Full Description
Neuroblastoma is the third most common malignancy of childhood. accounting for 8% of all cancers in patients under 15 years of age. In the majority of cases. by the time neuroblastoma is diagnosed. it has already spread from its site of origin to involve distant sites. Approximately 90% of cases of neuroblastoma can be diagnosed by a combination of techniques including detection of specific tumour markers in the urine. histopathological and immunocytological assessment of involved bone marrow and the 'characteristic' appearances of tumours dem- onstrated by computerised tomography and ultrasonography. However. despite this plethora of techniques. up to. 10% of cases of neuroblastoma are still difficult to diagnose and rely on excisional biopsy of a site of disease. It was against this background that the scintigraphic localisation of neuroblastoma with the radiolabelled guanethidine analogue. mIBG. became available. With mIBG scintigraphy it is now possible to demonstrate the presence of neuro- blastoma (and related tumours) at the primary site. soft tissue sites. in the bone marrow and in cortical bone. in a single investigation.
The success of mIBG scintigraphy depends on many factors including the choice of isotope for labelling the mIBG. the equipment used to carry out the procedure. and the manipulation and interpretation of the information obtained. At the Royal Marsden Hospital we have performed over 100 mIBG studies in children. and our advice has frequently been sought by other centres who are. or intend to become.
Contents
1 An Overview of Neuroblastoma.- Pathology.- Clinical Features.- Diagnostic Features.- Clinical Staging.- Prognostic Features.- Treatment.- 2 Chemistry and Pharmacy of mIBG.- Pharmacology.- Radiolabelled mIBG Products.- Formulations and Stability of mIBG.- Toxicology.- 3 Techniques for Imaging with mIBG.- Patient Preparation.- Radiopharmaceuticals.- Gamma Camera Technique.- Administration of mIBG.- Planar Imaging.- Single-photon Emission Computed Tomography.- Hard Copy.- 4 The Normal Pattern of Distribution of mIBG in Children with a History of Cancer.- Normal Distribution.- The Thyroid Gland.- The Adrenal Gland.- The Liver.- The Spleen.- The Kidneys and Bladder.- The Gastrointestinal Tract.- The Lung.- The Heart.- The Salivary Glands, Nasopharynx and Lacrimal Glands.- The Bone Marrow.- Bone.- Normal mIBG Studies in Children of Different Ages.- 5 Case Studies with Abnormal Uptake of mIBG.- 6 Radiation Dosimetry of Radioiodine-Labelled mIBG.- Review of Radionuclide Dosimetry.- The Physical Properties of 123I and 131I.- Calculation of Absorbed Dose in Children.- 7 Practical Aspects of Targetted Radiotherapy with mIBG.- General Principles.- Principles of Therapy with mIBG.- Selection of Patients for mIBG Therapy.- The mIBG Therapy Room.- Patient Investigations Before Treatment.- Drugs which Interfere with mIBG Uptake.- Thyroid Blockade.- Selection of Activity of mIBG to Administer.- Sedation of Patients During Therapy.- Practical Considerations During Administration of mIBG.- Radiation Protection Guidelines.- Discharge after mIBG Therapy.- Appendices.- Appendix A: OPEC Chemotherapy.- Appendix B: High-Dose Melphalan followed by Autologous Bone Marrow Rescue.- Appendix C: Sedation for Children Undergoing mIBG Scintigraphy.- Appendix D: Thyroid Gland Blockade for mIBG Scintigraphy and Targetted Radiotherapy.- Appendix E: Drugs which Interfere with mIBG Studies.- Appendix F: Modified OPEC Chemotherapy.
