Skip to main content
SpringerLink
Log in

A dose-effect correlation for radioiodine ablation in differentiated thyroid cancer

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the range of absorbed doses delivered to thyroid remnants, blood, and red marrow from fixed administrations of radioiodine and to ascertain whether the success of ablation is more dependent on these absorbed doses than on the administered activity.

Methods

Twenty-three patients received 3,000 MBq radioiodine following near-total thyroidectomy. The maximum absorbed dose to remnants was calculated from subsequent single photon emission tomography scans. Absorbed doses delivered to blood and red marrow were calculated from blood samples and from whole-body retention measurements. The protein bound iodine (PBI) was also calculated.

Results

Maximum absorbed doses to thyroid remnants ranged from 7 to 570 Gy. Eighteen of the 23 patients had a successful ablation. A significant difference was seen between the absorbed doses delivered to thyroid remnants, blood, and red marrow for those patients that had a successful ablation compared to those with a failed ablation (p = 0.030, p = 0.043 and p = 0.048, respectively). The difference between the PBI values acquired at day 1 and day 6 were also indicative of response (p = 0.074).

Conclusions

A successful ablation is strongly dependent on the absorbed dose to the thyroid remnant. Dosimetry-based personalized treatment can prevent both sub-optimal administrations, which entails further radioiodine therapy, and excessive administration of radioactivity, which increases the potential for radiation toxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Haq M, Harmer C. Non-surgical management of thyroid cancer. In: Mazzaferri EL, Harmer C, Mallick U, Kendall-Taylor P, editors. Practical management of thyroid cancer. London: Springer-Verlag; 2006. p. 171–91.

    Chapter  Google Scholar 

  2. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JWA, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154(6):787–803.

    Article  PubMed  CAS  Google Scholar 

  3. Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA. Review: I-131 activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J Clin Endocrinol Metab. 2007;92(1):28–38.

    Article  PubMed  CAS  Google Scholar 

  4. Mallick U, Harmer C, Hackshaw A. The HiLo trial: a multicentre randomised trial of high- versus low-dose radioiodine, with or without recombinant human thyroid stimulating hormone, for remnant ablation after surgery for differentiated thyroid cancer. Clin Oncol. 2008;20(5):325–6.

    Article  CAS  Google Scholar 

  5. Benua RS, Cicole NR, Sonenburg N, Rawson RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid carcinoma. Am J Roentgenol Radium Ther Nucl Med. 1962;87:171–82.

    PubMed  CAS  Google Scholar 

  6. 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(3):451–6.

    PubMed  CAS  Google Scholar 

  7. O'Connell MEA, Flower MA, Hinton PJ, Harmer CL, McCready VR. Radiation-dose assessment in radioiodine therapy—dose-response relationships in differentiated thyroid-carcinoma using quantitative scanning and PET. Radiother Oncol. 1993;28(1):16–26.

    Article  PubMed  Google Scholar 

  8. Maxon HR, Thomas SR, Samaratunga RC. Dosimetric considerations in the radioiodine treatment of macrometastases and micrometastases from differentiated thyroid cancer. Thyroid. 1997;7(2):183–7.

    Article  PubMed  CAS  Google Scholar 

  9. Koral KF, Adler RS, Carey JE, Beierwaltes WH. I-131 treatment of thyroid-cancer—absorbed dose calculated from post-therapy scans. J Nucl Med. 1986;27(7):1207–11.

    PubMed  CAS  Google Scholar 

  10. Chang LT. A method for attenuation correction in radionuclide computed tomography. IEEE Trans Nucl Sc. 1978;25:638–43.

    Article  Google Scholar 

  11. Chittenden S, Pratt B, Pomeroy K, Black P, Long C, Smith N, et al. Optimization of equipment and methodology for whole-body activity retention measurements in children undergoing targeted radionuclide therapy. Cancer Biother Radiopharm. 2007;22(2):247–53.

    Google Scholar 

  12. Loevinger R, Budinger T, Watson E. MIRD primer for absorbed dose calculations. New York: Society of Nuclear Medicine; 1988.

    Google Scholar 

  13. Hanscheid H, Lassmann 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(4):648–54.

    PubMed  Google Scholar 

  14. Cristy M, Eckerman K. Specific absorbed fractions of energy at various ages from internal photon sources. ORNL/TM-8381 V1–V7. Oak Ridge: Oak Ridge National Laboratory; 1987.

    Google Scholar 

  15. Flux GD, Guy MJ, Beddows R, Pryor M, Flower MA. Estimation and implications of random errors in whole-body dosimetry for targeted radionuclide therapy. Phys Med Biol. 2002;47(17):3211–23.

    Article  PubMed  Google Scholar 

  16. Lassmann M, Haenscheid 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 Imag. 2008;35(7):1405–12.

    Article  Google Scholar 

  17. Zieve L, Vogel WC, Schultz AL. Determination of protein-bound radioiodine with an ion-exchange resin. J Lab Clin Med. 1956;47:663–8.

    PubMed  CAS  Google Scholar 

  18. Hammersley PAG, Al Saadi A, Chittenden S, Flux GD, McCready VR, Harmer CL. Value of protein-bound radioactive iodine measurements in the management of differentiated thyroid cancer treated with I-131. Br J Radiol. 2001;74(881):429–33.

    PubMed  CAS  Google Scholar 

  19. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJG, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35:1941–59.

    Article  PubMed  CAS  Google Scholar 

  20. Perros P, Clarke SEM, Franklyn J et al (2007) British Thyroid Association and Royal College of Physicians. Guidelines for the management of thyroid cancer, 2nd edn.

  21. Cooper DS, Doherty GM, Haugen BR, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association Guidelines Taskforce. Thyroid. 2006;16(2):109–41.

    Article  PubMed  Google Scholar 

  22. Hyer S, Kong A, Pratt B, Harmer C. Salivary gland toxicity after radioiodine therapy for thyroid cancer. Clin Oncol. 2007;19(1):83–6.

    Article  CAS  Google Scholar 

  23. Rubino C, de Vathaire F, Dottorini ME, et al. Second primary malignancies in thyroid cancer patients. Brit J Cancer. 2003;89(9):1638–44.

    Article  PubMed  CAS  Google Scholar 

  24. Dewaraja YK, Wilderman SJ, Ljungberg M, Koral KF, Zasadny K, Kaminiski MS. Accurate dosimetry in 131I radionuclide therapy using patient-specific, 3-dimensional methods for SPECT reconstruction and absorbed dose calculation. J Nucl Med. 2005;46(5):840–9.

    PubMed  CAS  Google Scholar 

  25. Buckley SE, Saran FH, Gaze MN, Chittenden SC, Partridge M, Lancaster D, et al. Dosimetry for fractionated I131 mIBG therapies in patients with primary resistant high-risk neuroblastoma: preliminary results. Cancer Biother Radiopharm. 2007;22(1):105–12.

    Article  PubMed  CAS  Google Scholar 

  26. Hermanska J, Karny M, Zimak J, Jirsa L, Samal M, Vlcek P. Improved prediction of therapeutic absorbed doses of radioiodine in the treatment of thyroid carcinoma. J Nucl Med. 2001;42(7):1084–90.

    PubMed  CAS  Google Scholar 

  27. Sgouros G, Kolbert KS, Sheikh A, Pentlow, Mun EF, Barth A, et al. Patient-specific dosimetry for I-131 thyroid cancer therapy using I-124 PET and 3-dimensional-internal dosimetry (3D-ID) software. J Nucl Med. 2004;45(8):1366–72.

    PubMed  CAS  Google Scholar 

  28. Stabin MG. The case for patient-specific dosimetry in radionuclide therapy. Cancer Biother Radiopharm. 2008;23(3):273–84.

    Article  PubMed  CAS  Google Scholar 

  29. Lassmann M, Luster M, Hanscheid H, Reiners C. Impact of I-131 diagnostic activities on the biokinetics of thyroid remnants. J Nucl Med. 2004;45(4):619–25.

    PubMed  Google Scholar 

  30. Sisson JC, Avram AM, Lawson SA, Gauger PG, Doherty GM. The so-called stunning of thyroid tissue. J Nucl Med. 2006;47(9):1406–12.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

M.H. was supported by the Alison Luke Research Fund, which supports the Royal Marsden Hospital Charity. We acknowledge NHS funding to the NIHR Biomedical Research Centre.

Author information

Authors and Affiliations

  1. Department of Physics, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Glenn D. Flux, Sarah J. Chittenden, Susan Buckley & Cecilia Hindorf

  2. Thyroid Unit, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Masud Haq, Kate Newbold & Clive L. Harmer

Authors
  1. Glenn D. Flux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masud Haq
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah J. Chittenden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cecilia Hindorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kate Newbold
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Clive L. Harmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Glenn D. Flux.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flux, G.D., Haq, M., Chittenden, S.J. et al. A dose-effect correlation for radioiodine ablation in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 37, 270–275 (2010). https://doi.org/10.1007/s00259-009-1261-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-009-1261-3

Keywords

Search

Navigation