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Agent Indication Cycles and intervals Administered activity per cycle Dosimetry required? Organ constraints 131I-sodium iodide Differentiated thyroid cancer, remnant ablation, adjuvant, treatment of metastatic disease; benign thyroid disease such as goiter 1 Empiric variable activity based on indication or dosimetry guided to 2 Gy to blood or 2,960 MBq (80 mCi) retained in WB at 48 h if diffuse lung metastases No 2 Gy to blood 153Sm-lexidronam Symptomatic osteoblastic metastases 1 Fixed-weight–based activity, 37 MBq/kg No NA 89SrCl Symptomatic osteoblastic metastases 1 Fixed activity, 148 MBq No NA 223Ra-dichloride Prostate cancer, metastatic disease to bone 6 at 4-wk intervals Fixed-weight–based activity, 55 kBq/kg No NA 177Lu-DOTATATE Neuroendocrine tumor with somatostatin receptor expression 4 at 8-wk intervals Fixed activity, 7.4 GBq No NA 177Lu-PSMA-617 Prostate cancer, metastatic disease 4–6 cycles at 6-wk intervals Fixed activity, 7.4 GBq No NA 131I-MIBG/HSA- 131I-iobenguane* Pheochromocytoma or paraganglioma 2 at 12-wk intervals Fixed activity, for weight >62.5 kg, 17.5 GBq; for weight <62.5 kg, 296 MBq/kg Yes, WB planar days 0, 1–2, 2–5 *12 Gy to red marrow, 16.5 Gy to lung, 18 Gy to kidney, and 31 Gy to liver 90Y-ibritumomab tiuxetan Follicular or low-grade NHL 1 14.8 MBq/kg if platelets >150,000; 11.1 MBq/kg if platelets >100,000 and <150,000 No NA 131I-tositumomab† Relapsed or refractory NHL 1 Based on dosimetry: 75 cGy to WB if platelets >150,000; 65 cGy to WB if platelets >100,000 and <150,000 Yes, WB planar days 0, 2–4, 6–7 75 or 65 cGy to WB 90Y-TheraSphere Unresectable hepatocellular carcinoma 1 (whole-liver treatment often split over separate treatments) 80–150 Gy to liver Yes, tomographic perfused liver volume and planar lung shunt 80–150 Gy to liver, <30 Gy to lung per treatment and <50 Gy cumulative 90Y-SIR-Spheres Unresectable liver metastases from colorectal cancer 1 (whole-liver treatment often split over separate treatments) Calculation based on body surface area, liver volume, involved tumor volume, and lung shunt Yes, tomographic perfused liver volume and planar lung shunt <30 Gy to lung *The limits in the last column pertain to 131I-Iobenguane only.
↵†No longer commercially available.
NA = not applicable; HSA = high specific activity; NHL = non-Hodgkin Lymphoma.
