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Iodine-131-Metaiodobenzylguanidine Dosimetry in Cancer Therapy: Risk Versus Benefit

Department of Nuclear Medicine, Southampton General Hospital, Southampton, United Kingdom

Correspondence: For correspondence or reprints contact: Maria Tristam, MD, Nuclear Medicine, Southampton General Hospital, Level D, Centre Block, Tremona Rd., Southampton SO16 6YD, United Kingdom.

ABSTRACT

In the treatment of neural crest tumors, such as pheochromocytoma, with [¹³¹I]MIBG, bone marrow toxicity limits the amount of administered activity and, thus, a therapeutically useful tumor dose. Methods: We calculated tumor doses in a series of diagnostic studies with [¹²³I]MIBG using accurate quantification of SPECT and planar scintigraphy. By extrapolating diagnostic results to therapeutic activities of [¹³¹I]MIBG, we could compare the results with whole-body doses from a series of therapies. Results: The tumor dose was D_T = 2.2 mGy MBq^–1 (median value of 27 measurements, range 0.04 D_T 20 mGy MBq^–1) and the whole-body dose in a series of 16 patients undergoing 50 therapies was D_WB = 0.12 ± 0.04 mGy MBq^–1 (mean ± s.d.). The therapeutic ratio varied between 130 to below 10 in some patients. Conclusion: The results were compared with published data. We found clearly skewed distribution of tumor doses, with a majority of tumors receiving only a few mGy per MBq administered activity. In some patients, however, doses did reach 20 mGy MBq^–1.

Key Words: iodine-123-MIBG • pheochromocytoma • radionuclide therapy • dosimetry

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