131I- MIBG Therapy: Living in a Lead-Lined World

Presentation Description:
Despite advances in the treatment of high-risk neuroblastoma, cure rates remain <50% with neuroblastoma accounting for 15% of all pediatric oncology deaths (Maris, 2007, 2010). In Canada, there are 60-70 children newly diagnosed with neuroblastoma each year, with 50% of these cases being stage IV disease (Canadian Cancer Society, 2008).  Although most patients with stage IV high risk disease respond to front-line therapy, 50-60% will relapse and the prognosis for these children remains poor, with most dying from progressive disease. These children often suffer tumor related pain and undergo frequent cycles of chemotherapy for disease control, resulting in side effects such as febrile neutropenia, and many visits to hospital for supportive and follow up care.  The literature describes that 131I- MIBG therapy is effective in the treatment of refractory and relapse disease although is not a cure.  In a large multi-institutional phase 2 trial examining 131I-MIBG as monotherapy Matthay et al, concluded that this targeted radionuclide is highly active and effective in the treatment of refractory or relapse high risk neuroblastoma with an overall complete plus partial response rate of 36%.

Access for Canadian families has been limited by a lack of Canadian 131I- MIBG facilities. Currently there is only 1 center in Canada and approximately 10 in the US that offer this therapy, and as a result families seeking 131I-MIBG therapy travel long distances to receive this treatment. As a leader in research and innovation SickKids gained approval for the construction and implementation of a 131I-MIBG therapy suite on the inpatient haematology/oncology unit. This presentation provided an overview of the planning, development and implementation of the 131I-MIBG program at SickKids.

Denise Mills, RN(EC), MN, NP
Nurse Practitioner, Division of Haematology/Oncology
The Hospital for Sick Children, Toronto
Lawrence S. Bloomberg Cross Appointment at Faculty of Nursing
University of Toronto, Toronto

Sharleen Sawicki, RN, BScN, CPHON
Registered Nurse, Division of Haematology/Oncology
The Hospital for Sick Children, Toronto

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