Methods and Clinical Efficacy of Dosimetry-Based Treatment in Radioiodine Therapy of Thyroid Cancer

Chul Paeng Jin; Chung June-Key

doi:10.11106/jkta.2013.6.1.43

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Jin and June-Key: Methods and Clinical Efficacy of Dosimetry-Based Treatment in Radioiodine Therapy of Thyroid Cancer

Original Article

J Korean Thyroid Assoc 2013;6(1):43-48.

Published online: 3 May 2013

DOI: https://doi.org/10.11106/jkta.2013.6.1.43

Methods and Clinical Efficacy of Dosimetry-Based Treatment in Radioiodine Therapy of Thyroid Cancer

Chul Paeng Jin, Chung June-Key

Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

Address reprint requests to June-Key Chung, MD, PhD, Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-3341, Fax: 82-2-745-7690, E-mail: jkchung@snu.ac.kr

Received 14 October 2012 Accepted 30 October 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Radioiodine (RI) therapy is one of the key factors for the good prognosis of differentiated thyroid cancers. Currently, most of RI treatments are performed with predetermined fixed dose of RI, whereas strict dose adjustment is made in chemotherapy or external radiotherapy for cancer treatment. Although fixed dose methods have been practically effective in RI therapy hitherto, dose determination with individual radiation dosimetry is theoretically superior to use of empirical fixed dose, for maximization of treatment effect and minimization of adverse events. The theoretical superiority of dosimetry-based dose determination is not yet directly supported by clinical data of real world; however, indirect results support the use of dosimetry-based dose determination in several specific patient groups. In this review, the basis of dosimetry is briefly discussed with regard to necessity and practical methods. Additionally, the efficacy of dosimetry is also discussed through the data of clinical studies so far.

Keywords: Thyroid cancer, Radioiodine, Dosimetry, Fixed dose

References

1. Jung KW, Park S, Won YJ, Kong HJ, Lee JY, Seo HG, et al. Prediction of cancer incidence and mortality in Korea, 2012. Cancer Res Treat. 2012; 44(1):25–31.

2. Van Nostrand D, Atkins F, Yeganeh F, Acio E, Bursaw R, Wartofsky L. Dosimetrically determined doses of radioiodine for the treatment of metastatic thyroid carcinoma. Thyroid. 2002; 12(2):121–34.

3. Yi KH, Park YJ, Koong SS, Kim JH, Na DG, Ryu JS, et al. Revised Korean Thyroid Association management guidelines for patients with thyroid nodules and thyroid cancer. Endocrinol Metab. 2010; 25(4):270–97.

4. Maxon HR 3rd, Englaro EE, Thomas SR, Hertzberg VS, Hinnefeld JD, Chen LS, et al. Radioiodine-131 therapy for well-differentiated thyroid cancera quantitative radiation dosimetric approach: outcome and validation in 85 patients. J Nucl Med. 1992; 33(6):1132–6.

5. Maxon HR, Thomas SR, Hertzberg VS, Kereiakes JG, Chen IW, Sperling MI, et al. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med. 1983; 309(16):937–41.

6. Benua RS, Cicale NR, Sonenberg M, Rawson RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. Am J Roentgenol Radium Ther Nucl Med. 1962; 87:171–82.

7. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991; 21(1):109–22.

8. Sgouros G, Song H, Ladenson PW, Wahl RL. Lung toxicity in radioiodine therapy of thyroid carcinoma: development of a dose-rate method and dosimetric implications of the 80-mCi rule. J Nucl Med. 2006; 47(12):1977–84.

9. Song H, He B, Prideaux A, Du Y, Frey E, Kasecamp W, et al. Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases. J Nucl Med. 2006; 47(12):1985–94.

10. Hall P, Holm LE, Lundell G, Bjelkengren G, Larsson LG, Lindberg S, et al. Cancer risks in thyroid cancer patients. Br J Cancer. 1991; 64(1):159–63.

11. Dottorini ME, Lomuscio G, Mazzucchelli L, Vignati A, Colombo L. Assessment of female fertility and carcinogenesis after iodine-131 therapy for differentiated thyroid carcinoma. J Nucl Med. 1995; 36(1):21–7.

12. Ishikawa K, Noguchi S, Tanaka K, Fukuda A, Hirohata T. Second primary neoplasms in thyroid cancer patients. Jpn J Cancer Res. 1996; 87(3):232–9.

13. Rubino C, de Vathaire F, Dottorini ME, Hall P, Schvartz C, Couette JE, et al. Second primary malignancies in thyroid cancer patients. Br J Cancer. 2003; 89(9):1638–44.

14. Sawka AM, Thabane L, Parlea L, Ibrahim-Zada I, Tsang RW, Brierley JD, et al. Second primary malignancy risk after radioactive iodine treatment for thyroid cancer: a systematic review and meta-analysis. Thyroid. 2009; 19(5):451–7.

15. Iyer NG, Morris LG, Tuttle RM, Shaha AR, Ganly I. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer. 2011; 117(19):4439–46.

16. Wahl RL, Kroll S, Zasadny KR. Patient-specific whole-body dosimetry: principles and a simplified method for clinical implementation. J Nucl Med. 1998; 39(8 Suppl):14S–20S.

17. Furhang EE, Larson SM, Buranapong P, Humm JL. Thyroid cancer dosimetry using clearance fitting. J Nucl Med. 1999; 40(1):131–6.

18. Hermanska J, Karny M, Zimak J, Jirsa L, Samal M, Vlcek P. Improved prediction of therapeutic absorbed doses of radioiodine in the treatment of thyroid carcinoma. J Nucl Med. 2001; 42(7):1084–90.

19. Hänscheid H, Lassmann M, Luster M, Kloos RT, Reiners C. Blood dosimetry from a single measurement of the whole body radioiodine retention in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2009; 16(4):1283–9.

20. Freudenberg LS, Jentzen W, Marlowe RJ, Koska WW, Luster M, Bockisch A. 124-iodine positron emission tomography/computed tomography dosimetry in pediatric patients with differentiated thyroid cancer. Exp Clin Endocrinol Diabetes. 2007; 115(10):690–3.

21. Freudenberg LS, Jentzen W, Petrich T, Fromke C, Marlowe RJ, Heusner T, et al. Lesion dose in differentiated thyroid carcinoma metastases after rhTSH or thyroid hormone withdrawal: 124I PET/CT dosimetric comparisons. Eur J Nucl Med Mol Imaging. 2010; 37(12):2267–76.

22. Jentzen W, Balschuweit D, Schmitz J, Freudenberg L, Eising E, Hilbel T, et al. The influence of saliva flow stimulation on the absorbed radiation dose to the salivary glands during radioiodine therapy of thyroid cancer using 124I PET(/CT) imaging. Eur J Nucl Med Mol Imaging. 2010; 37(12):2298–306.

23. Jentzen W, Hobbs RF, Stahl A, Knust J, Sgouros G, Bockisch A. Pre-therapeutic (124)I PET(/CT) dosimetry confirms low average absorbed doses per administered (131)I activity to the salivary glands in radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2010; 37(5):884–95.

24. Sgouros G, Hobbs RF, Atkins FB, Van Nostrand D, Ladenson PW, Wahl RL. Three-dimensional radiobiological dosimetry (3D-RD) with 124I PET for 131I therapy of thyroid cancer. Eur J Nucl Med Mol Imaging. 2011; 38 Suppl 1:S41–7.

25. Van Nostrand D, Khorjekar GR, O’Neil J, Moreau S, Atkins FB, Kharazi P, et al. Recombinant human thyroid-stimulating hormone versus thyroid hormone withdrawal in the identification of metastasis in differentiated thyroid cancer with 131I planar whole-body imaging and 124I PET. J Nucl Med. 2012; 53(3):359–62.

26. Lassmann M, Hanscheid H, Chiesa C, Hindorf C, Flux G, Luster M. EANM Dosimetry Committee series on standard operational procedures for pre-therapeutic dosimetry I: blood and bone marrow dosimetry in differentiated thyroid cancer therapy. Eur J Nucl Med Mol Imaging. 2008; 35(7):1405–12.

27. Freudenberg LS, Jentzen W, Stahl A, Bockisch A, Rosenbaum-Krumme SJ. Clinical applications of 124I-PET/CT in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2011; 38 Suppl 1:S48–56.

28. Sgouros G, Kolbert KS, Sheikh A, Pentlow KS, Mun EF, Barth A, et al. Patient-specific dosimetry for 131I thyroid cancer therapy using 124I PET and 3-dimensional-internal dosimetry (3D-ID) software. J Nucl Med. 2004; 45(8):1366–72.

29. Verburg FA, Lassmann M, Mader U, Luster M, Reiners C, Hanscheid H. The absorbed dose to the blood is a better predictor of ablation success than the administered 131I activity in thyroid cancer patients. Eur J Nucl Med Mol Imaging. 2011; 38(4):673–80.

30. Klubo-Gwiezdzinska J, Van Nostrand D, Atkins F, Burman K, Jonklaas J, Mete M, et al. Efficacy of dosimetric versus empiric prescribed activity of 131I for therapy of differentiated thyroid cancer. J Clin Endocrinol Metab. 2011; 96(10):3217–25.

31. Kulkarni K, Van Nostrand D, Atkins F, Aiken M, Burman K, Wartofsky L. The relative frequency in which empiric dosages of radioiodine would potentially overtreat or undertreat patients who have metastatic well-differentiated thyroid cancer. Thyroid. 2006; 16(10):1019–23.

32. Tuttle RM, Leboeuf R, Robbins RJ, Qualey R, Pentlow K, Larson SM, et al. Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med. 2006; 47(10):1587–91.

33. Dorn R, Kopp J, Vogt H, Heidenreich P, Carroll RG, Gulec SA. Dosimetry-guided radioactive iodine treatment in patients with metastatic differentiated thyroid cancer: largest safe dose using a risk-adapted approach. J Nucl Med. 2003; 44(3):451–6.

34. Lee JJ, Chung JK, Kim SE, Kang WJ, Park do J, Lee DS, et al. Maximal safe dose of I-131 after failure of standard fixed dose therapy in patients with differentiated thyroid carcinoma. Ann Nucl Med. 2008; 22(9):727–34.

35. Jentzen W, Schneider E, Freudenberg L, Eising EG, Gorges R, Muller SP, et al. Relationship between cumulative radiation dose and salivary gland uptake associated with radioiodine therapy of thyroid cancer. Nucl Med Commun. 2006; 27(8):669–76.

36. Liu B, Kuang A, Huang R, Zhao Z, Zeng Y, Wang J, et al. Influence of vitamin C on salivary absorbed dose of 131I in thyroid cancer patients: a prospective, randomized, single-blind, controlled trial. J Nucl Med. 2010; 51(4):618–23.

37. Liu B, Huang R, Kuang A, Zhao Z, Zeng Y, Wang J, et al. Iodine kinetics and dosimetry in the salivary glands during repeated courses of radioiodine therapy for thyroid cancer. Med Phys. 2011; 38(10):5412–9.

38. Lassmann M, Reiners C, Luster M. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer. 2010; 17(3):R161–72.

Fig. 1.

Dose-response relationships of tumor and normal cells in radiation therapy.

Table 1.

Commonly recommended dose for RI therapy of thyroid cancer

	Van Nostrand et al.²⁾	Yl et al.³⁾
Local lymph node metastasis 150–175 mCi
Lung metastasis	175–200 mCi	100–200 mCi*
Bone metastasis	200 mCi

*In case of lung metastasis, it is considered to control whole-body remaining dose at 48 hours under 80 mCi

Table 2.

Modified dosimetry methods to evaluate dose of bone marrow

Authors	Major modification
Benua et al.⁶⁾ Wahl et al.¹⁶⁾ Furhang et al.¹⁷⁾ Hermanska et al.¹⁸⁾ Hänscheid et al.¹⁹⁾	Monoexponential curve fitting using measurements of blood, urine, and whole body counts, 6 times until 96 hours Substitution of whole body counting with imaging Use of only image counting without blood sampling Biexponential curve fitting Simplified calculation using single measurement at 48 hours

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