Das Neuroblastom: Diagnostik und Therapie mit meta-Iodbenzylguanidin

Zusammenfassung

Das Neuroblastom ist der häufigste extrakranielle solide Tumor des Kindesalters mit einem Anteil von ca. 7–10% an den pädiatrischen Malignomen und ist für etwa 15% der Krebstodesfälle im Kindesalter verantwortlich. In Deutschland erkranken etwa 130 Kinder pro Jahr. Meta-Iodbenzylguanidin (mIBG) hat sich seit der Einführung durch Dr. Donald Wieland um 1980 zu einem unverzichtbaren Bestandteil in der Diagnostik entwickelt und bietet therapeutische Möglichkeiten. Die vorliegende Arbeit basiert auf der DGN-Verfahrensanweisung zur mIBG-Szintigrafie und berücksichtigt aktuelle Entwicklungen der Diagnostik, die Methoden der PET/CT und auch aktuelle Entwicklungen in der Therapie. Für den Versorgungsstandard in Deutschland ist die Beachtung der Verfahrensanweisung zur mIBG-Szintigrafie wichtig, um eine hohe diagnostische Bildqualität zu gewährleisten. SPECT gehört zum unverzichtbaren Standard. Die Bildqualität darf nicht durch eine zu niedrig angesetzte injizierte Aktivität gefährdet werden. Hochdosis-mIBG-Therapien werden in enger Kooperation mit den Kinderonkologen durchgeführt und sollten in Zentren mit adäquater Erfahrung erfolgen.

Abstract

Neuroblastoma is the most common extracranial malignant solid tumor during childhood, accounts for about 7–10% of all pediatric malignancies and is responsible for about 15% of cancer deaths in children. In Germany, about 130 patients are diagnosed of neuroblastoma each year. Since its introduction by Dr. Donald Wieland in 1980, meta-Iodobenzylguanidine (mIBG) has become an integral part for diagnosis and therapy of neuroblastoma patients. This publication is based on the national procedure guideline for mIBG scintigraphy and includes the most recent developments in diagnosis, PET/CT methods and in mIBG therapy. For the maintenance of high medical standards an adequate image quality by adherence to the procedure guideline is mandatory. SPECT is an integral part of image acquisition. Image quality must not be jeopardized by reducing injected activity below values which are known to provide diagnostic images. High-dose mIBG therapies are usually performed in close cooperation with pediatric oncologists and should be done in centers with adequate experience.

Schlüsselwörter

Neuroblastom - I-123-meta-Iodbenzylguanidin (I-123-mIBG) - I-131-meta-Iodbenzylguanidin (I-131-mIBG)

Key words

neuroblastoma - I-123-meta-Iodobenzylguanidine (I-123-mIBG) - I-131-meta-Iodobenzylguanidine (I-131-mIBG)

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