DIfferent genomic and metabolic patterns between mass-screening-positive and mass-screening-negative later-presenting neuroblastomas

Article Abstract:

In 1985, Japan extended a mass screening program for the detection of neuroblastoma, a major cancer of childhood, to cover the entire population. While it is hoped that the early identification of neuroblastoma in many cases will result in better survival for the affected children, it might also be anticipated that the mass screening program might yield new insights into the physiological aspects of this cancer. The mass screening program involves the measurement of vanillylmandelic acid and homovanillic acid in the urine of infants at the age of six months. These substances are metabolic by-products of catecholamines, a class of biochemicals important in the nervous system and commonly produced by neuroblastoma cells. As might be expected, this mass screening has detected some cases, while other cases have developed later, after a negative mass screening test. Researchers have not found any fundamental differences in the nature of the disease between the cases detected by screening and those which are detected some time afterward. Out of a total of 43 cases of neuroblastoma, 30 had been detected by the mass screening test. The majority of these cases were in the early stages and all 30 children remain alive with no evidence of disease. In contrast, the 13 cancers which were not conclusively identified by the early screening test were more advanced at the time of diagnosis. A genetic analysis revealed abnormalities in the second group. The N-myc gene is believed to play a role in the development of some cancers; this gene was found to be amplified, that is, present in larger than normal quantities, in seven of the 13 patients with negative screening tests but none of the patients who were diagnosed by mass screening. Of the 13 patients who were initially negative by the mass screening test, only two remain alive. These results are interpreted as suggesting that there may be at least two distinct forms of neuroblastoma. The more benign form of the disease may have features which make it more likely to be identified in the mass screening, while a more malignant form of the illness is apparently more likely to be missed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Medical screening, Health screening

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Treatment of advanced neuroblastoma with I-131 meta-iodobenzylguanidine

Article Abstract:

Benzylguanidine is a chemical selectively taken up by cells of the sympathetic nervous system. This guanethidine derivative can be labelled with radioactive iodine, and both the 131-I and 123-I radioisotopes of iodine have been used in scintigraphic studies. In such studies, the selective uptake of the radioactive iodobenzylguanidine can be visualized using scintillation detectors. This technique has been used to image tumors such as pheochromocytoma, medullary thyroid carcinoma, paraganglioma, and neuroblastoma. The same selective uptake might be exploited in a therapeutic capacity as well. If the tumors take up a small dose of radioactive tracer for imaging, they might take up a larger dose of radioactive compound which might serve as a direct source of radiotherapy within the cancer itself. This technique was evaluated in the treatment of 31 children with advance neuroblastoma. All 31 patients had tumors that were visible on scintigraphy, indicating that their tumors took up the radioactive compound. All 31 patients had either failed to respond to conventional therapy or relapsed after conventional therapy. The children were given doses of radioactive I-131 meta-iodobenzylguanidine ranging from 2.8 to 6.0 gigaBecquerels (a gigaBecquerel is radioactivity at a level of one billion radioactive disintegrations per second). Two complete and four partial response were observed. These patients relapsed and all 31 patients are either dead or alive with disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Physiology, Radioactive tracers in physiology, Radioactive tracers

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