title: The prognostic impact of functional imaging with (123)I-mIBG in patients with stage 4 neuroblastoma >1 year of age on a high-risk treatment protocol: results of the German Neuroblastoma Trial NB97.
abstract: OBJECTIVE
  (123)I-meta-iodobenzylguanidine ((123)I-mIBG) scintigraphy is well established for staging and evaluation of response in children with high-risk neuroblastoma but its prognostic value in highly intensive first-line treatment protocols is uncertain. The presence of any (123)I-mIBG positive tumour tissue was correlated with event-free survival (EFS) and overall survival (OS).
  
  
  METHODS
  The prognostic impact of residual (123)I-mIBG uptake into the primary tumour and metastases for predicting outcome in 113 stage 4 neuroblastoma patients >1 year of the German Neuroblastoma Trial NB97 was assessed using a univariate log-rank test and multivariate Cox regression analysis.
  
  
  RESULTS
  All patients had (123)I-mIBG positive disease at initial staging. After four courses of induction chemotherapy, 71% of patients were still (123)I-mIBG positive for the primary tumour and 61% for metastases. After six courses, 39% of patients had (123)I-mIBG uptake by the primary tumour and 45% residual (123)I-mIBG positive metastatic disease. The (123)I-mIBG status of the primary tumour site had no bearing on outcome. Residual (123)I-mIBG positive metastatic disease after four (3-y-EFS 25.7+/-5.3% versus 55.9+/-7.6%, p=0.009; 3-y-OS 49.8+/-6.1% versus 65.0+/-7.3%; p=0.021) and after six chemotherapy cycles (3-y-EFS 27.5+/-6.2% versus 47.4+/-6.4%, p=0.011; 3-y-OS 50.5+/-7.1% vs 60.0+/-6.4%, p=0.031) was associated with poor outcome.
  
  
  CONCLUSIONS
  Functional imaging with (123)I-mIBG scintigraphy can identify poor responders with any persistent metastatic (123)I-mIBG uptake who are at a high risk of disease relapse. (123)I-mIBG response of the primary tumour site had no bearing on outcome.
authors.affiliation: Department of Nuclear Medicine, University of Cologne, Kerpener Street, 62, 50937 Köln (Cologne), Germany. Matthias.Schmidt@uni-koeln.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmidt
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Barbara
authors.initials: B
authors.lastname: Hero
authors.forename: Harald
authors.initials: H
authors.lastname: Schicha
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
mesh_terms: D019797:3-Iodobenzylguanidine; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D006801:Humans; D007223:Infant; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000628:therapy; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000628:therapy; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000379:methods; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine