title: Thyroid and hepatic function after high-dose 131 I-metaiodobenzylguanidine (131 I-MIBG) therapy for neuroblastoma.
abstract: 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.
authors.affiliation: Department of Pediatrics, UCSF Children's Hospital, University of California, San Francisco, California 94143-0106, USA.
authors.forename: Alekist
authors.initials: A
authors.lastname: Quach
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.forename: Vikash
authors.initials: V
authors.lastname: Mishra
authors.forename: Aimee
authors.initials: A
authors.lastname: Sznewajs
authors.forename: Janet
authors.initials: J
authors.lastname: Veatch
authors.forename: John
authors.initials: J
authors.lastname: Huberty
authors.forename: Benjamin
authors.initials: B
authors.lastname: Franc
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: Susan
authors.initials: S
authors.lastname: Groshen
authors.forename: Denice
authors.initials: D
authors.lastname: Wei
authors.forename: Paul
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: John M
authors.initials: JM
authors.lastname: Maris
authors.forename: Gregory
authors.initials: G
authors.lastname: Yanik
authors.forename: Randall A
authors.initials: RA
authors.lastname: Hawkins
authors.forename: Judith G
authors.initials: JG
authors.lastname: Villablanca
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D007457:Iodine Radioisotopes; D019797:3-Iodobenzylguanidine