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I-124 PET/CT image-based dosimetry in patients with differentiated thyroid cancer treated with I-131: correlation of patient-specific lesional dosimetry to treatment response

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Abstract

Purpose

The objective of this study is to evaluate the lesion absorbed dose (AD), biological effective dose (BED), and equivalent uniform dose (EUD) to clinical–response relationship in lesional dosimetry for 131I therapy.

Methods

Nineteen lesions in four patients with metastatic differentiated thyroid cancer (DTC) were evaluated. The patients underwent PET/CT imaging at 2 h, 24 h, 48 h, 72 h, and 96 h post administration of ~ 33–65 MBq (0.89–1.76 mCi) of 124I before undergoing 131I therapy. The 124I PET/CT images were used to perform dosimetry calculations for 131I therapy. Lesion dose–rate values were calculated using the time–activity data and integrated over the measured time points to obtain AD and BED. The Geant4 toolkit was used to run Monte Carlo on spheres the same size as the lesions to estimate EUD. The lesion AD, BED, and EUD values were correlated with response data (i.e. change in lesion size pre- and post-therapy): complete response (CR, i.e. disappearance of the lesion), partial response (PR, i.e. any decrease in lesion length), stable disease (SD, i.e., no change in length), and progressive disease (PD, i.e., any increase in length).

Results

The lesion responses were CR and PR (58%, 11/19 lesions), SD (21%, 4/19), and PD (21%, 4/19). For CR and PR lesions, the ADs, BEDs and EUDs were > 75 Gy for 82% (9/11) and < 75 Gy for 18% (2/11). The ADs and BEDs were < 75 Gy for SD and PD lesions.

Conclusion

By performing retrospective dosimetry calculations for 131I therapy based on 124I PET/CT imaging, we evaluated the correlation of three dosimetric quantities to lesional response. When lesion AD, BED, and EUD values were > 75 Gy, 47% (9/19) of the lesions had a CR or PR. The AD, BED, and EUD values for SD and PD lesions were < 75 Gy. The data presented herein suggest that the greater the lesion AD, BED, and/or EUD, the higher the probability of a therapeutic response to 131I therapy.

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Availability of Data and/or Code Availability

Data and code data are available upon request from the authors.

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Funding

This project was supported in part by The Catherine Heron and Al Schneider Fellowship in Thyroid Cancer. Also, we would like to thank the support of donations from our grateful patients at MedStar Washington Hospital Center.

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Author notes

  1. Donika Plyku and RobertF. Hobbs are co-first authors.

Authors and Affiliations

  1. Division, Nuclear Medicine Research, MedStar Health Research Institute, Hyattsville, MD, USA

    Donika Plyku, Di Wu & Douglas Van Nostrand

  2. Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC, USA

    Donika Plyku, Di Wu, Carlos Garcia & Douglas Van Nostrand

  3. Radiological Physics Division Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, 1550 Orleans St., CRBII 4M.61, Baltimore, MD, 21231, USA

    Donika Plyku, Robert F. Hobbs & George Sgouros

  4. Department of Radiation Oncology and Department of Radiology and Radiological Sciences, Johns Hopkins University, School of Medicine, 1550 Orleans St., CRBII 4M.62, Baltimore, MD, 21231, USA

    Robert F. Hobbs & George Sgouros

  5. Nuclear Medicine Research, Georgetown University School of Medicine, MedStar Health Research Institute and Washington Hospital Center, 110 Irving Street, N.W., Suite GA60F, Washington, DC, 20010, USA

    Donika Plyku & Douglas Van Nostrand

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  1. Donika Plyku
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Corresponding authors

Correspondence to George Sgouros or Douglas Van Nostrand.

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Conflict of interest

Douglas Van Nostrand: speaker and consultant for Jubilant DraxImage. No competing financial interests exist for the remaining authors.

Ethical approval

The original prospective study forming the source of this analysis of the data presented herein as well as this study itself were approved by the MedStar Health Institutional Review Board.

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Plyku, D., Hobbs, R.F., Wu, D. et al. I-124 PET/CT image-based dosimetry in patients with differentiated thyroid cancer treated with I-131: correlation of patient-specific lesional dosimetry to treatment response. Ann Nucl Med 36, 213–223 (2022). https://doi.org/10.1007/s12149-021-01655-y

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