I-131-MIBG radionuclide therapy is safe and cost-effective in the control of symptoms of the carcinoid syndrome

Background: The standard treatment used to control the symptoms of carcinoi d syndrome (CS) involves subcutaneous injections of the somatostatin analog ue octreotide. This is expensive (US$8000-16000 per year), and treatment ma y be for many years. The aim of this study was to evaluate the efficacy and cost-effectiveness of our experience over the last 5 years with 1-131-labe lled metaiodobenzylguanidine (MIBG) radionuclide therapy in the palliation of patients with CS. Methods: A consecutive series of 20 symptomatic patients (referred between 1994 and 1999) with CS were evaluated. Fifteen of them underwent I-123-MIBG scanning. Of the 13 patients with significant tracer uptake in metastatic deposits compared to background, 12 underwent a course of therapeutic I-131 -MIBG tone patient refused). Symptoms, biochemical markers, CT scans, follo w-up I-123-MIBG scans, and the requirement for octreotide were used to asse ss outcome of treatment. Costs of I-131-MIBG and octreotide treatments were compared. Results: MIBG treatment was well tolerated in all with only transient side- effects. Ten patients showed a measurable clinical improvement. Seven had a complete clinical response. The mean duration of response was 15.4 months. Octreotide was not required or was reduced in eight patients. Treatment wi th I-131-MIBG resulted in a saving of US$1000 per patient, with effective s ymptom control, when compared to octreotide. Conclusion: -131 MIBG therapy is a safe and cost-effective therapeutic opti on to successfully control symptoms in patients with carcinoid syndrome. (C ) 2001 Harcourt Publishers Ltd.