Sensitivity of surveillance studies for detecting asymptomatic and unsuspected relapse of high-risk neuroblastoma Journal Article


Authors: Kushner, B. H.; Kramer, K.; Modak, S.; Cheung, N. K. V.
Article Title: Sensitivity of surveillance studies for detecting asymptomatic and unsuspected relapse of high-risk neuroblastoma
Abstract: Purpose Relapse-free survival (RFS) is a powerful measure of treatment efficacy. We describe the sensitivity of standard surveillance studies for detecting relapse of neuroblastoma (NB). Patients and Methods The patients were in complete/very good partial remission of high-risk NB; routine monitoring revealed asymptomatic and, therefore, unsuspected relapses in 113 patients, whereas 41 patients had symptoms prompting urgent evaluations. Assessments every 2 to 4 months included computed tomography, iodine-131-metaiodobenzylguanidine (<sup>131</sup>I-MIBG; through November 1999) or iodine-123- metaiodobenzylguanidine (<sup>123</sup>I-MIBG) scan, urine catecholamines, and bone marrow (BM) histology. Bone scan was routine through 2002. Results <sup>123</sup>I-MIBG scan was the most reliable study for revealing unsuspected relapse; it had an 82% detection rate, which was superior to the rates with <sup>131</sup>I-MIBG scan (64%; P =.1), bone scan (36%; P &lt;.001), and BM histology (34%; P &lt;.001). Among asymptomatic patients, <sup>123</sup>I-MIBG scan was the sole positive study indicating relapse in 25 (27%) of 91 patients compared with one (4.5%) of 22 patients for <sup>131</sup>I-MIBG scan (P =.04) and 0% to 6% of patients for each of the other studies (P &lt;.001). Patients whose monitoring included <sup>123</sup>I-MIBG scan were significantly less likely than patients monitored by <sup>131</sup>I-MIBG scan to have an extensive osteomedullary relapse and had a significantly longer survival from relapse (P &lt;.001) and from diagnosis (P =.002). They also had significantly longer survival than patients with symptomatic relapses (P =.002). Conclusion <sup>123</sup>I-MIBG scan is essential for valid estimation of the duration of RFS of patients with high-risk NB. Without monitoring that includes <sup>123</sup>I-MIBG scan, caution should be used when comparing RFS between institutions and protocols. © 2009 by American Society of Clinical Oncology.
Keywords: adolescent; cancer survival; human tissue; disease-free survival; survival analysis; major clinical study; histopathology; cancer risk; disease free survival; cancer diagnosis; sensitivity and specificity; computer assisted tomography; neoplasm recurrence, local; bone marrow; clinical assessment; tomography, x-ray computed; patient monitoring; cancer regression; iodine radioisotopes; neuroblastoma; clinical evaluation; neoplasm metastasis; (3 iodobenzyl)guanidine i 123; 3-iodobenzylguanidine; cancer relapse; therapy effect; cancer epidemiology; bone and bones; high risk population; (3 iodobenzyl)guanidine i 131; catecholamine; catecholamines; bone scintiscanning; catecholamine urine level
Journal Title: Journal of Clinical Oncology
Volume: 27
Issue: 7
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2009-03-01
Start Page: 1041
End Page: 1046
Language: English
DOI: 10.1200/jco.2008.17.6107
PUBMED: 19171710
PROVIDER: scopus
PMCID: PMC2667809
DOI/URL:
Notes: --- - "Cited By (since 1996): 5" - "Export Date: 30 November 2010" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Brian Kushner
    190 Kushner
  2. Nai-Kong Cheung
    439 Cheung
  3. Kim Kramer
    168 Kramer
  4. Shakeel Modak
    159 Modak