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Iodine‐131 metaiodobenzylguanidine treatment for metastatic carcinoid
Author(s) -
Safford Shawn D.,
Coleman R. Edward,
Gockerman Jon P.,
Moore Joseph,
Feldman Jerome,
Onaitis Mark W.,
Tyler Douglas S.,
Olson John A.
Publication year - 2004
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20592
Subject(s) - medicine , iodine , oncology , metallurgy , materials science
BACKGROUND Iodine‐131 metaiodobenzylguanidine ( 131 I‐MIBG) is useful for imaging carcinoid tumors and recently has been applied to the palliative treatment of metastatic carcinoid in small studies. The authors now report their results on the therapeutic utility of high‐dose 131 I‐MIBG treatment in a large group of patients with metastatic carcinoid tumors. METHODS The authors performed a retrospective review of 98 patients with metastatic carcinoid who were treated at their institution with 131 I‐MIBG over a 15‐year period. Endpoints examined included the World Health Organization criteria for treatment response: symptoms, hormone (5‐hydroxyindoleacetic acid [5‐HIAA]) production, and clinical tumor response. RESULTS Patients received a median dose of 401 ± 202 millicuries (mCi) 131 I‐MIBG. The median survival after treatment was 2.3 years. Patients who experienced a symptomatic response had improved survival (5.76 years vs. 2.09 years; P < 0.01). For the 56 patients who had 5‐HIAA levels monitored, the mean urine 5‐HIAA levels decreased significantly after 131 I‐MIBG treatment (126 ± 122 ng/mL vs. 91 ± 125 ng/mL; P < 0.01); however, the patients with reduced 5‐HIAA levels did not experience improved survival (4.11 years vs. 3.42 years; P = 0.2). Patients who received an initial 131 I‐MIBG dose > 400 mCi lived longer than patients who received < 400 mCi (4.69 years vs. 1.86 years; P = 0.05). Radiographic tumor response did not predict survival. Toxicity included pancytopenia, thrombocytopenia, nausea, and emesis. CONCLUSIONS The current data support 131 I‐MIBG treatment in select patients with metastatic carcinoid who progress despite optimal medical management. Improved survival was predicted best by symptomatic response to 131 I‐MIBG treatment, but not by hormone or radiographic response. Cancer 2004. © 2004 American Cancer Society.