Treatment of Metastatic Pheochromocytoma and Paraganglioma With 131I-Meta-Iodobenzylguanidine (MIBG)

Kaltsas, Gregory; Mukherjee, J. J.; Foley, Rosemary; Britton, K. E.; Grossman, Ashley

doi:10.1097/01.ten.0000084154.02341.ad

Cited by 24 publications

(20 citation statements)

References 51 publications

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“…Some adrenal tumors are hormone secreting and responsible for endocrine pathology; however, the majority of them are nonfunctional. [8][9][10] Autopsy series have revealed a much higher prevalence of pheochromocytomas, 11 whereas they are relatively rare tumors found in about 4% of incidentally discovered adrenal masses. 4 Generally, adrenal tumors with a malignant potential grow faster than those with a benign phenotype.…”

mentioning

confidence: 99%

Diagnostic Role of Inhibin α-Subunit and Inhibin/Activin β-Subunit in Adrenal Cortical and Medullary Tumors in Egyptian Patients

Elmoneim

Samaka

Ali

2012

Applied Immunohistochemistry &Amp; Molecular Morphology

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Inhibin and activins are dimeric glycoproteins that are structurally and functionally related to transforming growth factor-β and are composed of 1 α-subunit and 1 of 2 β-subunits (βA or βB). In recent years, there has been controversy about their role in adrenal tumors and their suitability as a diagnostic/predictive marker. Inhibin α and inhibin/activin β protein expression was assessed on 47 adrenal tissue specimens by means of immunohistochemistry. Positive immunoreactivity of inhibin-α was seen in all studied hyperplastic adrenal glands, 90.9% of cortical adenomas, and 83.3% of adrenal cortical carcinomas. In contrast, the adrenomedullary neoplasms had a statistically significantly different behavior (P=0.001). We observed the negative expression of inhibin α in 85% and 80% of benign and malignant pheochromocytomas, respectively. As regards the immunoreactivity of inhibin/activin β, 80% of adrenal hyperplasias, 81.8% of cortical adenomas, and 83.3% of adrenal cortical carcinomas showed positivity. Strong-to-weak positive staining of inhibin/activin β was observed in 70% of benign pheochromocytomas, whereas malignant pheochromocytomas showed positive immunohistochemical staining in 40% of cases with weak intensity. The scoring of inhibin/activin β immunoreactivity between adrenocortical and adrenomeullary neoplasia failed to reach the significant value (P=0.1). Our results demonstrate that inhibin α had a diagnostic role, differentiating between the adrenocortical and adrenomedullary neoplasms. Moreover, inhibin/activin β might play a predictive role for malignant potential in pheochromocytoma. Further studies are warranted to determine whether they play a diagnostic/predictive role in adrenal tumors or are just surrogate markers for this group of neoplasia.

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confidence: 99%

Diagnostic Role of Inhibin α-Subunit and Inhibin/Activin β-Subunit in Adrenal Cortical and Medullary Tumors in Egyptian Patients

Elmoneim

Samaka

Ali

2012

Applied Immunohistochemistry &Amp; Molecular Morphology

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“…( 123 I-MIBG) or 131 I-metaiodobenzylguanidine ( 131 I-MIBG) scintigraphy has been used extensively as a first-line nuclear medicine technique [9] in the evaluation of PHEO or paraganglioma (PG). 123 I-MIBG scintigraphy, because of its greater sensitivity and less exposure to radiation, is recommended for use instead of 131 I-MIBG scintigraphy [10].…”

Section: I-metaiodobenzylguanidinementioning

confidence: 99%

Malignant pheochromocytoma in the elderly

Mazza¹,

Rubello

2015

Nuclear Medicine Communications

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“…Toxicity was mostly hematological and was reported in 26% of patients. Despite a lack of complete tumor response, a palliative treatment effect of 131 I-MIBG therapy has been noted [48]. …”

Section: Mibg-radiotherapymentioning

confidence: 99%

“…Combination of 131 I-MIBG therapy with chemotherapy did not show any convincing results, but an increased toxicity, and cannot be recommended [48]. On the other hand, Hartley et al reported an increase of 123 I-MIBG uptake after a radiological response to chemotherapy, enabling successful 131 I-MIBG therapy to follow [54].…”

Section: Mibg-radiotherapymentioning

confidence: 99%

Treatment of Malignant Pheochromocytoma

Adjallé¹,

Plouin²,

Pacák³

et al. 2009

Horm Metab Res

102

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Pheochromocytoma (PCC) is a rare disease, mainly sporadic, but also associated with some familial disorders, with a malignancy frequency of approximately 10%. Only the presence of distant metastases, derived from large pleomorphic chromaffin cells, is widely accepted as a criterion of malignancy. Variable symptoms may be caused by production and release of catecholamines. Since there is no curative treatment for malignant PCC and due to its unfavorable prognosis, assuring quality of life is one of the main therapeutic objectives. Besides a long-term medical treatment of symptoms using selective α-1 blockers and nonselective, noncompetitive α- and / or β-blockers, debulking surgery is the first treatment step. In case of a sufficient uptake of 123I-MIBG treatment with targeted radiation therapy, use of 131I-MIBG is an option as an adjuvant therapy, following debulking surgery. Chemotherapy should be applied to patients without positive MIBG-scan, with no response to 131I-MIBG or progression after radionuclide treatment, and especially in cases with high proliferation index. The most effective chemotherapy regimen appears to be the CVD-scheme, including cyclophosphamide, vincristine, and dacarbazine. The so-called targeted molecular therapies with treatment combinations of temozolomide and thalidomide, or sunitinib monotherapy, and novel therapeutic somatostatin analogues have shown promising results and should thus encourage clinical trials to improve the prognosis of metastatic PCC. Within this review the current treatment modalities and novel molecular strategies in the management of this disease are discussed and a treatment algorithm is suggested.

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Treatment of Metastatic Pheochromocytoma and Paraganglioma With 131I-Meta-Iodobenzylguanidine (MIBG)

Cited by 24 publications

References 51 publications

Diagnostic Role of Inhibin α-Subunit and Inhibin/Activin β-Subunit in Adrenal Cortical and Medullary Tumors in Egyptian Patients

Diagnostic Role of Inhibin α-Subunit and Inhibin/Activin β-Subunit in Adrenal Cortical and Medullary Tumors in Egyptian Patients

Malignant pheochromocytoma in the elderly

Treatment of Malignant Pheochromocytoma

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