131I Thyroid cancer therapy in chronically bedridden & dialysis patients with severe renal failure: Challenges and solutions for determining the optimum therapy dose and how to minimize radiation dose to caregivers

Learning Objectives 1. How to recognize necessary special considerations and patient-needs during 131I treatments of chronically bedridden & dialysis patients. 2. How to identify and establish members of ‘multimodality key personnel’ 3. How to address radiation safety issues and needs of special need patients. 4. How to determine the optimum 131I therapy dose and its timing in regards to other medical treatments, procedures in patients with special needs. 5. How to manage the radiation safety issues and needs of personnel who are providing services to patients of special needs, and how to minimize their 131I therapy related radiation burden. 6. How to properly assess, measure and discard 131I contaminated medical disposables used during the process.

131I therapy for postoperative ablation of thyroid remnants and treatment of residual differentiated thyroid cancer or its metastasis may become a challenging task when being applied to patients with special needs i.e. in chronically bedridden patient, dialysis dependent patients or in patients who cannot swallow and dependent on gastric tube feedings. Aim of this presentation is to share our experience via example cases representing such challenging patients, including: A quadriplegic patient with draining/wet decubitus ulcers; A renal failure patient dependent on 3 dialysis/week; and A gastric feeding tube dependent chronically bedridden patient. Discussions are include: Relevant medical discussions such as possible treatment complications, side effects, therapeutic alternatives, expected patient outcome. Proper handling of liquid 131I use; how to obtain legally valid written informed consent from a quadriplegic patient; optimum 131I therapy dose calculation in renal failure patients; logistics of radiation safety; minimizing procedure related radiation dose burden to the care givers; and administrative and legal aspects of such therapies.