Repeated Radionuclide therapy in metastatic paraganglioma leading to the highest reported cumulative activity of 131I-MIBG

Abstract

131I-MIBG therapy for neuroendocrine tumours may be dose limited. The common range of applied cumulative activities is 10-40 GBq. We report the uneventful cumulative administration of 111 GBq (= 3 Ci) 131I-MIBG in a patient with metastatic paraganglioma. Ten courses of 131I-MIBG therapy were given within six years, accomplishing symptomatic, hormonal and tumour responses with no serious adverse effects. Chemotherapy with cisplatin/vinblastine/dacarbazine was the final treatment modality with temporary control of disease, but eventually the patient died of progression. The observed cumulative activity of 131I-MIBG represents the highest value reported to our knowledge, and even though 12.6 GBq of 90Y-DOTATOC were added intermediately, no associated relevant bone marrow, hepatic or other toxicity were observed. In an individual attempt to palliate metastatic disease high cumulative activity alone should not preclude the patient from repeat treatment.

Figure 1

Post-therapeutic ¹³¹I-MIBG scans (anterior and posterior view) of the 1^st (a) and 5^th (b) therapy showing the well-accumulating metastases in the early to mid stages of the disease.

Figure 2

¹²³I-MIBG (a) and ¹¹¹In-pentetreotide (b) scans before MIBG therapy no. 9, followed by the post-therapeutic ¹³¹I-MIBG scan (c): Later stage metastases to the lungs, liver, lymph nodes, soft tissue and bone, still displaying avid tracer uptake. The ¹¹¹In-pentetreotide scan shows no additional lesions compared to the MIBG scans.

Figure 3

¹³¹I-MIBG cycles with the resulting cumulative activity and other treatments over the course of time.