Startseite Medizin Individualized dosimetry in children and young adults with differentiated thyroid cancer undergoing iodine-131 therapy
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Individualized dosimetry in children and young adults with differentiated thyroid cancer undergoing iodine-131 therapy

  • , , , und EMAIL logo
Veröffentlicht/Copyright: 13. Juli 2020
Journal of Pediatric Endocrinology and Metabolism
Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 33 Heft 8

Abstract

Objectives

The amount of Iodine-131 to treat young patients with differentiated thyroid cancer (DTC) has not been established so far. The purpose of this study was to perform and compare blood dosimetry by “Hanscheid’s approach”and lesion dosimetry by “Maxon’s approach”.

Methods

Seventy-one DTC patients ≤21 years were given diagnostic activity of 74 MBq 131I followed by whole-body scan (WBS) at 2 h (pre-void), 24 h, 48 h, and ≥72 h. Pre-therapy blood and lesion dosimetry were conducted to determine the absorbed doses to blood and lesions and to predict the therapeutic activity. The administered activities were varied from 1.11–5.55 GBq of 131I depending on disease extent. Post therapy dosimetries were again performed by acquiring WBS data at 24 h, 48 h, and ≥72 h.

Results

In blood dosimetry, the difference between predicted therapy activity (PTA) and actual therapeutic activity (ATA) was statistically significant in remnant and lung lesions but insignificant in nodal metastases (p=0.287). In lesion dosimetry, the difference between PTA and ATA was statistically significant for lung metastasis patients; however, not significant in remnant (p=0.163) and nodal metastases (p=0.054). The difference between predicted and observed absorbed dose was insignificant in blood dosimetry whereas, significant in lesion dosimetry.

Conclusions

The PTA based on 0.3 Gy recommendations of Hanscheid et al. may be adequate for patients with remnant or nodal metastases but inadequate for lung metastases. Lesion dosimetry demonstrated that there is scope to decrease the 131I empiric ATA for remnant and nodal metastases; at the same time, there is scope to increase in lung metastasis patients.

Keywords: children; dosimetry; iodine-131; radioactive iodine therapy; thyroid cancer
Corresponding author: Dr. Prof. Head Chandrasekhar Bal, M.D., D. Sc., Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 11 26593210, E-mail:

  1. Research Funding: There is no source of funding.

  2. Author contributions: The role of authors in this study is as mentioned below: 1. Praveen Kumar: Data collection, analysis, and interpretation of the data 2. Nishikant A. Damle: Analysis and interpretation of the data 3. Sandeep Agarwala: Selection of patients recruited in the study and data interpretation 4. S.N. Dwivedi: Statistical analysis 5. Chandrasekhar Bal: Study design, analysis, and interpretation of the data.

  3. Competing Interests: No potential conflicts of interest relevant to this article exist.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Ethical approval was obtained from the institute human ethics committee (IESC/T-87/28.02.2014).

References

1. Seidlin, SM, Marinelli, LD, Oshry, E. Radioactive iodine therapy: effect on functioning metastases of adenocarcinoma of thyroid. J Am Med Assoc 1946;132:838–47. https://doi.org/10.1001/jama.1946.02870490016004.Suche in Google Scholar

2. Jarzab, B, Handkiewicz-Junak, D, Wloch, J. Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review. Endocr Relat Cancer 2005;12:773–803.10.1677/erc.1.00880Suche in Google Scholar PubMed

3. Reynolds, JC. Comparison of 131I absorbed radiation doses in children and adults: a tool for estimating therapeutic 131I doses in children. DOE/EH-0406. Springfield, Virginia: US Department of Commerce, Technology Administration, National Technical Information Service; 1994.Suche in Google Scholar

4. Franzius, C, Dietlein, M, Biermann, M, Frühwald, M, Linden, T, Bucsky, P, et al. Procedure guideline for radioiodine therapy and 131I whole-body scintigraphy in pediatric patients with differentiated thyroid cancer. Nuklearmedizin 2007;46:224–31.10.1160/nukmed-0288Suche in Google Scholar PubMed

5. Jarzab, B, Handkiewicz Junak, D, Włoch, J, Kalemba, B, Roskosz, J, Kukulska, A, et al. Multivariate analysis of prognostic factors for differentiated thyroid carcinoma in children. Eur J Nucl Med 2000;27:833–41.10.1007/s002590000271Suche in Google Scholar PubMed

6. Hoe, FM, Charron, M, Moshang, TJr. Use of the recombinant human TSH stimulated thyroglobulin level and diagnostic whole-body scan in children with differentiated thyroid carcinoma. J Pediatr Endocrinol Metab 2006;19:25–30. https://doi.org/10.1515/jpem.2006.19.1.25.Suche in Google Scholar

7. Lau, WF, Zacharin, MR, Waters, K, Wheeler, G, Johnston, V, Hicks, RJ. Management of pediatric thyroid carcinoma: recent experience with recombinant human thyroid-stimulating hormone in preparation for radioiodine therapy. Intern Med J 2006;36:564–70. https://doi.org/10.1111/j.1445-5994.2006.01149.x.Suche in Google Scholar

8. Snyder, WS, Ford, MR, Warner, GG, Watson, SB. S absorbed dose per unit cumulated activity for selected radionuclides and organs: MIRD Pamphle. No 11. Reston, Virginia: Society of Nuclear Medicine; 1975.Suche in Google Scholar

9. Piruzan, E, Haghighatafshar, M, Faghihi, R, Entezarmahdi, SM. Calculation of blood dose in patients treated with 131I using MIRD, imaging, and blood sampling methods. Medicine (Baltimore) 2016;95:3154. https://doi.org/10.1097/md.0000000000003154.Suche in Google Scholar

10. Giostra, A, Richetta, E, Pasquino, M, Miranti, A, Cutaia, C, Brusasco, G, et al. Red marrow and blood dosimetry in 131I treatment of metastatic thyroid carcinoma: pre-treatment versus in-therapy results. Phys Med Biol 2016;61:4316–26. https://doi.org/10.1088/0031-9155/61/11/4316.Suche in Google Scholar

11. Snyder, J, Gorman, C, Scanlon, P. Thyroid remnant ablation: the questionable pursuit of an ill-defined goal. J Nucl Med 1983;24:659–65.Suche in Google Scholar

12. Koral, KF, Adler, RS, Carey, JE, Beierwaltes, WH. Iodine-131 treatment of thyroid cancer: absorbed dose calculated from post-therapy scans. J Nucl Med 1986;27:1207–11.Suche in Google Scholar

13. Maxon, HR3rd, Englaro, EE, Thomas, SR, Hertzberg, VS, Hinnefeld, JD, Chen, LS, et al. Radioiodine-131 therapy for well-differentiated thyroid cancer–a quantitative radiation dosimetric approach: outcome and validation in 85 patients. J Nucl Med 1992;33:1132–6.Suche in Google Scholar

14. Samuel, AM, Rajashekharrao, B. Radioiodine therapy for well-differentiated thyroid cancer: a quantitative dosimetric evaluation for remnant thyroid ablation after surgery. J Nucl Med 1994;35:1944–50.Suche in Google Scholar

15. 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;44:451–6.Suche in Google Scholar

16. Bal, CS, Kumar, A, Pant, GS. Radioiodine dose for remnant ablation in differentiated thyroid carcinoma: a randomized clinical trial in 509 patients. J Clin Endocrinol Metab 2004;89:1666–73. https://doi.org/10.1210/jc.2003-031152.Suche in Google Scholar

17. Bal, CS, Kumar, A, Chandra, P, Dwivedi, SN, Pant, GS. A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing subtotal thyroidectomy. Acta Oncol 2006;45:1067–72. https://doi.org/10.1080/02841860500418377.Suche in Google Scholar

18. Hänscheid, H, Lassmann, M, Luster, M, Thomas, SR, Pacini, F, Ceccarelli, C, et al. Iodine biokinetics and dosimetry in radioiodine therapy of thyroid cancer: procedures and results of a prospective international controlled study of ablation after rhTSH or hormone withdrawal. J Nucl Med 2006;47:648–54.Suche in Google Scholar

19. Verburg, FA, Hänscheid, H, Biko, J, Hategan, MC, Lassmann, M, Kreissl, MC, et al. Dosimetry-guided high-activity (131)I therapy in patients with advanced differentiated thyroid carcinoma: initial experience. Eur J Nucl Med Mol Imaging 2010;37:896–903. https://doi.org/10.1007/s00259-009-1303-x.Suche in Google Scholar

20. Verburg, FA, Lassmann, M, Mäder, U, Luster, M, Reiners, C, Hänscheid, 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;38:673–80. https://doi.org/10.1007/s00259-010-1689-5.Suche in Google Scholar

21. Samuel, AM, Rajashekharrao, B, Shah, DH. Pulmonary metastases in children and adolescents with well-differentiated thyroid cancer. J Nucl Med 1998;39:1531–6.Suche in Google Scholar

22. Verburg, FA, Reiners, C, Hänscheid, H. Approach to the patient: role of dosimetric RAI Rx in children with DTC. J Clin Endocrinol Metab 2013;98:3912–9. https://doi.org/10.1210/jc.2013-2259.Suche in Google Scholar

23. Hanscheid, 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. Endocrine-Related Cancer 2009;16:1283–89. https://doi.org/10.1677/erc-09-0076.Suche in Google Scholar

24. Maxon, HR. Quantitative radioiodine therapy in the treatment of differentiated thyroid cancer. Q J Nucl Med 1999;43:313–23.Suche in Google Scholar

25. Thomas, SR, Samaratunga, RC, Sperling, M, Maxon, HR3rd. The predictive estimate of blood dose from external counting data preceding radioiodine therapy for thyroid cancer. Nucl Med Biol 1993;20:157–62. https://doi.org/10.1016/0969-8051(93)90108-7.Suche in Google Scholar

26. Traino, AC, Di Martino, F, Boni, G, Mariani, G, Lazzeri, M. A minimally invasive method to evaluate 131I kinetics in blood. Radiat Prot Dosimetry 2004;109:249–52. https://doi.org/10.1093/rpd/nch041.Suche in Google Scholar

27. Sisson, JC, Shulkin, BL, Lawson, S. Increasing efficacy and safety of treatments of patients with well-differentiated thyroid carcinoma by measuring body retentions of 131I. J Nucl Med 2003;44:898–903.Suche in Google Scholar

28. 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.Suche in Google Scholar

29. Retzlaff, JA, Tauxe, WN, Kiely, JM, Stroebel, CF. Erythrocyte volume, plasma volume, and lean body mass in adult men and women. Blood 1969;33:649–67. https://doi.org/10.1182/blood.v33.5.649.649.Suche in Google Scholar

30. Maxon, HR, Smith, HS. Radioiodine-131 in the diagnosis and treatment of metastatic differentiated thyroid cancer. Endo Metab Clin North Am 1990;19:685–718. https://doi.org/10.1016/s0889-8529(18)30317-7.Suche in Google Scholar

31. 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;309:937–41. https://doi.org/10.1056/nejm198310203091601.Suche in Google Scholar

32. Press, OW, Eary, JF, Appelbaum, FR, Martin, PJ, Badger, CC, Nelp, WB, et al. Radiolabeled-antibody therapy of B-cell lymphoma with autologous bone marrow support. N Engl J Med 1993;329:1219–24. https://doi.org/10.1056/nejm199310213291702.Suche in Google Scholar

33. Jain, SC, Mehta, SC, Kumar, B, Reddy, AR, Nagaratnam, A. Formulation of the reference Indian adult: anatomic and physiologic data. Health Phys 1995;68:509–22. https://doi.org/10.1097/00004032-199504000-00008.Suche in Google Scholar

34. Stabin, MG. Fundamentals of nuclear medicine dosimetry. Steps in dose calculation. USA: Springer; 2008.Suche in Google Scholar

35. Benua, RS, Leeper, RD. A method and rationale for treating metastatic thyroid carcinoma with the largest safe dose of 131I. Front Thyroidol 1986;2:1317–21.Suche in Google Scholar

36. 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;44:451–6.Suche in Google Scholar

37. 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;47:1587–91.Suche in Google Scholar

38. Giostra, A, Richetta, E, Pasquino, M, Miranti, A, Cutaia, C, Brusasco, G, et al. Red marrow and blood dosimetry in 131I treatment of metastatic thyroid carcinoma: pre-treatment versus in-therapy results. Phys Med Biol 2016;7:4316–26. https://doi.org/10.1088/0031-9155/61/11/4316.Suche in Google Scholar

39. Piruzan, E, Haghighatafshar, M, Faghihi, R, Entezarmahdi, SM. Calculation of blood dose in patients treated with 131I using MIRD, imaging, and blood sampling methods. Medicine (Baltimore) 2016;95:3154. https://doi.org/10.1097/md.0000000000003154.Suche in Google Scholar

40. Verburg, FA, Biko, J, Diessl, S, Demidchik, Y, Drozd, V, Rivkees, SA, et al. I-131 activities as high as safely administrable (AHASA) for the treatment of children and adolescents with advanced differentiated thyroid cancer. J Clin Endocrinol Metab 2011;96:1268–71. https://doi.org/10.1210/jc.2011-0520.Suche in Google Scholar

41. Haugen, BR, Alexander, EK, Bible, KC, Doherty, GM, Mandel, SJ, Nikiforov, YE, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016;26:1–133. https://doi.org/10.1089/thy.2015.0020.Suche in Google Scholar

42. Linderkamp, O, Versmold, HT, Riegel, KP, Betke, K. Estimation and prediction of blood volume in infants and children. Europ J Pediat 1977;125:227–34. https://doi.org/10.1007/bf00493567.Suche in Google Scholar

43. Liu, B, Zeng, Y, Wang, JT, Zhao, Z, Mu, D, Kuang, AR. Determining the activities of 131I with a dose-rate constraint method for the treatment of differentiated thyroid carcinoma with diffuse pulmonary metastases. Sichuan Da Xue Xue Bao Yi Xue Ban 2010;41:513–7. 20629335.Suche in Google Scholar PubMed

44. Kumar, P, Bal, C, Damle, NA, Ballal, S, Dwivedi, SN, Agarwala, S. Lesion-wise comparison of pre-therapy and post-therapy effective half-life of iodine-131 in pediatric and young adult patients with differentiated thyroid cancer undergoing radioiodine therapy. Nucl Med Mol Imaging 2019;53:199–207. https://doi.org/10.1007/s13139-019-00592-z.Suche in Google Scholar

45. Jeevanram, RK, Shah, DH, Sharma, SM, Ganatra, RD. Influence of initial large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients. Int J Rad Appl Instrum B 1986;13:277–9. https://doi.org/10.1016/0883-2897(86)90108-x.Suche in Google Scholar

46. Walrand, S, Hesse, M, Jamar, F. Statistical and radiobiological analysis of the so-called thyroid stunning. EJNMMI Res. 2015;5:67–72. https://doi.org/10.1186/s13550-015-0144-9.Suche in Google Scholar

47. Lassmann, M, Luster, M, Hänscheid, H, Reiners, C. Impact of I-131 diagnostic activities on the biokinetics of thyroid remnants. J Nucl Med 2004;45:619–25.Suche in Google Scholar

48. Valentin, J. Basic anatomical and physiological data for use in radiological protection: reference values. A report of age- and gender-related differences in the anatomical and physiological characteristics of reference individuals. ICRP Publication 89. Ann ICRP 2002;32:5–265.10.1016/S0146-6453(03)00002-2Suche in Google Scholar

49. Chiesa, C, Castellani, MR, Vellani, C, Orunesu, E, Negri, A, Azzeroni, R, et al. Individualized dosimetry in the management of metastatic differentiated thyroid cancer. Q J Nucl Med Mol Imaging 2009;53:546–61.Suche in Google Scholar
Received: 2020-02-18
Accepted: 2020-04-23
Published Online: 2020-07-13
Published in Print: 2020-08-27

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Review Article
  3. Pharmacological treatment strategies for patients with monogenic obesity
  4. Original Articles
  5. Influence of FTO (Fat mass and obesity) gene and parental obesity on Brazilian children and adolescents adiposity
  6. Developing waist circumference, waist-to-height ratio percentile curves for Pakistani children and adolescents aged 2–18 years using Lambda-Mu-Sigma (LMS) method
  7. Screening for celiac disease among children with overweight and obesity: toward exploring celiac iceberg
  8. Relationship between breastfeeding and obesity in high school girls
  9. Saudi children with celiac disease: are they at risk of developing type-1 diabetes mellitus?
  10. The relation of serum endocan and soluble endoglin levels with metabolic control in children and adolescents with type 1 diabetes mellitus
  11. From infancy to adulthood: challenges in congenital nephrogenic diabetes insipidus
  12. Thyroid peroxidase antibodies are common in children with HLA-conferred susceptibility to type 1 diabetes, but are weakly associated with thyroid function
  13. Individualized dosimetry in children and young adults with differentiated thyroid cancer undergoing iodine-131 therapy
  14. Association study of DLK1 in girls with idiopathic central precocious puberty
  15. Clinical, biochemical and genetic characteristics of children with congenital adrenal hyperplasia due to 17α-hydroxylase deficiency
  16. Morning specimen is not representative of metabolic control in Tunisian children with phenylketonuria: a repeated cross-sectional study
  17. Fibroblast growth factor 23 and its role in phosphate homeostasis in growing children compared to adults
  18. Utility and duration of leuprolide stimulation testing in children
  19. Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy – an observational study
  20. Case Reports
  21. Metyrapone as treatment in the neonatal McCune–Albright syndrome
  22. Tumor-induced rickets-osteomalacia: an enigma
  23. Porto-systemic shunt – a rare cause of hyperandrogenism in children. Two case reports and review of literature
  24. Hypercalcemia from hypervitaminosis A in a child with autism
https://doi.org/10.1515/jpem-2020-0072
Schlagwörter für diesen Artikel
children; dosimetry; iodine-131; radioactive iodine therapy; thyroid cancer

Artikel in diesem Heft

  1. Frontmatter
  2. Review Article
  3. Pharmacological treatment strategies for patients with monogenic obesity
  4. Original Articles
  5. Influence of FTO (Fat mass and obesity) gene and parental obesity on Brazilian children and adolescents adiposity
  6. Developing waist circumference, waist-to-height ratio percentile curves for Pakistani children and adolescents aged 2–18 years using Lambda-Mu-Sigma (LMS) method
  7. Screening for celiac disease among children with overweight and obesity: toward exploring celiac iceberg
  8. Relationship between breastfeeding and obesity in high school girls
  9. Saudi children with celiac disease: are they at risk of developing type-1 diabetes mellitus?
  10. The relation of serum endocan and soluble endoglin levels with metabolic control in children and adolescents with type 1 diabetes mellitus
  11. From infancy to adulthood: challenges in congenital nephrogenic diabetes insipidus
  12. Thyroid peroxidase antibodies are common in children with HLA-conferred susceptibility to type 1 diabetes, but are weakly associated with thyroid function
  13. Individualized dosimetry in children and young adults with differentiated thyroid cancer undergoing iodine-131 therapy
  14. Association study of DLK1 in girls with idiopathic central precocious puberty
  15. Clinical, biochemical and genetic characteristics of children with congenital adrenal hyperplasia due to 17α-hydroxylase deficiency
  16. Morning specimen is not representative of metabolic control in Tunisian children with phenylketonuria: a repeated cross-sectional study
  17. Fibroblast growth factor 23 and its role in phosphate homeostasis in growing children compared to adults
  18. Utility and duration of leuprolide stimulation testing in children
  19. Effect of an interval rehabilitation program with home-based, vibration-assisted training on the development of muscle and bone in children with cerebral palsy – an observational study
  20. Case Reports
  21. Metyrapone as treatment in the neonatal McCune–Albright syndrome
  22. Tumor-induced rickets-osteomalacia: an enigma
  23. Porto-systemic shunt – a rare cause of hyperandrogenism in children. Two case reports and review of literature
  24. Hypercalcemia from hypervitaminosis A in a child with autism
Jetzt anmelden und 20% sparen
Institutioneller Zugang
Wie funktioniert Authentifizierung?
Gewinner des OpenAthens UX Award 2026
Gewinner des OpenAthens UX Award 2026
Haben Sie eine Idee, wie wir unsere Website verbessern können?
Bitte schreiben Sie uns.
© 2026 De Gruyter Brill
Heruntergeladen am 30.3.2026 von https://www.degruyterbrill.com/document/doi/10.1515/jpem-2020-0072/html
Button zum nach oben scrollen