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Journal of Nuclear Medicine Vol. 50 No. 9 1518-1524
© 2009 by Society of Nuclear Medicine
doi: 10.2967/jnumed.109.064469

Basic Science Investigation

Whole-Body Dosimetry for Individualized Treatment Planning of 131I-MIBG Radionuclide Therapy for Neuroblastoma

Susan E. Buckley1, Sarah J. Chittenden1, Frank H. Saran2, Simon T. Meller2 and Glenn D. Flux1

1 Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom; and 2 Department of Paediatrics, Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom

Correspondence: For correspondence or reprints contact: Glenn D. Flux, Department of Physics, Royal Marsden NHS Foundation Trust, Downs Rd., Sutton, Surrey SM2 5PT, U.K. E-mail: glenn.flux{at}icr.ac.uk

The aims of this study were to examine the relationship between whole-body absorbed dose and hematologic toxicity and to assess the most accurate method of delivering a prescribed whole-body absorbed dose in 131I-metaiodobenzylguanidine (131I-MIBG) therapy for neuroblastoma. Methods: A total of 20 children (1–12 y), 5 adolescents (13–17 y), and 1 adult (20 y) with stage 3 or 4 neuroblastoma were treated to a prescribed whole-body absorbed dose, which in most cases was 2 Gy. Forty-eight administrations of 131I-MIBG were given to the 26 patients, ranging in activity from 1,759 to 32,871 MBq. For 30 administrations, sufficient data were available to assess the effect of whole-body absorbed dose on hematologic toxicity. Comparisons were made between the accuracy with which a whole-body absorbed dose could be predicted using a pretherapy tracer study and the patient's most recent previous therapy. The whole-body absorbed dose that would have been delivered if the administered activity was fixed (7,400 MBq) or determined using a weight-based formula (444 MBq·kg–1) was also estimated. Results: The mean whole-body absorbed dose for patients with grade 4 Common Terminology Criteria for Adverse Events (CTCAE) neutropenia after therapy was significantly higher than for those with grade 1 CTCAE neutropenia (1.63 vs. 0.90 Gy; P = 0.05). There was no correlation between administered activity and hematologic toxicity. Absorbed whole-body doses predicted from previous therapies were within ±10% for 70% of the cases. Fixed-activity administrations gave the largest range in whole-body absorbed dose (0.30–3.11 Gy). Conclusion: The results indicate that even in a highly heterogeneous and heavily pretreated patient population, a whole-body absorbed dose can be prescribed accurately and is a more accurate predictor of hematologic toxicity than is administered activity. Therefore, a whole-body absorbed dose can be used to deliver accurate and reproducible 131I-MIBG therapy on a patient-specific basis.

Key Words: dosimetry • 131I MIBG therapy • neuroblastoma • treatment planning

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.


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