Treatment Side Effects

Both Y-90-ibritumomab tiuxetan and I-131-tositumomab have comparable side effect profiles when given at the FDA-approved nonmyeloablative doses. In the series by Dr. Witzig, summarizing the safety of Y-90-ibritumomab tiuxetan in a series of 349 patients treated with this approach, 80 of the patients were noted to have had at least one adverse event. Patients experienced additional toxi-cities such as chills, fever, or flushing 21 , 13 , or 5 of the time, respectively (16). Many of these events...

Biological Basis Of Iodine Accumulation In Thyroid Tissue

The sodium iodide symporter (NIS) is responsible for the specificity of RAI for thyroid tissue. This transmembrane protein transports iodide against an electrochemical gradient via a sodium-dependent active transport mechanism by which two sodium ions are transported along with one iodide ion (4). Synthesis of this protein is regulated by activation at the thyrotropin receptor (5). Following the characterization of the NIS gene in 1996, much research has been directed toward understanding the...

Radiation Safety

As a general rule, it is prudent to keep radiation exposures at the lowest possible levels. This is the principle underlying the phrase As low as reasonably achievable, or ALARA. As national radiation safety regulations may vary, the following recommendations should be considered as suggestions only. Patients who receive more than 1100 MBq (30 mCi) of I-131 should be admitted to an individual hospital room with a private bathroom. Appropriate radioactive trash disposal containers should be...

Contraindications To Radioactive Iodine Therapy

A patient who is pregnant should not be treated with RAI (7). RAI crosses freely into the placenta, and the fetal thyroid tissue is capable of accumulating iodine after the 12th week of gestation. Administration of RAI during this period may result in severe neonatal hypothyroidism. Fetal and neonatal thyroid irradiation may also increase the risk of developing thyroid cancer later. Retained activity in the maternal bladder may also increase the risk of malignancy by direct radiation exposure...

Patient Instructions Precautions And Followup

Following the administration of therapeutic doses of RAI, contamination from excretion of RAI in urine, perspiration, breastmilk, and saliva, can be associated with internal accumulation of RAI by others who come in contact with the patient. Potential avenues of radiation exposure to others include ingestion of iodine-131 excreted by the patient, and from emitted gamma rays from iodine-131 (Table 3). Although there is little evidence to suggest that small amounts of radiation from iodine-131...

Dose For Toxic Nodular Goiter

In addition to GD, thyrotoxicosis can also result from a single hyperfunctioning nodule, or multiple hyperfunctioning nodules (i.e., toxic multinodular goiter). Although antithyroid drugs can ameliorate hyperthyroidism, definitive treatment is more commonly accomplished with RAI or surgery. Less commonly, percutaneous ethanol injection has also been used for large solitary nodules (16,17). Compared with treatment with RAI, hypothyroidism is a more common sequel of surgery (18). The choice of...

Factors Influencing Prognosis and Outcome

The prognosis of DTC may be determined by an interaction of three factors Other thyroid diseases Family history Tumor variables Histology Multifocality Lymph-node metastases Capsular invasion Extrathyroid extension Distant metastases Irradiation-induced carcinoma Oncogenes Therapy variables Extent of resection Radioiodine therapy Age Age over 40 years at the beginning of the therapy is the most important adverse prognostic factor. Prognosis becomes progressively worse thereafter, particularly...

Dosimetry Considerations Y90Ibritumomab Tiuxetan

The use of Y-90-ibritumomab tiuxetan does not require formal dosimetry calculations when used according to FDA-approved guidelines. This approach uses a mCi kg therapeutic dose, but does require In-111 imaging to ensure that an altered biodistribution does not occur. To evaluate for such an altered biodistribution, patients are given trace-labeled In-111-ibritumomab tiuxetan following the rituximab cold infusion. They then undergo serial whole-body gamma camera imaging over several following...

Indications and Contraindications for 224RaCl Therapy in Ankylosing Spondylitis

The decision for treatment with 224RaCl always should be made in close collaboration of the nuclear medicine specialist and the rheumatologist. Diagnosis of AS and a failure of conservative pharmacotherapy with both nonsteroidal anti-inflammatories and analgesics, or the presence of specific contraindications against these drugs are a prerequisite. The patients frequently complain of lower back pain, severe morning stiffness in the back and spine, and of breathing impairment owing to...

References

Witzig TE, White CA, Gordon LI, et al. Safety of yttrium-90 ibritumomab tiuxetan radioimmunotherapy for relapsed low-grade, follicular, or transformed non-hodgkin's lymphoma. J Clin Oncol 2003 21 1263-1270. 2. Horning SJ. Future directions in radioimmunotherapy for B-cell lymphoma. Semin Oncol 2003 30(suppl) 29-34. 3. Press OW. Radioimmunotherapy for non-Hodgkin's lymphomas a historical perspective. Semin Oncol 2003 (suppl) 10-21. 4. Press OW, Unger JM, Braziel RM, et al. A phase 2 trial of...

Contraindications To The Use Of Radiopharmaceuticals For Pain Relief

A single site of bone pain should receive teletherapy. Metastatic disease detected radiographically where there is no osteoblastic response (i.e., a bone scan showing no abnormality in the painful site) as, for example, in about half of the myeloma patients, should not be treated with these agents, as there will be no localization where the Tc-99m medronate or oxidronate bone scan shows no increased uptake. In painful sites where marked osteolysis (over 50 of the cortex destroyed by tumor) is...

Dose For Graves Disease

The amount of RAI to be administered for treating hyperthyroidism related to GD may be selected empirically or determined by a dose calculation based on the assessments of thyroid mass and function (Table 1). Standard treatment usually involves a single administration of RAI. The administration of small amounts of activity (e.g., 2 mCi) at frequent intervals is not recommended, because it allows patients to remain hyperthyroid for longer periods of time, and has not been proven superior at...

Goals And Expected Outcomes Of Treatment

With adequate doses of radioactivity, an 80 response rate should be expected. A primary goal of treatment is to resolve hyperthyroidism in as short a time as possible. However, with RAI doses calculated to achieve this goal in the majority of patients, a significant number of patients will ultimately become hypothyroid. The incidence of hypothyroidism was first estimated at 20 to 40 of patients one year after RAI therapy (30). With more conservative doses of RAI, the incidence of hypothyroidism...

Rhenium186

Collins C, Eary JF, Donaldson G, et al. Samarium-153-EDTMP in bone metastases of hormone refractory prostate carcinoma a Phase I II trial. J Nucl Med 1993 34 1839-1844. Grade 3 (of 4) hematologic toxicity occurred in 35-40 of patients at dosages of 2.5-3.0 mCi kg. No dosage response relationship was statistically significant. deKlerk JMH, van Dieren EB, van het Schip AD, et al. Bone marrow absorbed dose of rhenium-186-HEDP and the relationship with decreased platelet counts. J Nucl Med 1996 37...

Clinical Course of Ankylosing Spondylitis

Low back pain and stiffness in the sacroiliac region in the early morning are often the only symptoms in the beginning of the disease. If the pain lasts for more than three months, especially in patients below the age of 40, the diagnosis of AS should be taken into account. Typically, pain and stiffness decrease during exercise. Another possible symptom is an alternating and transient pain in the anterior chest wall, the neck, in the knee joints or the heels. These complaints may be triggered...

Treatment Of Children With Hyperthyroidism

Graves' disease is the most common cause of hyperthyroidism in childhood. As in adults, there are a number of options regarding the treatment of hyperthyroid-ism in children. The three most common treatment options are medical therapy with antithyroid drugs, treatment with RAI, and surgery. Medical therapy with antithyroid drugs carries a small risk of serious adverse reactions, which include hepatic failure and agranulocytosis. Upon discontinuation of antithyroid drugs, relapse can be expected...