Thyroid and hepatic function after high-dose 131 I-metaiodobenzylguanidine (131 I-MIBG) therapy for neuroblastoma.
BACKGROUND
(131) I-Metaiodobenzylguanidine ((131) I-MIBG) provides targeted radiotherapy for children with neuroblastoma, a malignancy of the sympathetic nervous system. Dissociated radioactive iodide may concentrate in the thyroid, and (131) I-MIBG is concentrated in the liver after (131) I-MIBG therapy. The aim of our study was to analyze the effects of (131) I-MIBG therapy on thyroid and liver function.


METHODS
Pre- and post-therapy thyroid and liver functions were reviewed in a total of 194 neuroblastoma patients treated with (131) I-MIBG therapy. The cumulative incidence over time was estimated for both thyroid and liver toxicities. The relationship to cumulative dose/kg, number of treatments, time from treatment to follow-up, sex, and patient age was examined.


RESULTS
In patients who presented with Grade 0 or 1 thyroid toxicity at baseline, 12  ±  4% experienced onset of or worsening to Grade 2 hypothyroidism and one patient developed Grade 2 hyperthyroidism by 2 years after (131) I-MIBG therapy. At 2 years post-(131) I-MIBG therapy, 76  ±  4% patients experienced onset or worsening of hepatic toxicity to any grade, and 23  ±  5% experienced onset of or worsening to Grade 3 or 4 liver toxicity. Liver toxicity was usually transient asymptomatic transaminase elevation, frequently confounded by disease progression and other therapies.


CONCLUSIONS
The prophylactic regimen of potassium iodide and potassium perchlorate with (131) I-MIBG therapy resulted in a low rate of significant hypothyroidism. Liver abnormalities following (131) I-MIBG therapy were primarily reversible and did not result in late toxicity. (131) I-MIBG therapy is a promising treatment for children with relapsed neuroblastoma with a relatively low rate of symptomatic thyroid or hepatic dysfunction.
Quach
Alekist
A
Department of Pediatrics, UCSF Children's Hospital, University of California, San Francisco, California 94143-0106, USA.
Ji
Lingyun
L
Mishra
Vikash
V
Sznewajs
Aimee
A
Veatch
Janet
J
Huberty
John
J
Franc
Benjamin
B
Sposto
Richard
R
Groshen
Susan
S
Wei
Denice
D
Fitzgerald
Paul
P
Maris
John M
JM
Yanik
Gregory
G
Hawkins
Randall A
RA
Villablanca
Judith G
JG
Matthay
Katherine K
KK
D019797:3-Iodobenzylguanidine / Q000009:adverse effects*; D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects*; D008099:Liver / Q000528:radiation effects*; D008111:Liver Function Tests; D008297:Male; D009447:Neuroblastoma / Q000532:radiotherapy*; D013961:Thyroid Gland / Q000528:radiation effects*; D055815:Young Adult
D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D019797:3-Iodobenzylguanidine