Impact of metaiodobenzylguanidine scintigraphy on assessing response of high-risk neuroblastoma to dose-intensive induction chemotherapy Journal Article

Authors: Kushner, B. H.; Yeh, S. D. J.; Kramer, K.; Larson, S. M.; Cheung, N. K. V.
Article Title: Impact of metaiodobenzylguanidine scintigraphy on assessing response of high-risk neuroblastoma to dose-intensive induction chemotherapy
Abstract: Purpose: The International Neuroblastoma Response Criteria (INRC) recommend, but do not make mandatory, metaiodobenzylguanidine (MIBG) scans. We present the first report on the effect of MIBG scans on the classification of response to dose-intensive induction therapy. Patients and Methods: After dose-intensive induction and before consolidative therapy, 162 Memorial Sloan-Kettering Cancer Center (MSKCC) patients with high-risk neuroblastoma (NB) had MIBG scans (99 with 131I, 63 with 123I), computed tomography, 99mTc-bone scan, bone marrow (BM) tests, and urine catecholamine measurements. Induction included high-dose cyclophosphamide (140 mg/ kg) plus other agents and high-dose cisplatin (200 mg/m2)/ etoposide (600 mg/m2). Results: In 90 patients treated with dose-intensive therapy from diagnosis at MSKCC, the use of MIBG scintigraphy increased the incomplete response numbers from 14 (15.5%) to 20 (22%), giving a complete remission/very good partial remission (CR/VGPR) rate of 78%. In 72 patients treated before referral to MSKCC for intensified therapy, MIBG findings changed the response classification of one patient; the CR/VGPR rate was 43%. MIBG scans showed no BM disease in 15 of 38 patients with histologically/ evident NB in BM but did show uptake consistent with BM involvement in five patients who had no NB observed in BM tests. Conclusion: With the less effective therapy consequent to the intensification of induction only after initial exposure to standard-dose chemotherapy, MIBG scintigraphy merely confirms the findings of other staging modalities for detection of relatively widespread residual NB. However, when dose-intensive therapy is initiated at diagnosis, the reliable achievement of major disease responses makes extensive BM testing and MIBG scintigraphy prerequisites for accurate determination of disease status. © 2003 by American Society of Clinical Oncology.
Keywords: adolescent; adult; cancer chemotherapy; child; controlled study; preschool child; treatment response; child, preschool; major clinical study; cisplatin; cancer risk; dose response; antineoplastic agent; radiopharmaceuticals; computer assisted tomography; bone marrow; etoposide; antineoplastic combined chemotherapy protocols; cyclophosphamide; drug effect; dose-response relationship, drug; histology; risk; cancer regression; iodine 131; diagnostic agent; infant; neuroblastoma; radiopharmaceutical agent; scintiscanning; (3 iodobenzyl)guanidine; 3-iodobenzylguanidine; remission; remission induction; urine; cancer scintiscanning; catecholamine; catecholamines; bone scintiscanning; catecholamine urine level; iodine 123; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 21
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2003-03-15
Start Page: 1082
End Page: 1086
Language: English
DOI: 10.1200/jco.2003.07.142
PUBMED: 12637474
PROVIDER: scopus
Notes: Export Date: 12 September 2014 -- Source: Scopus
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MSK Authors
  1. Samuel D J Yeh
    53 Yeh
  2. Brian Kushner
    190 Kushner
  3. Nai-Kong Cheung
    438 Cheung
  4. Kim Kramer
    168 Kramer
  5. Steven M Larson
    762 Larson