Approach to the Role of Dosimetric RAI RX in Children with DTC

Abstract

 

Pediatric differentiated thyroid cancer (DTC) patients frequently present with lymph node and/or distant (lung) metastases. Such patients warrant an aggressive treatment consisting of surgical removal of all surgically accessible local metastases as well as further treatment with one or more courses of radioiodine therapy (RAI). It is still a subject of debate in literature how much I-131 should be administered to pediatric patients. Patients can either be given a fixed (possibly body weight adjusted) activity or a dosimetry based activity, which is often considerably higher.Here, we will present a typical case of a pediatric patient who was treated using a dosimetric approach. Then we will discuss the basis of dosimetry and the procedures involved, followed by a discussion of when to use dosimetric RAI as well as the pros and cons of the various approaches in pediatric patients.In general, two opposite approaches to dosimetry exist: either the activity that is as high as safely administrable (AHASA) is determined based on the radiation exposure to the critical organs at risk (in pediatric patients these are the bone marrow and, in patients with lung metastases, the lungs), or a lesion-based approach in which the activity that is required to deliver a certain radiation dose to the metastatic lesion(s) is determined.Because the latter approach requires an accurate volumetry of the target lesion(s), which is not possible in children with disseminated pulmonary metastases, which are often not visible with morphologic imaging techniques, we advocate using the AHASA approach in children with extensive metastatic DTC.

Learning Objectives

 Upon completion of this educational activity, participants should be able to:

  • Identify a patient in whom dosimetric RAI may provide a clinical benefit
  • Describe the procedures involved in dosimetric RAI
  • Describe the potential clinical benefit of dosimetric RAI
  • Perform the medical procedure of dosimetric RAI in cooperation with a medical physicist

Additional Information

Target Audience: 
Physician-in-practice
Fellow
Resident
Clinical researcher
Scientific researcher
Educator/Teacher
Pharmacist
Nurse/Nurse practitioner
Physician assistant
Allied health professional
Other
Competency Area: 
Professionalism
Patient Care and Procedural Skills
Medical Knowledge
Topic Area: 
General Endocrinology
Level of Outcomes: 
Level 1 (Participation)
Level 2 (Satisfaction)
Level 3A (Learning: Declarative Knowledge (Knows))
Level 3B (Learning: Procedural Knowledge (Knows How))
Level 4 (Learning: Competence (Shows How))
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credits
  • 1.00 CME Certificate of Participation
Course opens: 
10/01/2013
Course expires: 
03/31/2015
Rating: 
0

Disclosure Policy

Authors, editors, and Endocrine Society staff involved in planning this JCEM Journal-based CME activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. The Endocrine Society has reviewed all disclosures and resolved all identified conflicts of interest.

The following authors reported relevant financial relationships:

Frederik A. Verburg, M.D., Ph.D., has received speakers’ fees and research support from Genzyme Corp. and is a paid member of an advisory board for Roche Healthcare. Christoph Reiners, M.D., has received speakers’ fees and research support from Genzyme Corp.

The following author reported no relevant financial relationships:

Heribert Hänscheid , M.D., has no relevant financial relationships.

The following JCEM Editors reported relevant financial relationships:

The Editor-in-Chief, Leonard Wartofsky, M.D., is a Consultant for Asurogen, Genzyme, and IBSA, and is on the Speaker's Bureau for Genzyme. Kenneth Burman, M.D., is a Consultant for Medscape and UpToDate; a Reviewer for the Endocrine Fellows Foundation; and has received Institutional Grants for Research from Amgen, Eisei, and Pfizer. Samuel Dagogo-Jack, M.D., is a Consultant for Merck and Novo Nordisk; a Grantee for the American Diabetes Association, AstraZeneca, Boehringer Ingelheim, National Institutes of Health, and Novo Nordisk; and a Grant Reviewer for the American Diabetes Association and National Institutes of Health. Silvio Inzucchi, M.D., is a Consultant/Advisor for Boehringer Ingelheim, Genentech, Janssen, Merck, and Takeda; has DSMB Activity with Amgen, Esai, and Gilead; and receives CME support from Abbott, Amylin, Boeringher-Ingelheim, Merck, and Takeda. Kieren Mather, M.D., received an Investigator-initiated Grant from Novo Nordisk. Lynnette Nieman, M.D., is an Author/Editor for UpToDate, and receives Research Support from HRA-Pharmaceutical.

The following JCEM Editors reported no relevant financial relationships: Paolo Beck-Peccoz, M.D.; David Ehrmann, M.D.; David Handelsman, Ph.D.; Michael Kleerekoper, M.D.; Merrily Poth, M.D.; Constantine Stratakis, M.D.

Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.

Acknowledgement of Commercial Support

JCEM Journal-based CME activities are not supported by grants, other funds, or in-kind contributions from commercial supporters.

Available Credit

  • 1.00 AMA PRA Category 1 Credits
  • 1.00 CME Certificate of Participation

Accreditation Period

Course opens: 
10/01/2013
Course expires: 
03/31/2015

Required Hardware/software

To participate in this activity, learners should:

  • Have access to a computer with an Internet connection
  • Use a major web browser, such as Internet Explorer 10+, Firefox 32+, Safari 7+, or Chrome 37+; in addition, cookies must be enabled in the browser's options.