Targeted Radiotherapy with 131I-MIBG
For patients with refractory or relapsed disease, 131I-MIBG therapy is a cornerstone of the 2026 US clinical landscape. MIBG is a molecule that is naturally absorbed by neuroblastoma cells;
by attaching a radioactive iodine isotope to it, doctors can deliver high-energy radiation directly to tumors throughout the body while sparing most healthy tissue. Leading US centers, such as Children's Hospital of Philadelphia and MSK Kids, are now investigating moving MIBG therapy earlier in the treatment process—during the induction phase—to reduce the overall toxic chemotherapy burden. This "molecularly targeted" radiation is particularly effective for treating bone and bone marrow metastases that are difficult to reach with external beam radiation.