title: Targeted therapy with low doses of 131I-MIBG is effective for disease palliation in highly refractory neuroblastoma.
abstract: BACKGROUND
  Palliative treatment ore remains a significant clinical problem.
  
  
  OBJECTIVE
  To retrospectively determine the clinical response to 131I-MIBG therapy at low doses in patients with refractory neuroblastoma.
  
  
  METHODS
  We performed a retrospective chart review of 10 patients with neuroblastoma treated with 1311-MIBG at Rambam Health Care Campus from 1994 to 2012. Clinical data, number of 131I-MIBG courses delivered, toxicities, and clinical responses were reviewed. MIBG scan was performed after each course.
  
  
  RESULTS
  Twenty-one courses of 131I-MIBG were delivered to 10 patients (3 girls, 7 boys). Their mean age was 3.8 years (range 1.5-6 years). All patients received several protocols of chemotherapy including the high dose form. Three patients received three courses of 131I-MIBG with a minimum of 6 weeks between each course, five patients received two courses, and two patients received only one course. An objective response to the first course was obtained in nine patients and to the second course in six of eight, and in three children who underwent the third course the pain decreased. One patient has no evidence of disease, four are alive with disease, and five died of the disease. No unanticipated toxicities were observed.
  
  
  CONCLUSIONS
  Low dose 131I-MIBG is an effective and relatively non-toxic treatment in neuroblastoma disease palliation. Rapid and reproducible pain relief with 131I-MIBG was obtained in most of the children. Treatment with systemic radiotherapy in the form of low dose 131I-MIBG was easy to perform and effective in cases of disseminated neuroblastoma, demonstrating that this primary therapy can be used for palliative purposes.
authors.affiliation: Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Israel. m_benarush@rambam.health.gov.il
authors.forename: Myriam
authors.initials: M
authors.lastname: Weyl Ben-Arush
authors.forename: Ayelet
authors.initials: A
authors.lastname: Ben Barak
authors.forename: Raquel
authors.initials: R
authors.lastname: Bar-Deroma
authors.forename: Shifra
authors.initials: S
authors.lastname: Ash
authors.forename: Gal
authors.initials: G
authors.lastname: Goldstein
authors.forename: Hanna
authors.initials: H
authors.lastname: Golan
authors.forename: Haim
authors.initials: H
authors.lastname: Houri
authors.forename: Dalia
authors.initials: D
authors.lastname: Waldman
authors.forename: Neta
authors.initials: N
authors.lastname: Nevo
authors.forename: Rachel
authors.initials: R
authors.lastname: Bar Shalom
authors.forename: Alison
authors.initials: A
authors.lastname: Berniger
authors.forename: Alexander
authors.initials: A
authors.lastname: Nevelsky
authors.forename: Amos
authors.initials: A
authors.lastname: Toren
authors.forename: Isaac
authors.initials: I
authors.lastname: Yaniv
authors.forename: Abraham
authors.initials: A
authors.lastname: Kuten
mesh_terms: D019797:3-Iodobenzylguanidine / Q000008:administration & dosage* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001859:Bone Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000188:drug therapy* / Q000473:pathology; D009447:Neuroblastoma / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019797:3-Iodobenzylguanidine