Nuklearmedizin 2007; 46(04): 121-128
DOI: 10.1160/nukmed-0076
Zertifizierte Fortbildung
Schattauer GmbH

124I-PET dosimetry in advanced differentiated thyroid cancer: Therapeutic impact

124I-PET-Dosimetrie bei fortgeschrittenem differenzierten Schilddrüsenkarzinom: Therapeutische Relevanz 1,2Department of Nuclear Medicine (Director: Prof. Dr. med. Dr. rer. nat. A. Bockisch1, Prof. Dr. med. W. Knapp2)
L. S. Freudenberg
1   University of Duisburg/Essen
,
W. Jentzen
1   University of Duisburg/Essen
,
R. Görges
1   University of Duisburg/Essen
,
T. Petrich
2   Medizinische Hochschule Hannover, Germany
,
R. J. Marlowe
3   Independent Medical Writer and Editor, Jersey City, NJ, USA
,
J. Knust
1   University of Duisburg/Essen
,
A. Bockisch
1   University of Duisburg/Essen
› Institutsangaben
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Publikationsverlauf

Received: 08. Dezember 2006

accepted in revised form: 08. März 2007

Publikationsdatum:
28. Dezember 2017 (online)

Summary

Purpose: This study evaluated the impact of 124I-positron emission tomography (PET) dosimetry on post-primary surgery therapy in radioiodine-naive patients with advanced differentiated thyroid cancer (DTC). Patients, material, methods: In each of 28 thyroidectomized patients with high-risk DTC (one or more of pT4, pN1 or pM1), we gave 23.50 MBq of 124I as an oral capsule and performed PET dosimetry to calculate the individualized therapeutic 131I activity that would, insofar as possible, achieve a radioiodine dose ≥100 Gy to all metastases without exceeding 2 Gy to the blood (a surrogate for bone marrow toxicity). We thus determined the absorbed lesion dose per GBq of administered 131I activity (LDpA) based on serial PET (4, 24, 48, 72 and 96 h after oral 124I intake) and PET/computed tomography (25 h after 124I intake) and the critical blood activity (CBA) based on blood and whole-body radiation counting (2, 4, 24, 48, 72, 96 h after 124I intake). We compared the dosimetry-based interventions with our standard empirical protocol. Results: 25 patients had a total of 126 iodine-positive metastases. 18 (72%) of the 25 had solely iodine-avid metastases, while seven (28%) had both iodine- avid and -non-avid metastases. In two patients (8%), none of the iodine-avid metastases could have been practically treated with a sufficient radiation dose. Relative to the empirical protocol, 124I-PET dosimetry findings changed management in 7 (25%) patients, e. g. allowing application of activities >11 GBq 131I. Further changes included implementation of hematological back-up in a patient found to be at risk of life-threatening marrow toxicity, and early multimodal therapy in 9 (32%) patients. Conclusion: 124I-PET dosimetry is a useful routine procedure in advanced DTC and may allow safer or more effective radioiodine activities and earlier multimodal interventions than do standard empirical protocols.

Zusammenfassung

Ziel: In dieser Studie wurden die Implikationen der 124I-Positronenemissionstomographie(PET)-Dosimetrie bei Patienten mit fortgeschrittenem differenzierten Schilddrusenkarzinom (DTC) fur die erste Radioiodtherapie (RIT) untersucht. Patienten, Material, Methoden: Bei 28 thyroidektomierten Patienten mit Hochrisiko-DTC (pT4, pN1 und/oder M1) wurde eine 124I-PET-Dosimetrie nach oraler Gabe einer 124I-Kapsel (23.50 MBq) durchgefuhrt. Ziel war, die individuelle 131I-Aktivitat zu errechen, die eine Radioioddosis von ≥100 Gy in allen Metastasen erzielt, ohne die Blutdosis von 2 Gy (Surrogat fur Knochenmarktoxizitat) zu uberschreiten. Die Berechnung erfolgte durch Bestimmung der absorbierten Lasionsdosis pro verabreichter 131I-Aktivitat (LDpA) auf dem Boden serieller PET- und PET/ CT-Messungen (4, 24, 25, 48, 72 und 96 h nach 124I-Applikation) sowie der Bestimmung der kritischen Blutdosis (CBA) mittels Blutproben und Ganzkorpermessungen. Wir verglichen die Dosimetrieergebnisse mit Vorgaben der Standardprotokolle. Ergebnisse: 25 von 28 Patienten hatten 126 iodspeichernde Metastasen. 18 der 25 Patienten (72%) hatten ausschlieslich iodspeichernde Metastasen, sieben Patienten hatten zusatzlich nicht iodspeichernde Metastasen. Bei zwei Patienten (8%) hatte keine der Metastasen mit einer suffizienten Strahlendosis behandelt werden konnen. Im Vergleich zum Standardprotokoll, wurde das therapeutische Vorgehen bei sieben Patienten (25%) geandert (z. B. >11 GBq 131I appliziert). Weitere Anderungen betrafen ein hamatologisches Back-up bei einer Patientin mit dem Risiko einer lebensbedrohlichen Knochenmarktoxizitat und die Einleitung einer fruhen multimodalen Therapie bei neun Patienten (32%). Schlussfolgerung: Die 124I-PET-Dosimetrie ermoglicht die Planung individualisierter RIT und zeigt bei fortgeschrittenen DTC deutliche Anderungen des therapeutischen Vorgehens im Vergleich zu Standardtherapieprotokollen.

 
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