Targeted Therapy With Low Doses Of I-131-Mibg Is Effective For Disease Palliation In Highly Refractory Neuroblastoma

Background: Palliative treatment of refractory neuroblastoma remains a significant clinical problem.Objectives: To retrospectively determine the clinical response to I-131-MIBG therapy at low doses in patients with refractory neuroblastoma.Methods: We performed a retrospective chart review of 10 patients with neuroblastoma treated with I-131-MIBG at Rambam Health Care Campus from 1994 to 2012. Clinical data, number of I-131-MIBG courses delivered, toxicities, and clinical responses were reviewed. MIBG scan was performed after each course.Results: Twenty-one courses of I-131-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 I-131-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 I-131-MIBG is an effective and relatively non-toxic treatment in neuroblastoma disease palliation. Rapid and reproducible pain relief with I-131-MIBG was obtained in Most of the children. Treatment with systemic radiotherapy in the form of low dose I-131-MIBG was easy to perform and effective in cases of disseminated neuroblastoma, demonstrating that this primary therapy can be used for palliative purposes. IMAJ 2013; 15:31-34