MIBG scan for cure of neuroendocrine tumours
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Metaiodobenzylguanidine (MIBG) is a compound and structural analogue of the norepinephrine neurotransmitterbased on its chemistry. It owns a peculiar feature to selectively accumulate in the certain structures of central nervous system. The compound is used as a radiopharmaceutical agent (radiotracer) for diagnostics and treatment of different oncologic pathologies.
Content
- Core of the treatment technique
- Indications
- Pheochromocytoma
- Paraganglioma
- Carcinoid tumors
- Neuroblastoma
- Medullary thyroid cancer
- Contraindications
- Treatment of neuroendocrine tumors abroad
Core of the treatment technique
Metaiodobenzylguanidine contains radioactive iodine (a radiopharmaceutical agent labeled with iodine atoms - I131) as a part of molecule. That’s why it emits a small amount of radiation. Since this radiotracer is a structural analogue of norepinephrine, it is selectively accumulates in the central nervous structures and in the adrenal glands after the parenteral (avoiding digestive tract) administration. Cells die due to the radiation in the region of MIBG accumulation. This feature is used to destroy tumors that predominantly have a neurodermal origin (neuroendocrine tissues that have adrenergic innervation).
Indications
Key factor for MIBG use is a presence of inoperable tumor pathology, which develops from neuroendocrine tissue.Such oncologic processes include pheochromocytoma, paraganglioma, carcinoid tumors, neuroblastoma, metastatic and recurrent medullary thyroid cancer.
Pheochromocytoma
Pheochromocytoma is a tumor of adrenal medulla that produces catecholamine hormones (epinephrine, norepinephrine) during its growth. Tumor is peculiar with the absence of malignancy and metastases. However, it leads to considerable functional changes of cardiovascular and nervous system because of the increased catecholamine level in the blood. MIBG accumulates in the tumor in 88% of cases which partially destroys cancerous cells and reduces the size of malformation. Also, this helps to decrease level of catecholamine hormones in the blood. 60% of patients are noticed to have stabilized course of the oncologic process.
Paraganglioma
Paraganglioma is a benign brain malformation peculiar with the slow growth and paraganglionic cells origin. Malformation is not life-threatening itself, though its placement in the human brain may lead to disruption of its various structures and to violation of its function. MIBG accumulates very well in paraganglioma and helps to significantly reduce the size of malformation after a therapy series (46% of cases).
Carcinoid tumors
Carcinoid tumors represent malformations located in digestive tract and pancreas. Tumors have enterochromaffin origin and are characterized by malignant growth and metastases. Radiopharmaceutical agent accumulates well in the cells of malformation after MIBG administration in 69% of cases. MIBG accumulation leads to the cells death, reduction of the tumor and its metastases. Meanwhile, tumor reduces twice after a therapy course in 63% of cases.
Neuroblastoma
Neuroblastoma is an embryonic tumor localized in the structures of the sympathetic part of the nervous system. MIBG accumulates well in the tumor in 90% of cases. Correct dosage leads to regression (reverse development) of the malformation in 36% of cases.
Medullary thyroid cancer
Medullary thyroid cancer is a comparatively rare malignant formation with the aggressive growth and hormones production (a hormone-active tumor).
Recurring course of medullary thyroid cancer with the formation of metastases (daughter formations) in other areas of the body, the only alternative treatment is the use of MIBG.
Fine radiopharmaceutical agent accumulation is registered in the majority of cases. This technique allows partial regression of medullary thyroid cancer and its metastases in 40% of cases. Patients’ condition stabilizes in 60% of cases.
Contraindications
Absolute medical contraindication for the use of MIBG with a therapeutic purpose is the individual intolerance to the radiopharmaceutical agent, as well as the development of a pronounced allergic reaction.
Relative medical contraindications include:
- Unacceptable risk of patient’s isolation
- Progressive decrease in the kidneys function
- Myelosuppression which is a decrease in the number of certain leukocytes in the blood (neutrophils, basophils, eosinophils)
- Expressed changes in the state of peripheral blood
In case a patient has some relative contraindications, they first perform therapy to improve kidneys or blood condition and then only start MIBG.
Side effects are possible during the therapy course which include nausea, vomiting form time to time, worsening of the bone marrow function.
MIBG doses, the regimen of application and the duration of the therapy course are chosen individually for each patient. A control study with a visualization of the malformation, determination of its size, and also the level of catecholamine hormones in the blood should be prescribed during the therapy. Condition of a bone marrow, kidneys and also of the peripheral blood is supervised repeatedly.
Treatment of neuroendocrine tumors abroad
In addition to the technical complexity, MIBG radionuclide therapy requires special attention to the preliminary preparation of the patient. First, it is necessary to carefully assess the presence of contraindications to the procedure in order to make sure that it is safe. Secondly, it is necessary to cancel or substitute many drugs a few days before the procedure (e.g. antihypertensive drugs, neuroleptics, antihormonal agents). Specialized hospitals in Europe cope with these tasks successfully.
Booking Health is the medical tourism operator that has been organizing the treatment of people with neuroendocrine tumors in the world's leading hospitals for more than 15 years. Booking Health offers help in such important aspects:
- Choosing the right hospital based on the annual qualification profile
- Establishing communication directly with your physician
- Preparing medical program in advance, without repeating previous examinations
- Providing favorable costs, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking the appointment on the necessary date
- Monitoring medical program at all stages
- Help in buying and forwarding of medicines
- Communication with the hospital after treatment completion
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Offering service of the highest level: booking hotels and plane tickets, transfer organization
- Services of interpreter and personal medical coordinator
To start planning your treatment, please, leave the request on the Booking Health website. Our patient case manager or medical advisor will contact you the same day to discuss all the details. Aim of our work is to help you in improving and maintaining your health.
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Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Alexandra Solovey. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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