General Remarks

A case of 123I-MIBG radio-guided navigation surgery for progressive neuroblastoma

Masatoshi Hirasawa, Kazutoshi Miyamoto
Department of Surgery, Division of Pediatric Surgery, Asahikawa Medical College

Abstract

　For surgical resection of progressive neuroblastoma（NB）, it is difficult to distinguish viable tumor from scar tissue after multidisciplinary therapy.
　A 4 year old girl with stage 4 NB underwent subtotal resection of a huge retroperitoneal primary tumor, followed by 3 courses of chemotherapy. On inspection after surgery, a viable tumor remained visible on CT and 123I-MIBG. A routine scintigram dose of 123I-MIBG was injected 24 hours prior to the operation. A scintigram was obtained 23 hours later. The residual tumor was not visible at the operative site, but it was detectable using a gamma probe（Tyco GPS navigator）. 123I-MIBG navigation is an effective tool to determine the surgical area for a complete resection.
　After 2 additional courses of chemotherapy, the recurrent tumor was detected by CT and 123I-MIBG. Additional radiation and chemotherapy were performed, but the additional therapy was not effective. We therefore performed a 2nd 123I-MIBG navigation surgery. After the 2nd surgery, the recurrent tumor was too small to be seen with a gamma probe and we could not perform a complete resection.
　123I-MIBG navigation is an effective tool for surgical resection, but it may be difficult to find small tumors or recurrent tumors after multidisciplinary therapy.

Keywords：Neuroblastoma, Radio-guided navigation surgery, ¹²³I-MIBG