Role of 131I-metaiodobenzylguanidine in the treatment of neuroblastoma.

Background: Standard chemo-radiotherapy methods for the treatment of children with advanced neuroblastoma (NBL) including bone marrow transplant approaches have been disappointing. These poor results can be ascribed to the evolution of residual drug-resistant cell populations. Curative attempts should therefore be directed to their elimination during induction treatment. This can best be accomplished through the use of multiple, non-cross-resistant agents early in therapy. 131I-Metaiodobenzylguanidine (131I-MIBG) provides a mechanism for the delivery of high doses of radiation to NBL lesions. Experience reported from several institutions indicates an approximate 50% response rate in previously treated children with advanced NBL.
Conclusions: A better strategy is to employ 131I-MIBG together with intensive chemotherapy at the time of diagnosis. A pilot study adopting these principles and supported by laboratory data has been designed and is underway.