Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children's oncology group
Department of Radiation Oncology; Quality Assurance Review Center
3-Iodobenzylguanidine; Antibodies; Child; Female; Humans; Infant; Iodine Radioisotopes; Male; Neoplasm Staging; Neuroblastoma; Prognosis; *Research Report; Stem Cell Transplantation
Neoplasms | Oncology | Radiology
Radiolabeled metaiodobenzylguanidine (mIBG) is a highly sensitive and specific marker for detecting neuroblastoma. A semiquantitative mIBG score (Curie score [CS]) was assessed for utility as a prognostic indicator for a cohort of patients with high-risk metastatic disease.
METHODS: mIBG scans from 280 patients with mIBG-avid, stage 4 neuroblastoma enrolled on the Children's Oncology Group (COG) protocol A3973 were evaluated at diagnosis (n = 280), after induction chemotherapy (n = 237), and after an autologous stem cell transplantation (n = 178). Individual mIBG scans were evaluated at 10 different anatomic regions, with the scoring of each site (0-3) based on the extent of disease at that anatomic region.
RESULTS: There was no correlation between CS at diagnosis and subsequent treatment outcome. Patients with a CS > 2 after induction therapy had a significantly worse event-free survival (EFS) than those with scores 2 identified a cohort of patients at greater risk for an event, independent of other known neuroblastoma factors, including age, MYCN status, ploidy, mitosis-karyorrhexis index, and histologic grade. For MYCN-amplified tumors, the presence (CS > 0) versus absence (CS = 0) of residual mIBG avidity after induction was associated with a significantly worse outcome (3-y EFS: 11.8% +/- 7.8% vs. 49.6% +/- 7.7%, respectively; P = 0.003). After transplantation, patients with a CS > 0 had an EFS inferior to that of patients with a CS of 0 (3-y EFS: 28.9% +/- 6.8% vs. 49.3% +/- 4.9%, respectively [n = 133]; P = 0.009).
CONCLUSION: Curie scoring carries prognostic significance in the management of patients with high-risk neuroblastoma. In particular, patients with CSs > 2 after induction have extremely poor outcomes and should be considered for alternative therapeutic strategies.
DOI of Published Version
Yanik GA, Parisi MT, Shulkin BL, Naranjo A, Kreissman SG, London WB, Villablanca JG, Maris JM, Park JR, Cohn SL, McGrady P, Matthay KK. Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children's oncology group. J Nucl Med. 2013 Apr;54(4):541-8. doi: 10.2967/jnumed.112.112334. Epub 2013 Feb 25. PubMed PMID: 23440556. Link to article on publisher's site
Journal of nuclear medicine : official publication, Society of Nuclear Medicine
Yanik, Gregory A.; Parisi, Marguerite T.; Shulkin, Barry L.; Naranjo, Arlene; Kreissman, Susan G.; London, Wendy B.; Villablanca, Judith G.; Maris, John M.; Park, Julie R.; Cohn, Susan L.; McGrady, Patrick; and Matthay, Katherine K., "Semiquantitative mIBG scoring as a prognostic indicator in patients with stage 4 neuroblastoma: a report from the Children's oncology group" (2013). Radiation Oncology Publications and Presentations. 7.