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Impact of Whole‐Body Radiation Dose on Response and Toxicity in Patients With Neuroblastoma After Therapy With 131 I‐Metaiodobenzylguanidine (MIBG)
Author(s) -
Trieu Megan,
DuBois Steven G.,
Pon Elizabeth,
Nardo Lorenzo,
Hawkins Randall A.,
Marachelian Araz,
Twist Clare J.,
Park Julie R.,
Matthay Katherine K.
Publication year - 2016
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25816
Subject(s) - medicine , neuroblastoma , nuclear medicine , correlation , spearman's rank correlation coefficient , radiation therapy , rank correlation , analysis of variance , oncology , toxicity , confounding , statistics , genetics , geometry , mathematics , machine learning , computer science , biology , cell culture
Background 131 I‐metaiodobenzylguanidine ( 131 I‐MIBG) is a targeted radiopharmaceutical for patients with neuroblastoma. Despite its tumor‐specific uptake, the treatment with 131 I‐MIBG results in whole‐body radiation exposure. Our aim was to correlate whole‐body radiation dose (WBD) from 131 I‐MIBG with tumor response, toxicities, and other clinical factors. Methods This retrospective cohort analysis included 213 patients with high‐risk neuroblastoma treated with 131 I‐MIBG at UCSF Benioff Children's Hospital between 1996 and 2015. WBD was determined from radiation exposure rate measurements. The relationship between WBD ordered tertiles and variables were analyzed using Cochran–Mantel–Haenszel test of trend, Kruskal–Wallis test, and one‐way analysis of variance. Correlation between WBD and continuous variables was analyzed using Pearson correlation and Spearman rank correlation. Results WBD correlated with 131 I‐MIBG administered activity, particularly with 131 I‐MIBG per kilogram ( P < 0.001). Overall response rate did not differ significantly among the three tertiles of WBD. Correlation between response by relative Curie score and WBD was of borderline significance, with patients receiving a lower WBD showing greater reduction in osteomedullary metastases by Curie score (r s = 0.16, P = 0.049). There were no significant ordered trends among tertiles in any toxicity measures (grade 4 neutropenia, thrombocytopenia < 20,000/μl, and grade > 1 hypothyroidism). Conclusions This study showed that 131 I‐MIBG activity per kilogram correlates with WBD and suggests that activity per kilogram will predict WBD in most patients. Within the range of activities prescribed, there was no correlation between WBD and either response or toxicity. Future studies should evaluate tumor dosimetry, rather than just WBD, as a tool for predicting response following therapy with 131 I‐MIBG.