S-Space College of Medicine/School of Medicine (의과대학/대학원) Nuclear Medicine (핵의학전공) Journal Papers (저널논문_핵의학전공)
Maximal safe dose of I-131 after failure of standard fixed dose therapy in patients with differentiated thyroid carcinoma
- Lee, Jong Jin; Chung, June-Key; Kim, Sung Eun; Kang, Won Jun; Park, Do Joon; Lee, Dong Soo; Cho, Bo Youn; Lee, Myung Chul
- Issue Date
- Springer Verlag
- Ann Nucl Med. 2008;22(9):727-34
- Adult; Aged; Dose Fractionation; Dose-Response Relationship, Radiation; Female; Humans; Iodine Radioisotopes/*administration & dosage/*toxicity; Leukemia/*chemically induced/*prevention & control; Male; *Maximum Tolerated Dose; Middle Aged; Radiopharmaceuticals/administration & dosage/toxicity; Radiotherapy Dosage; Thyroid Neoplasms/*radiotherapy; Treatment Failure; Treatment Outcome; Young Adult
- 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.
- 0914-7187 (Print)
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