131 I METAJODOBENZYLGUANIDIN V KOMBINACIS HYPERBARICKOU OXYGENOTERAPIÍ V LÉČBĚPROGNOSTICKY VYSOCE NEPŘÍZNIVÝCH FOREMNEUROBLASTOMU

I-Meta-Iodobenzylguanidine in the Treatment of the High RiskNeuroblastoma Patients – Experiences from the Department of Pediatric Oncology in Faculty Hospital Motol inPrague

Background.
Despite of improving diagnostics, development of new drugs and treatmen strategies, pa tients withbiologically unfavourable, advanced or relapsed neuroblastoma remain practically incurable. Treatment relatedtoxicity, requirement for personnel and financial costs have became limiting. Tumor specific therapy representedby131I-meta-iodobenzylguanidine (MIBG) administration could become an alternative improving the overallsurvival. In comparison with standard external radiotherapy the targeted therapy enables to achieve radiation 5 to10 times higher with lower organ toxicity. Data published by European and American colleagues brought evidenceof high efficacy of this method. It motivated us to set and develop the method at our department.Type of Study. Retrospective analysis of therapeutic results and side effects of the administration of131I-meta--iodobenzylguanidine in high-risk neuroblastoma patients cured at the Department of Pediatric Oncology in Praguesince 1997 till 2000.Method and Results.131I-meta-iodobenzylguanidine was fourteen times therapeutically administered in sevenhigh-risk relapsed neuroblastoma patients. Four children received a single dose of131I-meta-iodobenzylguanidine,three patients were treated repeatedly. The first dose represented 5,5 GBq, repeated dose 3,7 GBq, irrespective tothe body weight. Each MIBG administration was followed by four days hyperbaric oxygen therapy. The treatmentwas well tolerated, acute and late side effects were not serious and only rarely reached grade 3 or 4 according to theInternational North American Children’s Cancer Group Classification. Three of the seven children have survivedwith no evidence of the disease. Four children died of the disease progress.Conclusions.131I-meta-iodobenzylguanidine treatment combined with hyperbaric oxygen therapy becomes a well-tolerated therapy for high-risk neuroblastoma patients non-responding to the conventional treatment. Though the131I-meta-iodobenzylguanidine administration probably cannot cure these patients, the repeated administration canbring long lasting remission.

Key words:
neuroblastoma,I MIBG, targeted radiotherapy, hyperbaric oxygen therapy, therapy.