Despite aggressive research and treatment, high-risk neuroblastoma continues to have a devastating mortality rate of more than 40%. Research conducted over the past 2 decades has shown that the radioisotope 131I-MIBG (metaiodobenzylguanidine) is effective in the treatment of this difficult patient population. The purpose of this article is to review the diagnosis, staging, and conventional treatment of neuroblastoma and to understand the mechanism of action of MIBG and 131I-MIBG. This article also reviews treatments for high-risk neuroblastoma patients and analyzes recent research studies that used 131I-MIBG to better define the role of this treatment in high-risk neuroblastoma patients. In addition, this article explores the role of the advanced practice nurse to serve at the forefront in the implementation of a multidisciplinary 131I-MIBG treatment program.
Bailey, H.H., Mulcahy, R.T., Tutsch, K.D., Arzoomanian, R.Z., Alberti, D., Tombes, M.B., et al. (1994). Phase I clinical trial of intravenous 1-buthione sulfoxime and melphalan: An attempt at modulation of glutathione. Journal of Clinical Oncology, 12, 194-205.
2.
Brodeur, G.M., Pritchard, J., Berthold, F., Carlsen, N.L.T., Castel, V., Castleberry, R.P., et al. (1993). Revisions of international criteria for neuroblastoma diagnosis, staging, and response to treatment. Journal of Clinical Oncology, 11, 1466-1477.
3.
Brophy, P. (n.d.). Development of 131I-MIBG as a targeted radiotherapeutic for children with neuroblastoma. Unpublished manuscript.
4.
Brophy, P., Schmus, C., & Balistreri, L. (2004). Meeting the nursing challenges in treating children with 131I-MIBG. Journal of Pediatric Oncology Nursing, 21, 9-15.
5.
Dadd, G. ( 2002). Neuroblastoma. In C. R. Baggott, K. P. Kelly, D. Fochtman, & G. V. Foley (Eds.), Nursing care of children and adolescents with cancer (pp. 545-554). Philadelphia: W. B. Saunders.
6.
De Kraker, J., Hoefnagel, K.A., Verschuur, A.C., van Eck, B., van Santen, H.M., & Caron, H.N. ( 2008). Iodine-131-metaiodobenzylguanidine as initial induction therapy in stage 4 neuroblastoma patients over 1 year of age. European Journal of Cancer, 44, 551-556.
7.
Goldsby, R.E., & Matthay, K.K. ( 2004). Neuroblastoma: Evolving therapies for a disease with many faces. Pediatric Drugs, 6, 107-122.
8.
Howard, J.P., Maris, J.M., Kersun, L.S., Huberty, J.P., Cheng, S.C., Hawkins, R.A., et al. (2005). Tumor response and toxicity with multiple infusions of high dose 131I-MIBG for refractory neuroblastoma. Pediatric Blood Cancer, 44, 232-239.
9.
Kang, T.I., Brophy, P., Hickeson, M., Heyman, S., Evans, A.E., Charron, M., et al. (2003). Targeted radiotherapy with submyeloblative doses of 131I-MIBG is effective for disease palliation in highly refractory neuroblastoma. Journal of Pediatric Hematology Oncology, 25, 769-773.
10.
Katzenstein, H.M., & Cohn, S.L. ( 1998). Advances in diagnosis and treatment of neuroblastoma . Current Opinion in Oncology, 10, 43-51.
11.
Kushner, B.H., Cheung, N.K.V., Kramer, K., Dunkel, I.J., Calleja, E., & Boulad, F. ( 2001). Topotecan combined with myeloablative doses of thiotepa and carboplatin for neuroblastoma, brain tumors, and other poor risk solid tumors in children and young adults. Bone Marrow Transplantation , 28, 551-556.
Mastrangelo, S., Tornesello, A., Diociaiuti, L., Pession, A., Prete, A., Rufini, V., et al. (2001). Treatment of advanced neuroblastoma: Feasibility and therapeutic potential of a novel approach combining 131-I-MIBG and multiple drug therapy. British Journal of Cancer, 84, 460-464.
14.
Matthay, K.K., Tan, J.C., Villablanca, J.G., Yanik, G.A., Veatch, J., Franc, B., et al. (2006). Phase I dose escalation of iodine-131-metaiodobenzylguanidine with myeloablative chemotherapy and autologous stem-cell transplantation in refractory neuroblastoma: A new approaches to neuroblastoma therapy consortium study. Journal of Clinical Oncology, 24, 500-506.
15.
Matthay, K.K., Yanik, G., Messina, J., Quach, A., Huberty, J., Cheng, S.C., et al. (2007). Phase II study on the effect of disease sites, age, and prior therapy on response to iodine-131-metaiodobenzylguanidine therapy in refractory neuroblastoma. Journal of Clinical Oncology , 25, 1054-1060.
16.
McCluskey, A.G., Boyd, M., Gaze, M.N., & Maris, R.J. ( 2005). [131I]MIBG and topotecan: A rationale for combination therapy for neuroblastoma. Cancer Letters, 228, 221-227.
17.
Miano, M., Garaventa, A., Pizzitola, M.R., Lo Piccolo, M.S., Dallorso, S., Villavecchia, G.P., et al. (2001). Megatherapy combining I131 metaiodobenzylguadidine and high-dose chemotherapy with haematopoietic progenitor cell rescue for neuroblastoma. Bone Marrow Transplantation, 27, 571-574.
18.
Pashankar, F.D., O’Dorisio, M.S., & Menda, Y. ( 2005). MIBG and somatostatin receptor analogs in children: Current concepts on diagnostic and therapeutic use. Journal of Nuclear Medicine, 46, 55S-61S.
19.
Saylors, R.L., Stine, K.C., Sullivan, J., Kepner, J.L., Wall, D.A., Bernstein, M.L., et al. (2001). Cyclophosphamide plus topotecan in children with recurrent or refractory solid tumors: A pediatric oncology group phase II study. Journal of Clinical Oncology, 19, 3463-3469.
20.
Tepmongkol, S., & Heyman, S. ( 1999). 131I-MIBG therapy in neuroblastoma: Mechanisms, rationale, and current status. Medical and Pediatric Oncology , 32, 427-431.
21.
van Santen, H.M., de Kraker, J., van Eck, B.L.F., de Vijler, J.J.M., & Vulsma, T. ( 2003). Improved radiation protection of the thyroid gland with thyroxine, methimazole, and potassium iodide during diagnostic and therapeutic use of radiolabeled metaiodobenzylguanidine in children with neuroblastoma . Cancer, 98, 389-396.
