Thyroid and hepatic function after high‐dose 131I‐metaiodobenzylguanidine (131I‐MIBG) therapy for neuroblastoma

Abstract

Background ¹³¹I‐Metaiodobenzylguanidine (¹³¹I‐MIBG) provides targeted radiotherapy for children with neuroblastoma, a malignancy of the sympathetic nervous system. Dissociated radioactive iodide may concentrate in the thyroid, and ¹³¹I‐MIBG is concentrated in the liver after ¹³¹I‐MIBG therapy. The aim of our study was to analyze the effects of ¹³¹I‐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 ¹³¹I‐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 ¹³¹I‐MIBG therapy. At 2 years post‐¹³¹I‐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 ¹³¹I‐MIBG therapy resulted in a low rate of significant hypothyroidism. Liver abnormalities following ¹³¹I‐MIBG therapy were primarily reversible and did not result in late toxicity. ¹³¹I‐MIBG therapy is a promising treatment for children with relapsed neuroblastoma with a relatively low rate of symptomatic thyroid or hepatic dysfunction. Pediatr Blood Cancer 2011;56:191–201.