title: Treatment of advanced neuroblastoma in children over 1 year of age: the critical role of ¹³¹I-metaiodobenzylguanidine combined with chemotherapy in a rapid induction regimen.
abstract: BACKGROUND
  The prognosis of patients with advanced neuroblastoma (NB) remains poor. Major and early responses have an important bearing on treatment outcome. Iodine-131-metaiodobenzylguanidine (¹³¹I-MIBG) has the potential to deliver large doses of radiation specifically to NB cells. We evaluated the toxicity of, and response to, a novel induction regimen that included ¹³¹I-MIBG combined with cisplatin, cyclophosphamide, etoposide, vincristine, and doxorubicin.
  
  
  METHODS
  Thirteen children over 1 year of age with advanced NB at diagnosis were investigated extensively. ¹³¹I-MIBG was administered on day 10; this was preceded by chemotherapy in the five patients in group 1 (described in our previous study), and both preceded and followed by chemotherapy in the eight patients in group 2. The final induction regimen (used for group 2) lasted 1 month. Evaluation was performed 40 days after the start of treatment.
  
  
  RESULTS
  In both groups 1 and 2, the extent of hematologic toxicity, which was the only side effect, was similar to that seen with chemotherapy alone. Doses of ¹³¹I-MIBG as high as 16.6 mCi/kg showed no evidence of toxicity, even in patients with extensive bone marrow infiltration. Overall, we recorded two patients with a complete response (CR), six very good partial responses (VGPR), four partial responses (PR), and one mixed response (MR). In group 2, CR/VGPR were observed in patients treated with higher doses of ¹³¹I-MIBG.
  
  
  CONCLUSIONS
  The results of this pilot study show that ¹³¹I-MIBG, in combination with chemotherapy, appears to play an important role in a new and effective induction regimen for advanced NB.
authors.affiliation: Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy. stefano.mastrangelo@rm.unicatt.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Mastrangelo
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.forename: Antonio
authors.initials: A
authors.lastname: Ruggiero
authors.forename: Angela
authors.initials: A
authors.lastname: Di Giannatale
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riccardi
mesh_terms: D019797:3-Iodobenzylguanidine / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D009447:Neuroblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D010865:Pilot Projects; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D002945:Cisplatin