^(131)I-MIBG治疗58例恶性嗜铬细胞瘤的临床疗效与副反应

58 cases of malignant pheochromocytoma treated by 131 I MIBG——therapeutic results and adverse events

目的探讨用１３１Ｉ间碘苄胍（ＭＩＢＧ）治疗５８例恶性嗜铬细胞瘤软组织转移灶的临床价值。方法第一疗程每月静脉滴注１３１ＩＭＩＢＧ２５９０～３７００ＭＢｑ，共６个月。此后每隔２～３个月继续治疗１～３次。用ＭＩＲＤ法测试肿瘤吸收剂量。结果①５８例患者按肿瘤大小分成３组。第１组肿瘤体积＜８ｃｍ３（１１例），第２组８～２０ｃｍ３（２１例），第３组＞２０ｃｍ３（２６例）。第１组１１例肿瘤平均吸收剂量为１２９２４２ｃＧｙ，每克肿瘤吸收剂量在１０００ｃＧｙ以上，治疗后均见肿瘤消失，达到治愈目的。第２组肿瘤平均吸收剂量与第１组相似，但每克肿瘤平均吸收剂量为７１７６ｃＧｙ，仅见３６％（８例）肿瘤缩小，７６％患者尿儿茶酚胺量下降，但６４％患者治疗前后肿瘤未见变化。第３组每克肿瘤平均吸收剂量为２７７０ｃＧｙ，治疗后３０％患者肿瘤增大，２０％患者死亡，余５０％患者症状有改善，但肿瘤大小无变化。②对５８例患者作治疗后３，５，１０ａ随访，发现１３１ＩＭＩＢＧ治疗后对骨髓的抑制影响较小，仅见５１％患者有严重的骨髓抑制，且骨髓抑制与治疗剂量大小无关；大部分患者见一过性白细胞下降。结论１３１ＩＭＩＢＧ对恶性嗜铬细胞瘤有一定的?

Objective Clinical experience in treatment of 58 cases of malignant pheochromocytoma with metastasis is hereby reported Methods Monthly intravenous injection of 131 I MIBG 2590～3700 MBq was instituted for 6 months, afterwards, treatment of the same dose was resumed at 2～3 month interval for another 1～3 doses MIRD was applied to estimate the tumor absorption dose Results Patients were classified into 3 groups according to their tumor size In the first group, the tumor was <8 cm 3 (11 cases), in the second group, 8～20 cm 3 (21 cases), and in the third group, the tumor size was >20 cm 3 (26 cases) In the first group, the mean absorption dose was 12924 4 cGy and the absorption dose per gram of tumor was above 1000 cGy After treatment, tumors disappeared in all patients, attaining treatment goal In the second group, the absorption dose was similar to that of the first group, but the mean absorption dose per gram was 717 6 cGy, and tumor mass regression was only 36% (8 cases) 76% (16 cases) showed reduced urinary catecholamine; however, 64% showed no regression of tumor size In the third group, the absorption dose per gram tumor tissue was 277 cGy, and 30% demonstrated tumor enlargement, 20% of the patients died; the remaining 50% showed symptomatic improvement without any change in tumor size In 58 cases, 3, 5, 10 year follow up was carried out The results showed that 131 I MIBG treatment did not demonstrate significant bone marrow suppression; only 5 1% had severe bone marrow suppression, and for most of them, bone marrow suppression was only temporary Furthermore, bone marrow suppression was not related to the 131 I MIBG dosage been used in the treatment Conclusions 131 I MIBG is of certain therapeutic effectiveness of symptomatic improvement, such as blood pressure and urinary catecholamine decreasing However, complete tumor mass disappearance has only been found in small tumors Thus, treatment with 131 I MIBG should be instituted immediately after surgical resection to eradicate the residual tumor cells and to prevent recurrences Bone marrow suppression is temporary and not dosage related Treatment can be reinstituted after several weeks