Regular Article
131I-MIBG radionuclide therapy is safe and cost-effective in the control of symptoms of the carcinoid syndrome

https://doi.org/10.1053/ejso.2001.1132Get rights and content

Abstract

Background The standard treatment used to control the symptoms of carcinoid syndrome (CS) involves subcutaneous injections of the somatostatin analogue octreotide. This is expensive (US$8000–16 000 per year), and treatment may be for many years. The aim of this study was to evaluate the efficacy and cost-effectiveness of our experience over the last 5 years with 1-131-labelled metaiodobenzylguanidine (MIBG) radionuclide therapy in the palliation of patients with CS.Methods A consecutive series of 20 symptomatic patients (referred between 1994 and 1999) with CS were evaluated. Fifteen of them underwent123I-MIBG scanning. Of the 13 patients with significant tracer uptake in metastatic deposits compared to background, 12 underwent a course of therapeutic131I-MIBG (one patient refused). Symptoms, biochemical markers, CT scans, follow-up123I-MIBG scans, and the requirement for octreotide were used to assess outcome of treatment. Costs of131I-MIBG and octreotide treatments were compared. Results MIBG treatment was well tolerated in all with only transient side-effects. Ten patients showed a measurable clinical improvement. Seven had a complete clinical response. The mean duration of response was 15.4 months. Octreotide was not required or was reduced in eight patients. Treatment with131I-MIBG resulted in a saving of US$1000 per patient, with effective symptom control, when compared to octreotide.Conclusion 1-131 MIBG therapy is a safe and cost-effective therapeutic option to successfully control symptoms in patients with carcinoid syndrome.

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Correspondence to: Mr G. Poston, Consultant Surgeon, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. Tel: +44 151 706 3484; Fax: +44 151 706 5827

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