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. 2011 Feb;56(2):191-201.
doi: 10.1002/pbc.22767. Epub 2010 Sep 9.

Thyroid and Hepatic Function After High-Dose 131 I-metaiodobenzylguanidine (131 I-MIBG) Therapy for Neuroblastoma

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Free PMC article

Thyroid and Hepatic Function After High-Dose 131 I-metaiodobenzylguanidine (131 I-MIBG) Therapy for Neuroblastoma

Alekist Quach et al. Pediatr Blood Cancer. .
Free PMC article

Abstract

Background: (131) I-Metaiodobenzylguanidine ((131) I-MIBG) provides targeted radiotherapy for children with neuroblastoma, a malignancy of the sympathetic nervous system. Dissociated radioactive iodide may concentrate in the thyroid, and (131) I-MIBG is concentrated in the liver after (131) I-MIBG therapy. The aim of our study was to analyze the effects of (131) I-MIBG therapy on thyroid and liver function.

Procedure: Pre- and post-therapy thyroid and liver functions were reviewed in a total of 194 neuroblastoma patients treated with (131) I-MIBG therapy. The cumulative incidence over time was estimated for both thyroid and liver toxicities. The relationship to cumulative dose/kg, number of treatments, time from treatment to follow-up, sex, and patient age was examined.

Results: In patients who presented with Grade 0 or 1 thyroid toxicity at baseline, 12 ± 4% experienced onset of or worsening to Grade 2 hypothyroidism and one patient developed Grade 2 hyperthyroidism by 2 years after (131) I-MIBG therapy. At 2 years post-(131) I-MIBG therapy, 76 ± 4% patients experienced onset or worsening of hepatic toxicity to any grade, and 23 ± 5% experienced onset of or worsening to Grade 3 or 4 liver toxicity. Liver toxicity was usually transient asymptomatic transaminase elevation, frequently confounded by disease progression and other therapies.

Conclusion: The prophylactic regimen of potassium iodide and potassium perchlorate with (131) I-MIBG therapy resulted in a low rate of significant hypothyroidism. Liver abnormalities following (131) I-MIBG therapy were primarily reversible and did not result in late toxicity. (131) I-MIBG therapy is a promising treatment for children with relapsed neuroblastoma with a relatively low rate of symptomatic thyroid or hepatic dysfunction.

Figures

FIGURE 1
FIGURE 1. Flowchart of All Patients with Pre and Post Therapy Thyroid Data
1 Two patients had elevated T4 only, and 1 patient had both elevated T4 and low TSH. 2 This patient had Grade 1 Low TSH only at baseline, but developed Grade 1 hypothyroidism after 131I-MIBG treatment. 3 One patient had elevated T4 only and one patient had both elevated T4 and low TSH. 4 Of these patients, nine developed compensated hypothyroidism. 5 Of these patients, three developed compensated hypothyroidism
FIGURE 2
FIGURE 2. Cumulative Incidence of Increased Thyroid and Liver Toxicity after 131I-MIBG Treatment (see Statistical Methods section)
A) Solid line is cumulative incidence of onset or worsening to grade 2 thyroid toxicity compared to baseline. Dashed line is cumulative incidence of onset or worsening to grade 1 or grade 2 thyroid toxicity compared to baseline. B) Solid line is cumulative incidence of onset or worsening to grade 3 or 4 liver toxicity compared to baseline. Dashed line is cumulative incidence of onset or worsening to any grade liver toxicity compared to baseline.

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