High-dose 131I-metaiodobenzylguanidine therapy for 12 patients with malignant pheochromocytoma

Cancer. 2003 Jul 15;98(2):239-48. doi: 10.1002/cncr.11518.


Background: 131I-Metaiodobenzylguanidine (131I-MIBG) can be used systemically to treat malignant pheochromocytoma. To improve outcome, the authors used higher levels of activity of 131I-MIBG than previously reported. The authors reported the response rates and toxicity levels in patients with malignant pheochromocytoma or paraganglioma who were treated with high-dose 131I-MIBG.

Methods: Following debulking surgery and stem cell harvest, 12 patients with malignant pheochromocytoma or paraganglioma were treated with 131I-MIBG. Five had received previous external beam radiation and/or chemotherapy. The median single treatment dose was 800 mCi (37 gigabecquerels; range, 386-866 mCi) or 11.5 mCi/kg (range, 5.6-18.3 mCi/kg). The median cumulative dose was 1015 mCi (range, 386-1690 mCi).

Results: Three patients had a complete response, two of whom had soft tissue and skeletal metastases. Their median follow-up was 45 months (range, 23-101 months). Seven patients had a partial response (PR), with a median follow-up 43 months (range, 6-47 months). Two patients without a response died with progressive disease (PD) and 2 patients with an initial PR died of PD at 13 and 11 months, respectively. Grade 3 thrombocytopenia occurred after 79% (15 of 19) of treatments had been administered. Grade 3 and 4 neutropenia followed 53% (10 of 19) and 19% (4 of 19) of treatments, respectively. One patient required stem cell infusion, and one developed primary ovarian failure.

Conclusions: The single and cumulative doses of 131I-MIBG were approximately 2-3.5 times higher than those used at other centers. Unlike previous reports, two patients with both skeletal and soft tissue metastases had a complete response. Hematologic toxicity was significant but tolerable. High-dose 131I-MIBG may lead to long-term survival in patients with malignant pheochromocytoma.

Publication types

  • Evaluation Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 3-Iodobenzylguanidine / administration & dosage
  • 3-Iodobenzylguanidine / therapeutic use*
  • Adolescent
  • Adrenal Gland Neoplasms / radiotherapy*
  • Adrenal Gland Neoplasms / secondary
  • Adult
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / therapeutic use*
  • Child
  • Dose-Response Relationship, Radiation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Paraganglioma / radiotherapy*
  • Paraganglioma / secondary
  • Pheochromocytoma / radiotherapy*
  • Pheochromocytoma / secondary
  • Treatment Outcome


  • Antineoplastic Agents
  • 3-Iodobenzylguanidine