Radiation Pneumonitis and Fibrosis: A Complication of Radioiodine Treatment of Pulmonary Metastases From Cancer of the Thyroid*

Rall, J. E.; Alpers, Joseph B.; Lewallen, Charles G.; Sonenberg, Martin; Berman, M.; Rawson, Rulon W.

doi:10.1210/jcem-17-11-1263

Cited by 97 publications

(17 citation statements)

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“…Twelve of these patients had lung metastases and had received cumulative radioiodine treatment doses of 500-800 mCi (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) GBq). The aerosol study was done in the morning prior to treatment with radioiodine (off thyroxine for 5 weeks) in the afternoon, the last treatment dose being about six months previously.…”

Section: Methodsmentioning

confidence: 99%

“…The radiation dose delivered to the lung may be quite high, and results in radiation pneumonitis and fibrosis. 23 The late effects from repeated therapeutic doses of radioiodine could damage normal pulmonary epithelium.24 A recent study25 has shown no significant alteration in the T'/2 in 35 patients who had received large cumulative radioiodine dose for lung metastases from thyroid cancer. Our study supports this conclusion, and though pneumonitis and pulmonary fibrosis may occur, there is no permanent damage to alveolar-capillary membrane as measured by the T'/clearance study.…”

Section: Inhalation Burnsmentioning

confidence: 99%

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Clinical studies of alveolar-capillary permeability using technetium-99m DTPA aerosol

Sundram

1995

Ann Nucl Med

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Soluble radioaerosols such as technetium-99m diethylene triamine pentacetate (DTPA) permit simple quantitative studies of alveolar-capillary permeability to be performed, since the submicronic aerosols are deposited mainly at the lung periphery and are cleared across the alveolar-capillary membrane. Regional alterations in permeability can also be noted using this radionuclide technique. We have measured the pulmonary epithelial permeability in normal subjects and the alteration in smokers, in glue-sniffers, in patients with inhalation burns, in chronic obstructive pulmonary disease (COPD) and in patients with lung metastases from thyroid cancer treated with radioiodine 131I. In the normal volunteers, the time taken for 50% of inhaled 99mTcDTPA to be cleared form the lungs (T1/2) was 66 minutes +/- 1sd of 12 mins. The smokers had a mean T1/2 of 20 mins +/- 1sd 4 min. In the hard-core glue-sniffing group, the majority were smokers who had stopped smoking and glue-sniffing for periods varying from 1 day to 42 days, and it was possible to note the changes in clearance times against period of abstinence. In the patients with inhalations burns, there was change in lung clearance arising from pulmonary epithelial damage; these patients showed increased rate of clearance (short T1/2) with mean T1/2 of 36 min +/- 1sd of 11 mins, while the retention images revealed regional lung damage in moderately severe inhalation burns. Twenty-four patients with COPD had inhalation scans done with Tc-99m tin colloid radioaerosol, and these images were compared with the perfusion lung scans done with 99mTc macroaggregated albumin (MAA); in general the perfusion images matched the defects noted in the inhalation scans. The 99mTc DTPA clearance rate in these patients was normal i.e. T 1/2 = 78 +/- 14 mins. In the thyroid cancer patients with lung metastases, who had high doses of radioiodine treatment, the T 1/2 values were normal or prolonged slightly, mean T1/2 = 76 min +/- 23.

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Section: Methodsmentioning

confidence: 99%

Section: Inhalation Burnsmentioning

confidence: 99%

Clinical studies of alveolar-capillary permeability using technetium-99m DTPA aerosol

Sundram

1995

Ann Nucl Med

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“…The incidence of leukaemia and secondary cancers is extremely low, of the order of 0.5% following radioiodine therapy [20,21]. Radiation fibrosis can also occur in patients with diffuse pulmonary metastatic disease and have received repeated therapy [22].…”

Section: Discussionmentioning

confidence: 99%

Treatment of advanced differentiated thyroid carcinoma with high activity radioiodine therapy

Haq

McCready

Harmer

2004

Nuclear Medicine Communications

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“…High doses of radioactive iodine have been linked to an increased risk of leukemia, bone, soft tissue, colorectal, and salivary gland cancers; 39-42 some authors suggest that there exists a linear relationship between 131 I dose and the risk of secondary cancer. Radiation pulmonary fibrosis in patients with pulmonary metastases after repeated 131 I doses is also a potential risk, 43 albeit rarely reported.…”

Section: -21mentioning

confidence: 99%

Follicular carcinoma of the thyroid with aggressive metastatic behavior in a pregnant woman: Report of a case and review of the literature

Parlea

Fahim²,

Muñoz³

et al. 2006

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Distant metastases as initial presentation of follicular carcinoma of the thyroid is rare, especially in young patients. We report the clinical and pathological features of a 33-year old pregnant patient with follicular carcinoma of the thyroid who presented with widespread bone and lung metastases at the time of diagnosis. the resected tumor had a focal insular component that showed extensive vascular invasion spreading beyond the thyroid capsule, and was associated with widespread bone and lung metastases. Despite its aggressive behavior, the tumor had low mitotic activity and Ki-67 nuclear labeling index. tumor cells showed high microvascular density and down-regulation of E-cadherin, a calcium-dependent trans-membrane epithelial protein molecule known to promote intercellular adhesion. We suggest that architectural differentiation of the tumor and cell proliferation rate are not reliable markers of metastatic behavior in this particular thyroid neoplasm. Microvascular density and down-regulation of E-cadherin expression in the tumor should be included among histologic hallmarks of metastatic potential. the role of pregnancy in the aggressive behavior of this tumor is discussed along with a literature review.

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Radiation Pneumonitis and Fibrosis: A Complication of Radioiodine Treatment of Pulmonary Metastases From Cancer of the Thyroid*

Cited by 97 publications

References 1 publication

Clinical studies of alveolar-capillary permeability using technetium-99m DTPA aerosol

Clinical studies of alveolar-capillary permeability using technetium-99m DTPA aerosol

Treatment of advanced differentiated thyroid carcinoma with high activity radioiodine therapy

Follicular carcinoma of the thyroid with aggressive metastatic behavior in a pregnant woman: Report of a case and review of the literature

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