131I mibg as a second line therapy in children with advanced neuroblastoma

الملخص EN

Objectives : to evaluate the role of 131I MIBG as a second line therapy in patients with advanced Neuro-blastoma.

Patients and Methods : 30 children with advanced Neuroblastoma who were either refractory to conventional chemotherapy or showed disease relapse after initial successful treatment, received 131I MIBG as a second line therapy in a dose of 100 mci per course, at 4 weeks interval for 3-4 courses.

Patients were isolated in private rooms, and given dexamethasone to guard against la-ryngeal edema and other radiation effects.

On the 5th day post MIBG therapy, whole body scintigraphy was done to all patients.

Assessment of response was done at the end of therapy by CAT scan, bone scan, 131I MIBG imaging and urinary VMA.

Results : Neuroblastoma patients were 15 boys, and 15 girls.

All were younger than 16 years.

There were 6 patients in stage III, and 24 in stage IV according to Evans stages.

Three patients received 1 course of 131I MIBG, 7 : 2 courses, 16 : 3 courses, 4 : 4 courses.

Three out of thirty (10 %) of the children showed disease progression, 1 / 30 (3.3 %) showed no response.

The rest showed varying degrees of response from stable disease in 2 / 30 (6.7 %).

Partial response in 18/30 (60%), and complete response in 6 / 30 (20 %).

At 2 years, 17 / 30 (56.7 %) are still alive and (13 / 30) are dead, 2 of them died of medical causes not related to Neuroblastoms.

The median performance status as measured by Panofsky index markedly improved post MIBG therapy : 80 % versus 60 % pretherapy(p < 0.001).

The median body weight significantly increased after therapy: 34 kg versus 27kg pretherapy (p < 0.05).

Conclusion : 131I MIBG therapy at a dose of 100 mci is a safe and effective line of therapy in advanced Neuro-blastoma.