Abstract
Objective
The maximal safe dose (MSD) on the basis of bone marrow irradiation levels allows the delivery of a large amount of I-131 to thyroid cancer tissue. The efficacy of MSD therapy in differentiated metastatic thyroid cancers that persisted after conventional fixed dose therapy is investigated.
Methods
Forty-seven differentiated thyroid carcinoma patients with non-responsive residual disease despite repetitive fixed dose I-131 therapy were enrolled in this study. Their postoperative pathologies were 43 papillary carcinomas and 4 follicular carcinomas. The MSD was calculated with the Memorial Sloan-Kettering Cancer Center protocol using serial blood samples. The MSDs were administered at intervals of 6 months. Treatment responses were evaluated using I-131 whole-body scans and serum thyroglobulin measurements.
Results
The mean calculated MSD was 12.5 ± 2.1 GBq (339.6 ± 57.5 mCi). Of the 46 patients, 7 (14.9%) showed complete remission, 15 (31.9%) partial remission, 19 (40.4%) stable disease, and 6 (12.8%) disease progression. Of the patients who showed complete or partial remission, 15 (65%) showed response after the first MSD session and 6 (26%) showed response after the second session. Twenty-nine patients (62%) experienced transient cytopenia after therapy, but three did not recover to the baseline level.
Conclusions
The maximal safe dose provides an effective means of treatment in patients who failed to respond adequately to conventional fixed dose therapy. I-131 MSD therapy can be considered in patients who fail fixed dose therapy.
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References
Simpson WJ, McKinney SE, Carruthers JS, Gospodarowicz MK, Sutcliffe Sb, Panzarella T. Papillary and follicular thyroid cancer: prognostic factors in 1,578 patients. Am J Med 1987;83:479–488.
Verburg FA, de Keizer B, Lips CJ, Zelissen PM, de Klerk JM. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol 2005;152:33–37.
Van Nostrand D, Atkins F, Yeganeh F, Acio E, Bursaw R, Wartofsky L. Dosimetrically determined doses of radioiodine for the treatment of metastatic thyroid carcinoma. Thyroid 2002;12:121–134.
Beierwaltes WH. The treatment of thyroid carcinoma with radioactive iodine. Semin Nucl Med 1978;8:79–94.
Kim YK, Chung JK, Lee DS, Cho BY, Jeong JM, Lee MC, et al. Ablation of remnant thyroid tissue with I-131 in well differentiated thyroid cancer after surgery. Korean J Nucl Med 1997;31:339–345.
Benua RS, Cicale NR, Sonenberg M, Rawson RW. The relation of radioiodine dosimetry to results and complications in the treatment of metastatic thyroid cancer. Am J Roentgenol Radium Ther Nucl Med 1962;87:171–182.
Maxon HR, Thomas SR, Hertzberg VS, Kereiake JG, Chen IW, Sperling MI, et al. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med 1983;309:937–941.
Robeson WR, Ellwood JE, Margulies P, Margouleff D. Outcome and toxicity associated with maximum safe dose radioiodine treatment of metastatic thyroid cancer. Clin Nucl Med 2002;27:556–566.
Arslan N, Ilgan S, Serdengecti M, Ozgven MA, Bayhan H, Okuyucu K, et al. Post-surgical ablation of thyroid remnants with high-dose 131I in patients with differentiated thyroid carcinoma. Nucl Med Commun 2001;22:1021–1027.
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;44:451–456.
Menzel C, Grunwald F, Schomburg A, Palmedo H, Bender H, Spath G, et al. “High-dose” radioiodine therapy in advanced differentiated thyroid carcinoma. J Nucl Med 1996;37:1496–1503.
Maxon HR III, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am 1990;19:685–718.
Kim JC, Yoon JH, Bom HS, Jaegal YJ, Song HC, Min JJ, et al. Development and assessment of individual maximum permissible dose method of I-131 therapy in high risk patients with differentiated papillary thyroid cancer. Korean J Nucl Med 2003;37:110–119.
Leeper RD. Thyroid cancer. Med Clin North Am 1985;69:1079–1096.
Schlumberger M, Challeton C, De Vathaire F, Travagli JP, Gardet P, Lumbroso JD, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med 1996;37:598–605.
Proye CA, Dromer DH, Carnaille BM, Gontier AJ, Goropoulos A, Carpentier P, et al. Is it still worthwhile to treat bone metastases from differentiated thyroid carcinoma with radioactive iodine? World J Surg 1992;16:640–645.
Eschmann SM, Reischl G, Bilger K, Kupferschlager J, Thelen MH, Dohmen BM, et al. Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET. Eur J Nucl Med Mol Imaging 2002;29:760–767.
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Lee, J.J., Chung, JK., Kim, S.E. et al. Maximal safe dose of I-131 after failure of standard fixed dose therapy in patients with differentiated thyroid carcinoma. Ann Nucl Med 22, 727–734 (2008). https://doi.org/10.1007/s12149-007-0179-8
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DOI: https://doi.org/10.1007/s12149-007-0179-8