PDF herunterladen
Horm Metab Res 2012; 44(05): 405-410
DOI: 10.1055/s-0032-1308992
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

External Beam Radiation Therapy (EBRT) for Patients with Malignant Pheochromocytoma and Non-Head and -Neck Paraganglioma: Combination with 131I-MIBG

L. Fishbein
1   Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
2   Division of Endocrinology, Diabetes and Metabolism, University of ­Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
L. Bonner
3   Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
D. A. Torigian
4   Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
K. L. Nathanson
1   Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
5   Division of Medical Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
D. L. Cohen
1   Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
6   Renal and HTN Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
D. Pryma
4   Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
7   Division of Nuclear Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
,
K. A. Cengel
3   Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 31. Oktober 2011

accepted 05. März 2012

Publikationsdatum:
07. Mai 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

In patients with malignant pheochromocytoma and paraganglioma, 131I-MIBG radiotherapy can achieve an objective response rate of 30–50% with the dose limiting toxicity being hematologic. Patients with disseminated disease, who also have a few index bulky or symptomatic lesions, may benefit from the addition of targeted external beam radiotherapy alone or in combination with systemic 131I-MIBG. The records of patients with malignant paraganglioma who were treated with external beam radiotherapy at the University of Pennsylvania from February 1973 to February 2011 were reviewed in an institutional review board approved retrospective study. Of the 17 patients with tumors in the thorax, abdomen, or pelvis, 76% had local control or clinically significant symptomatic relief for at least 1 year or until death. As expected, the predominant toxicity was due to irradiation of tumor-adjacent normal tissues without clinically significant hematologic toxicity. Due to widespread systemic metastases with areas of bulky, symptomatic tumor, 5 of the 17 patients were treated with sequential 131I-MIBG (2 mCi/kg per treatment) and external beam radiotherapy to 9 sites. In these patients, all areas that were irradiated with external beam radiotherapy showed durable objective response despite all patients eventually experiencing out-of-field systemic progression requiring other treatment. Four of these patients remain alive with excellent performance status 16, 18, 23, and 24 months after external beam radiotherapy. External beam radiotherapy can be highly effective in local management of malignant paraganglioma and can be used in conjunction with 131I-MIBG due to nonoverlapping toxicities with excellent control of locally bulky tumors.

Key words

metastatic - pheochromocytoma - paraganglioma - external beam radiotherapy - combined modality ­treatment
 

  • References

  • 1 DeLellis RA, Lloyd RV, Heitz PU, Eng C. eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Endocrine Organs. Lyon, France: IARC Press; 2004
    Suche in Google Scholar
  • 2 Drasin H. Treatment of malignant pheochromocytoma. Western J Med 1978; 128: 106-111
    PubMedSuche in Google Scholar
  • 3 Siddiqui MZ, Von Eyben FE, Spanos G. High-voltage irradiation and combination chemotherapy for malignant pheochromocytoma. Cancer 1988; 62: 686-690
    CrossrefPubMedSuche in Google Scholar
  • 4 Scott Jr HW, Reynolds V, Green N, Page D, Oates JA, Robertson D, Roberts S. Clinical experience with malignant pheochromocytomas. Surgery Gynecol Obstetr 1982; 154: 801-818
    PubMedSuche in Google Scholar
  • 5 Siatelis A, Konstantinidis C, Volanis D, Leontara V, Thoma-Tsagli E, Delakas D. Pheochromocytoma of the urinary bladder: report of 2 cases and review of literature. Minerva urologica e nefrologica. Italian J Urol Nephrol 2008; 60: 137-140
    PubMedSuche in Google Scholar
  • 6 Naguib M, Caceres M, Thomas Jr CR, Herman TS, Eng TY. Radiation treatment of recurrent pheochromocytoma of the bladder: case report and review of literature. Am J Clin Oncol 2002; 25: 42-44
    CrossrefPubMedSuche in Google Scholar
  • 7 Yu L, Fleckman AM, Chadha M, Sacks E, Levetan C, Vikram B. Radiation therapy of metastatic pheochromocytoma: case report and review of the literature. Am J Clin 1996; 19: 389-393
    PubMedSuche in Google Scholar
  • 8 Krych AJ, Foote RL, Brown PD, Garces YI, Link MJ. Long-term results of irradiation for paraganglioma. Int J Radiat Oncol Biol Phy 2006; 65: 1063-1066
    CrossrefPubMedSuche in Google Scholar
  • 9 Hinerman RW, Mendenhall WM, Amdur RJ, Stringer SP, Antonelli PJ, Cassisi NJ. Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagale. Head Neck 2001; 23: 363-371
    CrossrefPubMedSuche in Google Scholar
  • 10 Elshaikh MA, Mahmoud-Ahmed AS, Kinney SE, Wood BG, Lee JH, Barnett GH, Suh JH. Recurrent head-and-neck chemodectomas: a comparison of surgical and radiotherapeutic results. Int J Radiat Oncol Biol Phy 2002; 52: 953-956
    CrossrefPubMedSuche in Google Scholar
  • 11 Chino JP, Sampson JH, Tucci DL, Brizel DM, Kirkpatrick JP. Paraganglioma of the head and neck: long-term local control with radiotherapy. Am J Clin Oncol 2009; 32: 304-307
    CrossrefPubMedSuche in Google Scholar
  • 12 Mitchell DC, Clyne CA. Chemodectomas of the neck: the response to radiotherapy. The Br J Surg 1985; 72: 903-905
    PubMedSuche in Google Scholar
  • 13 Powell S, Peters N, Harmer C. Chemodectoma of the head and neck: results of treatment in 84 patients. Int J Radiat Oncol Biol Phy 1992; 22: 919-924
    CrossrefPubMedSuche in Google Scholar
  • 14 Divgi C. Targeted systemic radiotherapy of pheochromocytoma and medullary thyroid cancer. Sem Nucl Med 2011; 41: 369-373
    CrossrefPubMedSuche in Google Scholar
  • 15 Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweil J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247
    CrossrefPubMedSuche in Google Scholar
  • 16 Porter AT, McEwan AJ, Powe JE, Reid R, McGowan DG, Lukka H, Sathyanarayana JR, Yakemchuk VN, Thomas GM, Erlich LE, Crook J, Gulenchyn KY, Hong KE, Wesolowski C, Yardley J. Results of a randomized phase-III trial to evaluate the efficacy of strontium-89 adjuvant to local field external beam irradiation in the management of endocrine resistant metastatic prostate cancer. Int J Radiat Oncol Biol Phy 1993; 25: 805-813
    CrossrefPubMedSuche in Google Scholar