A case of malignant pheochromocytoma treated with 131I-metaiodobenzylguanidine and alpha-methyl-p-tyrosine.

Nakagami, Yuriko; Nomura, Kazuhiro; Kusakabe, Kiyoko; Miko, Nobuyasu; Tsushima, Toshio; Demura, Hiroshi

doi:10.2169/internalmedicine1962.29.329

Cited by 7 publications

(2 citation statements)

References 6 publications

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“…Other potentially effective anticancer therapies including radiation with 1311-MIBG [7,8] and chemotherapy [9,10] were not tested for the following reasons: 1311-MIBG was not accumulated Changes in treatments, urinary norepinephrine excretion, heart rates, and blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Teno

Tanabe²,

Nomura³

et al. 1996

Endocr J

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Abstract. Hypertension and norepinephrine hypersecretion in a 59-year-old woman suffering from malignant pheochromocytoma with multiple metastases were appropriately controlled with a-and 13-blockers, and a-methyltyrosine (a-MT), a catecholamine-synthesis inhibitor. Metastasized vertebrae were treated with external radiation to relieve pain, but this treatment had to be interrupted at a total dose of 20 Gy because the patient suffered acutely exacerbated hypertension (200/110 mmHg), tachycardia (160 beats/min) and a low-grade fever. Simultaneously her serum levels of LDH, potassium, urea nitrogen, creatinine, white blood cell count, CRP and norepinephrine were significantly increased, suggesting that this episode was due to radiation-induced tissue destruction and the leakage of catecholamines and possibly interleukin-6, a cytokine mediating inflammation which is reportedly present in pheochromocytoma.The marked hypertension was controlled by continuous iv administration of phentolamine and propranolol. Athough radiation therapy effectively relieves pain due to neoplasmic metastasis to the bone, physicians should be aware that life-threatening complications such as the above occur in malignant pheochromocytoma.Sufficient pretreatment with adrenergic blocking agents and/or cc-MT and careful monitoring of the patient's general condition during radiation therapy, even at a low dose, are highly recommended.

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Section: Discussionmentioning

confidence: 99%

“…Six to ten percent of pheochromocytoma cases are, however, reportedly malignant [1], 8.5% in Japan [2]. Especially extraadrenal pheochromocytomas are more often malignant (40%) [3].…”

mentioning

confidence: 99%

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Teno

Tanabe²,

Nomura³

et al. 1996

Endocr J

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Nuklearmedizinische Diagnostik und Therapie von Lebermetastasen

Risse¹,

Grünwald²

2002

LeberMetastasen

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The treatment of malignant pheochromocytoma with Iodine-131 metaiodobenzylguanidine (131I-MIBG): A comprehensive review of 116 reported patients

Loh

FitzGerald

Matthay

et al. 1997

J Endocrinol Invest

257

148

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Iodine-131 metaiodobenzylguanidine (131I-MIBG), a radiopharmaceutical agent used for scintigraphic localization of pheochromocytomas, has been employed to treat malignant pheochromocytomas since 1983 in a few specialized centers around the world. We review our clinical experience together with the published experience of 23 other centers in 10 countries, regarding the use of 1311-MIBG for treating patients with malignant adrenal pheochromocytomas or extra-adrenal paragangliomas. There were a total of 116 evaluable patients: 3 were from our current report and another 113 were reported in the literature from 1983 to 1996. A majority of the patients were selected for treatment based upon positive tracer uptake studies. The cumulative dose of 131I-MIBG administered ranged from 96 to 2,322 mCi (3.6 to 85.9 GBq), with a mean (+/-SD) of 490+/-350 mCi (18.1+/-13.0 GBq). The subjects received a mean single therapy dose of 158 mCi (5.8 GBq) and the number of doses administered ranged from 1 to 11, with a mean of 3.3+/-2.2 doses. Initial symptomatic improvement was achieved in 76% of patients, tumor responses in 30%, and hormonal responses in 45%. Five patients had complete tumor and hormonal responses, ranging from 16 to 58 months, which were sustained at the time of reporting. Patients with metastases to soft tissue had more favorable responses to treatment than those with metastases to bone. No difference was noted in the age between the responders and non-responders. Adverse effects, recorded in 41% of the treated patients, were generally mild except for one fatality from bone marrow aplasia. Among 89 patients with follow-up data, 45% of the responders had relapsed with recurrent or progressive disease after a mean interval of 29.3+/-31.1 months (median 19 months). Of patients with an initial response to 1311-MIBG, death was reported in 33% after a mean of 23.2+/-8.1 months (median 22 months) following treatment. Of non-responders, death was reported in 45% after a mean of 14.3+/-8.3 months (median 13 months). In conclusion, this review suggests that 131I-MIBG therapy may be a useful palliative adjunct in selected patients with malignant pheochromocytoma or paraganglioma. Although controlled studies are lacking, our review raises the hope that this therapeutic modality may prolong survival with an occasional sustained complete remission or possible cure.

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A case of malignant pheochromocytoma treated with 131I-metaiodobenzylguanidine and alpha-methyl-p-tyrosine.

Cited by 7 publications

References 6 publications

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Acutely Exacerbated Hypertension and Increased Inflammatory Signs Due to Radiation Treatment for Metastatic Pheochromocytoma.

Nuklearmedizinische Diagnostik und Therapie von Lebermetastasen

The treatment of malignant pheochromocytoma with Iodine-131 metaiodobenzylguanidine (131I-MIBG): A comprehensive review of 116 reported patients

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