Neuroblastoma is a form of childhood cancer that originates in the nervous system. It mainly occurs in young children: around 25 children in the Netherlands are diagnosed with it each year. To determine the most suitable treatment plan for each child, a scan is first used to locate the tumor and check for metastases in the body. Multiple scans are also performed throughout the treatment to monitor its effectiveness.
1.5 hours of lying still
Children currently receive a standard scan using the substance [¹²³I]mIBG. This method is effective but has drawbacks. Nine out of ten children diagnosed with neuroblastoma are under five years old. Because the current scan requires children to lie still for 1.5 hours, they often undergo anesthesia. This is unpleasant for many of these young children. Additionally, the substance currently used may be harmful to the thyroid, so children must take medication to prevent damage.
Alternative
The new study is examining whether the more modern [¹⁸F]mFBG PET/CT scan is a good alternative. This scan uses a different radioactive substance that is absorbed more quickly and leaves the body sooner. The scan images are also of higher quality. Dr. Bart de Keizer, nuclear medicine physician and radiologist at the Princess Máxima Center and UMC Utrecht and co-lead investigator of the study, says: 'In this study, we want to prove that the new method is at least as good as the existing one. Our goal is to make scanning less burdensome for children in the future, making this part of their treatment more comfortable.'
Dozens of scans
Previous research led by Dr. De Keizer and Prof. Dr. Lieve Tytgat at the Máxima has shown that the mFBG PET/CT scan is safe, but more scans are needed before it can be added to pediatric oncology guidelines. Therefore, 48 scans will be performed during the study on children with neuroblastoma or suspected neuroblastoma. Each child will receive both a standard [¹²³I]mIBG scan and a [¹⁸F]mFBG PET/CT scan. The study is coordinated by the trial and data center of the Máxima.
Lieve Tytgat, co-lead investigator, pediatric oncologist, and research group leader, says: 'A solid foundation for a new technique is very important. Less burdensome diagnostics can make a big difference, especially when a child is facing an intensive treatment process.'
Preparatory steps
Before the study could begin, sufficient availability of the new substance was ensured. The most reliable method of measurement for analyzing the PET/CT images was also determined. Pleun van de Water, a physician-researcher involved in the study, explains: 'When investigating the diagnostic value of a new scan, it’s important to perform the same measurements across multiple scans of children.'
Towards a new standard
If the results are positive, the [¹⁸F]mFBG PET/CT scan could become the new standard in the future. This would mean a more accurate and less burdensome scan for children with neuroblastoma—a significant step forward.
The clinical study MFBG PET-CT / PS22PET is made possible by the Dutch Foundation for Children with Cancer (KiKa). If you want to learn more about the previous research on mFBG, watch the video below.
