131I-MIBG Therapy in metastatic phaeochromocytoma and paraganglioma

Gedik, Gonca Kara; Hoefnagel, Cornelis A.; Bais, Evert; Olmos, Renato A. Valdés

doi:10.1007/s00259-007-0652-6

Cited by 113 publications

(79 citation statements)

References 8 publications

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“…Retrospective analysis was performed to determine the whole-body absorbed dose that would have been delivered had an activity of 7,400 MBq been administered in each of the 48 therapies. This is a standard protocol for many treatments for both pediatric and adult neuroendocrine tumors (1). As with the administration of a tracer study, linear extrapolation of the whole-body absorbed dose as a function of administered activity for the patient was assumed.…”

Section: Predictions Of Whole-body Absorbed Dose Delivered During Thementioning

confidence: 99%

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

Buckley¹,

Chittenden²,

Saran³

et al. 2009

J Nucl Med

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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 131 I-metaiodobenzylguanidine ( 131 I-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 131 I-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 MBqÁkg 21 ) 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 5 0.05). There was no correlation between administered activity and hematologic toxicity. Absorbed whole-body doses predicted from previous therapies were within 610% 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 131 I-MIBG therapy on a patient-specific basis.

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Section: Predictions Of Whole-body Absorbed Dose Delivered During Thementioning

confidence: 99%

“…Instead, standardized treatment regimens usually involve the administration of a fixed level of radioactivity or an activity based on patient weight or body surface area (1)(2)(3). However, European regulations now stipulate the need to perform individual patient treatment planning for TRT (4).…”

mentioning

confidence: 99%

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

Buckley¹,

Chittenden²,

Saran³

et al. 2009

J Nucl Med

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“…In general, doses below 11.1 GBq (300 mCi) are well tolerated without severe myelosuppression. Acute adverse events are transient and consist of mild to moderate nausea, vomiting, and hypertension (112). The most common subacute toxicity is myelosuppression, with thrombocytopenia being more common than neutropenia.…”

Section: I/ 131 I-mibg Theranostics For Pheo and Pglmentioning

confidence: 99%

Norepinephrine Transporter as a Target for Imaging and Therapy

Pandit‐Taskar

Modak

2017

J Nucl Med

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The norepinephrine transporter (NET) is essential for norepinephrine uptake at the synaptic terminals and adrenal chromaffin cells. In neuroendocrine tumors, NET can be targeted for imaging as well as therapy. One of the most widely used theranostic agents targeting NET is metaiodobenzylguanidine (MIBG), a guanethidine analog of norepinephrine. 123 I/ 131 I-MIBG theranostics have been applied in the clinical evaluation and management of neuroendocrine tumors, especially in neuroblastoma, paraganglioma, and pheochromocytoma. 123 I-MIBG imaging is a mainstay in the evaluation of neuroblastoma, and 131 I-MIBG has been used for the treatment of relapsed high-risk neuroblastoma for several years, however, the outcome remains suboptimal. 131 I-MIBG has essentially been only palliative in paraganglioma/pheochromocytoma patients. Various techniques of improving therapeutic outcomes, such as dosimetric estimations, high-dose therapies, multiple fractionated administration and combination therapy with radiation sensitizers, chemotherapy, and other radionuclide therapies, are being evaluated. PET tracers targeting NET appear promising and may be more convenient options for the imaging and assessment after treatment. Here, we present an overview of NET as a target for theranostics; review its current role in some neuroendocrine tumors, such as neuroblastoma, paraganglioma/ pheochromocytoma, and carcinoids; and discuss approaches to improving targeting and theranostic outcomes.

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“…Another reason to introduce fractionation may be for legal considerations, when treatment centres have a licence that specifies a maximum authorised activity for a radionuclide to be stored or handled in the facility. This limits the activity to administer for the heavier patients in treatments prescribed based on patient mass (Otte et al, 1999;Yanik et al, 2002;Gedik et al, 2008). Yet another reason may be the practical handling of high prescribed activities, in view of the radiological safety of staff, for which fractionation may be a feasible way to reduce the 3 effective dose to individual workers.…”

Section: Introductionmentioning

confidence: 99%

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG

et al. 2016

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In this work, the biologically effective dose (BED) is investigated for fractionated molecular radiotherapy (MRT). A formula for the Lea–Catcheside G-factor is derived which takes the possibility of combinations of sub-lethal damage due to radiation from different administrations of activity into account. In contrast to the previous formula, the new G-factor has an explicit dependence on the time interval between administrations. The BED of tumour and liver is analysed in MRT of neuroblastoma with 131I-mIBG, following a common two-administration protocol with a mass-based activity prescription. A BED analysis is also made for modified schedules, when due to local regulations there is a maximum permitted activity for each administration. Modifications include both the simplistic approach of delivering this maximum permitted activity in each of the two administrations, and also the introduction of additional administrations while maintaining the protocol-prescribed total activity. For the cases studied with additional (i.e. more than two) administrations, BED of tumour and liver decreases at most 12% and 29%, respectively. The decrease in BED of the tumour is however modest compared to the two-administration schedule using the maximum permitted activity, where the decrease compared to the original schedule is 47%.

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131I-MIBG Therapy in metastatic phaeochromocytoma and paraganglioma

Cited by 113 publications

References 8 publications

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

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

Norepinephrine Transporter as a Target for Imaging and Therapy

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG

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131I-MIBG Therapy in metastatic phaeochromocytoma and paraganglioma

Cited by 113 publications

References 8 publications

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

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

Norepinephrine Transporter as a Target for Imaging and Therapy

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with131I-mIBG

Contact Info

Product

Resources

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

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

Biologically effective dose in fractionated molecular radiotherapy—application to treatment of neuroblastoma with¹³¹I-mIBG