MIBG Therapy | Helios Clinic Berlin-Buch, Germany

MIBG therapy is a targeted radionuclide treatment used in selected neuroendocrine tumors that can actively concentrate meta-iodo-benzyl-guanidine (MIBG), also called iobenguane. MIBG is chemically similar to adrenaline and noradrenaline, so it is taken up by adrenergic (sympathetic) tissue and, in the right tumor types, by tumor deposits that share this biology. For therapy, MIBG is coupled to iodine-131 so that, after the compound is absorbed into the tumor, the radioactive component can irradiate the tumor from within. Uptake is described as occurring within minutes, while the radiation remains present for days because iodine-131 has a physical half-life of about 8 days. The emitted radiation has a short tissue range measured in millimeters, which supports the clinical intent of concentrating dose within tumor sites while limiting exposure to surrounding structures. The most established clinical targets are neuroendocrine tumors of “neuronal type,” particularly neuroblastoma, pheochromocytoma, and paraganglioma. Use can be considered in other malignancies only when they demonstrate increased MIBG accumulation; medullary thyroid carcinoma is a commonly referenced example of this “MIBG-avid only” category. A diagnostic MIBG study is central to selection because treatment depends on demonstrable tracer uptake in disease sites. Contemporary guidance for pheochromocytoma and paraganglioma imaging explicitly notes that I-123 MIBG scintigraphy helps identify candidates for I-131 MIBG therapy, and clinical pathways typically require confirmation of sufficient uptake before committing to therapeutic administration. The therapy is framed as palliative, aimed at shrinking tumor tissue and slowing growth, with the expectation of cure explicitly excluded and a potential delay of progression described for a subset of cases. It is an inpatient radionuclide admission lasting approximately three to six days. The radiopharmaceutical is administered via an indwelling venous cannula as an infusion over roughly two hours, with continuous blood pressure and ECG monitoring because hypertensive crises can occur during therapy, particularly in hormonally active disease; medication is available to manage such episodes. On discharge day, whole-body scintigraphy is performed to document radiotracer distribution, and laboratory monitoring is considered routine follow-up.