PRETREATMENT WITH [131I] METAIODOBENZYLGUANIDINE AND SURGICAL RESECTION OF ADVANCED NEUROBLASTOMA

Pretreatment with [131I] metaiodobenzylguanidine (MIBG) followed by su rgical resection in advanced neuroblastoma (stage 3 and 4) has been st udied in relation to resectability morbidity and mortality survival ra te after two gears, control of distant metastasis and serum levels of LDH as prognostic factors. Twenty-one patients with advanced neuroblas toma were primarily treated with MIBG radiotherapy followed by surgica l resection. Sixteen patients had stage 4 disease. Between 2 and 6 cou rses of MIBG treatment were given per patient. In 17 patients gross co mplete resection was achieved. Two patients developed complications di rectly related to the operation, one died as a result of this. The ove rall mortality was 38%. MIBG therapy resulted in partial response in 1 3 patients and in stable disease in 8 patients. Two years survival in the group with partial response was 86% and in the group with stable d isease 28%. Because of the resulting excellent general condition of th e patients the interval between pretreatment with MIBG and surgery cou ld be very short. Follow-up till December 1994 showed that 13 children were alive for 3 to 47 months. Seven had no evidence of disease. Preo perative MIBG de novo treatment in advanced neuroblastoma is equal to induction chemotherapy but less toxic.