Is it necessary to reduce the radioiodine dose in patients with thyroid cancer and renal failure?

Abstract

The objective of this study were to obtain dosimetric data from a patient with thyroid cancer simultaneously undergoing peritoneal dialysis therapy, so as to determine the appropriate amount of 131I activity to be applied therapeutically. Percentages of radioiodine in the blood and the whole-body were evaluated, and radiation absorbed doses were calculated according to OLINDA/EXM software. Whole-body 131I effective half-time was 45.5 hours, being four times longer than for patients without any renal dysfunction. Bone-marrow absorbed dose was 0.074 mGy/MBq, with ablative procedure maintenance at 3.7 GBq, as the reported absorbed dose was insufficiently restrictive to change the usual amount of radioiodine activity administered for ablation. It was concluded that radioiodine therapeutic-dose adjustment, based on individual patient dosimetry, is an important way of controlling therapy. It also permits the safe and potential delivery of higher doses of radiation to tumors and undesirable tissues, with a minimum of malignant effects on healthy tissues.

Bone marrow radiation dosimetry of high dose 131I treatment in differentiated thyroid carcinoma patients

“…In addition to this, in the limitations of $ix-administered activity, it lacks the description of the radioiodine biodistribution in the body, slow and long component of radioiodine clearance from the kidneys, and the transport of radioiodine in the blood stream are not determinant factors. However, literature shows that all of these factors are critical to the ef$iciency of treatment (18)(19)(20) . Excessive radioiodine administration can lead to side effects in the short or in the long term such as the induction of bone marrow suppression.…”

“…Exposure to radiation resulting from standard activities is heterogeneous and the radiation dosage absorbed by the blood changeable due to variety of many factors such as (patients' Body Mass Index, renal clearance) (20) . In thyroid cancer patients treated during hypothyroidism, blood dose may increase above 2 Gy after the administration of 7.4 GBq (200 mCi) (22) .…”

Can radioiodine be administered effectively and safely to a patient with severe chronic kidney disease?

“…Using I‐131 in patients with ESRD gives rise to a number of difficulties. The only conclusions regarding I‐131 treatment thus far have been derived from single case studies . The half‐life of I‐131 in these patients is longer, and its levels are higher.…”

“…The only conclusions regarding I-131 treatment thus far have been derived from single case studies. 16,18,[25][26][27]29 The half-life of I-131 in these patients is longer, and its levels are higher. As a result, the range between a safe and toxic dose to radiation-sensitive tissues can be significantly narrowed.…”

“…Literature evaluating efficacy and safety of radioiodine therapy for thyroid cancer in patients with end-stage renal disease13,[15][16][17][20][21][22][23][24][25][26][27]29,37 …”