Radiation Exposure From Outpatient Radioactive Iodine (&lt;SUP&gt;131&lt;/SUP&gt;I) Therapy for Thyroid Carcinoma

Grigsby, Perry W.; Siegel, Barry A.; Baker, Susan; Eichling, John O.

doi:10.1001/jama.283.17.2272

Cited by 91 publications

(40 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radiation exposures of household members of patients given more than 1110 MBq are well below the limit (5.0 mSv) mandated by US national regulations (Grigsby et al 2000). Small 131 I activities have appeal because of the lower cost and lower wholebody radiation to the patient, which has been estimated to be 6.1 mSv for 1110 MBq, 8.5 mSv for 1850 MBq, and 12.2 mSv for 2220 MBq (DeGroot & Reilly 1982).…”

Section: Activity For Thyroid Remnant Ablationmentioning

confidence: 95%

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

161

113

View full text Add to dashboard Cite

The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ( 131 I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and 131 I treatment, the likelihood of death from DTC is increased by several factors, including age > 45 years, tumor size > 1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment > 12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, 131 I treatment and levothyroxine suppression of TSH. Treatments with 131 I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome.Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for 131 I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 µg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to 131 I treatment. In addition, rhTSH can be given to prepare patients for 131 I remnant ablation or 131 I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.

show abstract

Section: Activity For Thyroid Remnant Ablationmentioning

confidence: 95%

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

161

113

View full text Add to dashboard Cite

show abstract

“…A large number of previous studies dealing with the topic of radiation protection mainly focused on general rules of handling radioactive material 6 , 7 , 8 , 9 , 10 , 11 , 12 and contamination, (13) or provide definite rules and regulations from expert panels (i.e., dose reference values for patients treated or diagnosed using radiation) 10 , 14 , 15 , 16 , 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

Effective method of measuring the radioactivity of ‐capsule prior to radioiodine therapy with significant reduction of the radiation exposure to the medical staff

Lützen

Zhao

Marx

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

Radiation Protection in Radiology, Nuclear Medicine and Radio Oncology is of the utmost importance. Radioiodine therapy is a frequently used and effective method for the treatment of thyroid disease. Prior to each therapy the radioactivity of the false[ 131Ifalse]‐capsule must be determined to prevent misadministration. This leads to a significant radiation exposure to the staff. We describe an alternative method, allowing a considerable reduction of the radiation exposure. Two false[ 131Ifalse]‐capsules false(normalA01=2818.5; normalA02=73.55.0 MBqfalse) were measured multiple times in their own delivery lead containers — that is to say, false[ 131Ifalse]‐capsules remain inside the containers during the measurements (shielded measurement) using a dose calibrator and a well‐type and a thyroid uptake probe. The results of the shielded measurements were correlated linearly with the false[ 131Ifalse]‐capsules radioactivity to create calibration curves for the used devices. Additional radioactivity measurements of 50 false[ 131Ifalse]‐capsules of different radioactivities were done to validate the shielded measuring method. The personal skin dose rate false(normalHPfalse(0.07false)false) was determined using calibrated thermo luminescent dosimeters. The determination coefficients for the calibration curves were normalR2>0.9980 for all devices. The relative uncertainty of the shielded measurement was <6.8%. At a distance of 10 cm from the unshielded capsule the normalHPfalse(0.07false) was 46.18 μSv/false(GBq⋅sfalse), and on the surface of the lead container containing the false[ 131Ifalse]‐capsule the normalHPfalse(0.07false) was 2.99 and 0.27 μSv/false(GBq⋅sfalse) for the two used container sizes. The calculated reduction of the effective dose by using the shielded measuring method was, depending on the used container size, 74.0% and 97.4%, compared to the measurement of the unshielded false[ 131Ifalse]‐capsule using a dose calibrator. The measured reduction of the effective radiation dose in the practice was 56.6% and 94.9 for size I and size II containers. The shielded false[ 131Ifalse]‐capsule measurement reduces the radiation exposure to the staff significantly and offers the same accuracy of the unshielded measurement in the same amount of time. In order to maintain the consistency of the measuring method, monthly tests have to be done by measuring a false[ 131Ifalse]‐capsule with known radioactivity.PACS number(s): 93.85.Np, 92.20.Td, 87.50.yk, 87.53.Bn

show abstract

“…19 We further demonstrated that the rat NIS gene can effectively induce growth arrest of human prostate tumor xenografts in mice after in vivo adenoviral gene delivery and administration of 3 mCi of 131 I. 16 Recently, we reported the capability of the rat NIS to effectively induce growth arrest of relatively large tumors (about 800 mm 3 ) in mice when treated with 3 mCi of 131 I. 20 The central limitation when translating NIS-131 I therapy from mouse models to humans is the inability to achieve an effective lethal dose per body weight equivalent to that observed in mice with 3 mCi of 131 I.…”

mentioning

confidence: 98%

“…We have also demonstrated 5-6-fold greater uptake of 125 I by rat NIS over human NIS in human cancer cells. Recently, we reported the capability of the rat NIS and 131 I to effectively induce growth arrest of relatively large tumors (approximately 800 mm 3 ) in an animal model. In the present work tumor growth inhibition was achieved using adenoviral delivery of the rat NIS gene and 1 mCi of 131 I (one-third of the dose used in earlier reports).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Rat sodium iodide symporter allows using lower dose of 131I for cancer therapy

et al. 2006

View full text Add to dashboard Cite

Efficient gene delivery is a critical obstacle for gene therapy that must be overcome. Until current limits of gene delivery technology are solved, identification of systems with bystander effects is highly desirable. As an anticancer agent, radioactive iodine 131 I has minimal toxicity. The physical characteristics of 131 I decay allow radiation penetration within a local area causing bystander killing of adjacent cells. Accumulation of 131 I mediated by the sodium iodide symporter (NIS) provides a highly effective treatment for well-differentiated thyroid carcinoma. Other types of cancer could also be treated by NIS-mediated concentration of lethal 131 I radiation in tumor cells. Our group and others previously reported that a significant antitumor effect in mice was achieved after adenoviral delivery of rat or human NIS gene following administration of 3 mCi of 131 I. We have also demonstrated 5-6-fold greater uptake of 125 I by rat NIS over human NIS in human cancer cells. Recently, we reported the capability of the rat NIS and 131 I to effectively induce growth arrest of relatively large tumors (approximately 800 mm 3 ) in an animal model. In the present work tumor growth inhibition was achieved using adenoviral delivery of the rat NIS gene and 1 mCi of 131 I (one-third of the dose used in earlier reports). We also demonstrated that a higher concentration of 123 I was accumulated in the NIS-expressing tumors than in the thyroid 20 min after radioiodine administration. The highest intratumoral radioiodine concentration was observed along the needle track; however, the rat NIS-131 I effectively induced growth arrest of tumor xenografts in mice through its radiological bystander effect. Importantly, the rat NIS allowed reducing the injected radioiodine dose by 70% with the same antitumor efficacy in pre-established tumors. These results suggest that the rat NIS gene may be advantageous compared to the human gene in its ability to enhance intratumoral 131 I uptake.

show abstract

Radiation Exposure From Outpatient Radioactive Iodine (<SUP>131</SUP>I) Therapy for Thyroid Carcinoma

Abstract: In our study, 131I doses to household members of patients receiving outpatient 131I therapy were well below the limit (5.0 mSv) mandated by current NRC regulations.

Cited by 91 publications

References 1 publication

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Effective method of measuring the radioactivity of ‐capsule prior to radioiodine therapy with significant reduction of the radiation exposure to the medical staff

Rat sodium iodide symporter allows using lower dose of 131I for cancer therapy

Contact Info

Product

Resources

About