First Strike personalized predictive radioiodine prescription for inoperable metastatic differentiated thyroid cancer

Document Type : Others

Author

Department of Nuclear Medicine, The Royal Melbourne Hospital, Australia

Abstract

Objective(s): The traditional practice of empiric radioiodine (I-131) prescription is scientifically obsolete and inappropriate for inoperable metastatic differentiated thyroid cancer. However, theranostically guided prescription is still years away for many institutions. A personalized predictive method of radioiodine prescription that bridges the gap between empiric and theranostic methods is presented. It is an adaptation of the “maximum tolerated activity” method, where serial blood sampling is replaced by population kinetics carefully chosen by the user. It aims to maximize crossfire benefits within safety constraints to overcome tumour absorbed dose heterogeneity for a safe and effective first radioiodine fraction i.e., the First Strike.
Methods: The EANM method of blood dosimetry was incorporated with population kinetics, marrow and lung safety constraints, body habitus and clinical assessment of metastatic extent. Population data of whole body and blood kinetics in patients with and without metastases, prepared by recombinant human thyroid stimulating hormone or thyroid hormone withdrawal, and the maximum safe marrow dose rate were deduced from published data. For diffuse lung metastases, the lung safety limit was linearly scaled by height and separated into lung and remainder-of-body components.
Results: The slowest whole body Time Integrated Activity Coefficient (TIAC) amongst patients with any metastases was 33.5±17.0 h and the highest percentage of whole body TIAC attributed to blood was 16.6±7.9%, prepared by thyroid hormone withdrawal. A variety of other average radioiodine kinetics is tabulated. Maximum safe marrow dose rate was deduced to be 0.265 Gy/h per fraction, where blood TIAC is normalised to administered activity. An easy-to-use calculator was developed which only requires height, weight and gender to populate recommendations for personalized First Strike prescription. The user decides by clinical gestalt whether the prescription is to be constrained by marrow or lung, then selects an activity depending on how extensive the metastases are likely to be. A Standard Female with oligometastasis and good urine output without diffuse lung metastasis is expected to safely tolerate 8.03 GBq of radioiodine as the First Strike.
Conclusion: This predictive method will help institutions rationalise the First Strike prescription based on radiobiologically sound principles, personalised to individual circumstances.

Keywords

Main Subjects

References

  1. Konijnenberg M, Herrmann K, Kobe C, Verburg F, Hindorf C, Hustinx R, et al. EANM position paper on article 56 of the Council Directive 2013/59/Euratom (basic safety standards) for nuclear medicine therapy. Eur J Nucl Med Mol Imaging. 2021; 48:67-72.
  2. Kao YH. Yes, the Holy Gray exists. Learn from modern radioembolisation. Eur J Nucl Med Mol Imaging. 2021; 48:4115-4117.
  3. Kao YH. Letter to the editor: Radioiodine is molecular radiotherapy governed by predictable deterministic radiobiology expressed in gray, not millicuries. Thyroid. 2022; 32:340-341.
  4. 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: 451-456.
  5. Luster M, Clarke SE, Dietlein M, Lassman M, Lind P, Oyen WJG, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008; 35:1941-1959.
  6. Stokkel MP, Handkiewicz Junak D, Lassmann M, Dietlein M, Luster M. EANM procedure guidelines for therapy of benign thyroid disease. Eur J Nucl Med Mol Imaging. 2010; 37:2218-2228.
  7. Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, et al. Appropriate use criteria for nuclear medicine in the evaluation and treatment of differentiated thyroid cancer. J Nucl Med. 2020; 61: 375-396.
  8. Bolch WE, Eckerman KF, Sgouros G, Thomas SR. MIRD pamphlet No. 21: a generalized schema for radiopharmaceutical dosimetry - standardization of nomenclature. J Nucl Med. 2009; 50:477-484.
  9. Thomas SR, Samaratunga RC, Sperling M, Maxon HR. Predictive estimate of blood dose from external counting data preceding radioiodine therapy for thyroid cancer. Nucl Med Biol. 1993; 20:157-162.
  10. Hanscheid H, Lassman 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: 1283-1289.
  11. Kao YH. A clinical dosimetric perspective uncovers new evidence and offers new insight in favor of 99mTc-macroaggregated albumin for predictive dosimetry in 90Y resin microsphere radioembolization. J Nucl Med. 2013; 54:2191-2192.
  12. Kao YH. Single time point tumour dosimetry assuming normal distribution of tumour kinetics. J Nucl Med. 2022; 63:803.
  13. 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; 35:1405-1412.
  14. Baechler S, Hobbs RF, Prideaux AR, Wahl RL, Sgouros G. Extension of the biological effective dose to the MIRD schema and possible implications in radionuclide therapy dosimetry. Med Phys. 2008; 35:1123-1134.
  15. Schumann S, Scherthan H, Pfestroff K, Schoof S, Pfestroff A, Hartrampf P, et al. DNA damage and repair in peripheral blood mononuclear cells after internal ex vivo irradiation of patient blood with 131 Eur J Nucl Med Mol Imaging. 2022; 49:1447-1455.
  16. Deandreis D, Rubino C, Tala H, Leboulleux S, Terroir M, Baudin E, et al. Comparison of Empiric Versus Whole-Body/-Blood Clearance Dosimetry-Based Approach to Radioactive Iodine Treatment in Patients with Metastases from Differentiated Thyroid Cancer. J Nucl Med. 2017; 58:717-722.
  17. Tanaka G, Kawamura H. Reference man models based on normal data from human populations. IRPA-10 Proceedings of the 10th international congress of the International Radiation Protection Association on harmonization of radiation, human life and the ecosystem. Japan Health Physics Society. 2000.
  18. 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; 87:171-182.
  19. 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.
  20. 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; 47:1977-1984.
  21. 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; 47:1985-1994.
  22. Peralta GP, Marcon A, Carsin AE, Abramson MJ, Accordini S, Amaral AF, et al. Body mass index and weight change are associated with adult lung function trajectories: the prospective ECRHS study. Thorax. 2020; 75:313-320.
  23. Hanscheid H, Lassman 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; 47:648-654.
  24. Remy H, Borget I, Leboulleux S, Guilabert N, Lavielle F, Garsi J, et al. 131I effective half-life and dosimetry in thyroid cancer patients. J Nucl Med. 2008; 49:1445-1450.
  25. Taieb D, Sebag F, Farman-Ara B, Portal T, Baumstarck-Barrau K, Fortanier C, et al. Iodine biokinetics and radioiodine exposure after recombinant human thyrotropin-assisted remnant ablation in comparison with thyroid hormone withdrawal. J Clin End Met 2010; 95: 3283-3290.
  26. Grenfell S, Roos D, Rijken J, Higgs B, Kirkwood I. Comparison of effective I-131 half-life between thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone for thyroid cancer: a retrospective study. J Med Imaging Radiat Oncol. 2015; 59:248-254.
  27. Ravichandran R, Al Balushi N. Radioactive (131) iodine body burden and blood dose estimates in treatment for differentiated thyroid cancer by external probe counting. World J Nucl Med. 2016; 15:153-160.
  28. Paolo de Barros P, Cagol Camozzato TS, Jahn T, Penna Soares FA, Machado da Silva L, de Aguiar Soares J, et al. Analysis of radiometry on patients undergoing radioactive iodine therapy. J Nucl Med Technol 2021; 49:75–81.
  29. Klain M, Nappi C, De Risi M, Piscopo L, Volpe F, Manganelli M, et al. Whole-Body Radioiodine Effective Half-Life in Patients with Differentiated Thyroid Cancer. Diagnostics (Basel). 2021; 11:1740.
  30. 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.
  31. Abuqbeitah M, Demir M, Kabasakal L, Çavdar İ, Uslu-Beşli L, Yeyin N, et al. Indirect assessment of the maximum empirical activity (250 mCi) with respect to dosimetry concepts in radioiodine therapy of metastatic differentiated thyroid cancer. Nucl Med Commun. 2018; 39:969-975.
  32. Pötzi C, Moameni A, Karanikas G, Preitfellner J, Becherer A, Pirich C, et al. Comparison of iodine uptake in tumour and nontumour tissue under thyroid hormone deprivation and with recombinant human thyrotropin in thyroid cancer patients. Clin Endocrinol (Oxf). 2006; 65:519-523.
  33. Freudenberg LS, Jentzen W, Petrich T, Frömke 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; 37:2267-2276.
  34. Rani D, Kaisar S, Awasare S, Kamaldeep, Abhyankar A, Basu S. Examining recombinant human TSH primed 131I therapy protocol in patients with metastatic differentiated thyroid carcinoma: comparison with the traditional thyroid hormone withdrawal protocol. Eur J Nucl Med Mol Imaging. 2014; 41:1767-1780.
  35. Plyku D, Hobbs RF, Huang K, Atkins F, Garcia C, Sgouros G, et al. Recombinant human thyroid-stimulating hormone versus thyroid hormone withdrawal in (124)I PET/CT-based dosimetry for (131)I therapy of metastatic differentiated thyroid cancer. J Nucl Med. 2017; 58:1146-1154.
Asia Oceania Journal of Nuclear Medicine and Biology
Volume 11, Issue 2
June 2023
Pages 158-167

Files

Share

How to cite

Statistics