose of 7.4 and 3.7 GBq, respectively, followed by surgery, if feasible, or followed by neoadjuvant chemotherapy and surgery. This was followed by consolidation with four courses of chemotherapy myeloablative chemotherapy and autologous stem-cell transplantation (ASCT). Consolidation therapy with 13-cis-retinoic acid was given for 6 months.
  
  
  RESULTS
  Of 44 consecutive patients, 41 were evaluable after two courses of (131)I-MIBG. The objective response rate at this point was 66%. In 24 patients, (131)I-MIBG was continued as pre-operative induction treatment. Seventeen patients required additional chemotherapy before surgery. After pre-operative therapy and surgery, the overall response rate was 73%.
  
  
  CONCLUSIONS
  First line (131)I-MIBG-targeted therapy is a valuable tool in the treatment of MIBG-positive high-risk neuroblastoma patients.
authors.affiliation: Emma Children's Hospital/Academic Medical Centre, Department of Paediatric Oncology Haematology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. j.dekraker@amc.uva.nl
authors.forename: Jan
authors.initials: J
authors.lastname: de Kraker
authors.forename: Kees A
authors.initials: KA
authors.lastname: Hoefnagel
authors.forename: Arnauld C
authors.initials: AC
authors.lastname: Verschuur
authors.forename: Berthe
authors.initials: B
authors.lastname: van Eck
authors.forename: Hanneke M
authors.initials: HM
authors.lastname: van Santen
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
mesh_terms: D019797:3-Iodobenzylguanidine / Q000627:therapeutic use*; D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004341:Drug Evaluation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D015474:Isotretinoin / Q000627:therapeutic use; D008297:Male; D009447:Neuroblastoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D015474:Isotretinoin