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Scintigraphic Response by ¹²³I-Metaiodobenzylguanidine Scan Correlates With Event-Free Survival in High-Risk Neuroblastoma

From the Division of Hematology/Oncology, Department of Pediatrics, Department of Radiology, and Stem Cell and Graft Engineering Laboratory, Northwestern University and Children's Memorial Hospital, Chicago, IL; Biostatistics Core Facility, The Robert H. Lurie Comprehensive Cancer Center, and Northwestern University Feinberg School of Medicine, Chicago, IL; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA; James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.

Address reprint requests to Morris Kletzel, MD, Northwestern University, Children's Memorial Hospital, 2300 Children's Plaza, Box #30, Chicago, IL 60614; e-mail: mkletzel{at}northwestern.edu

PURPOSE: To investigate whether response to induction therapy, evaluated by metaiodobenzylguanadine (MIBG) and bone scintigraphy, correlates with event-free survival (EFS) in children with high-risk neuroblastoma (NB).

PATIENTS AND METHODS: Twenty-nine high-risk NB patients were treated prospectively with an intensive induction regimen and consolidated with three cycles of high-dose therapy with peripheral blood stem-cell rescue. The scintigraphic response was evaluated by MIBG and bone scans using a semi-quantitative scoring system. The prognostic significance of the imaging scores at diagnosis and following induction therapy was evaluated.

RESULTS: A trend associating worse 4-year EFS rates for patients with versus without osteomedullary uptake on MIBG scintigraphs at diagnosis was seen (35% ± 11% v 80% ± 18%, respectively; P = .13). Similarly, patients with positive bone scans at diagnosis had worse EFS than those with negative scans, although the difference did not receive statistical significance (34% ± 10% v 83% ± 15%, respectively; P = .06). However, significantly worse EFS was observed in patients with a postinduction MIBG score of 3 compared to those with scores of less than 3 (0% v 58% ± 11%; P = .002). There was no correlation between bone scan scores and outcome following induction therapy.

CONCLUSION: MIBG scores 3 following induction therapy identifies a subset of NB patients who are likely to relapse following three cycles of high-dose therapy with peripheral blood stem-cell rescue, local radiotherapy, and 13-cis-retinoic acid. Alternative therapeutic strategies should be considered for patients with a poor response to induction therapy.

Supported in part by the Friends for Steven Pediatric Cancer Research Fund and the Robert H. Lurie Comprehensive Cancer Center, National Institutes of Health, National Cancer Institute Core Grant No. 5P30CA60553C.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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