Open AccessExperiences from Introducing Standardized High Dose 131I-mIBG Treatment of Children with Refractory Neuroblastoma: Differences in Effective Dose to Patients and Exposure to Caregivers
Author(s) -
Trine Hjørnevik,
Anne Catrine Trægde Martinsen,
Signe Elise Hagve,
Merethe Wigen Andersen,
Ann Cecillie Mørk,
Jan Gunnar Fjeld,
Ellen Ruud
Publication year - 2015
Publication title -
journal of nuclear medicine and radiation therapy
Language(s) - English
Resource type - Journals
ISSN - 2155-9619
DOI - 10.4172/2155-9619.1000258
Subject(s) - neuroblastoma , refractory (planetary science) , medicine , maximum tolerated dose , pediatrics , oncology , bioinformatics , pharmacology , toxicity , genetics , biology , astrobiology , cell culture
Aims: High dose 131I-meta iodobenzylguanidine (131I-mIBG) combined with radiosensitizing topotecan andperipheral blood stem cell support is a promising treatment regimen for children with neuroblastoma (NB). Here wepresent our first experiences, with particular focus on in vivo whole-body dosimetry and radiation exposure to familycaregivers and hospital staff.Methods: Five children with relapsed or refractory NB were treated during 2012-2014. 131I-mIBG wasadministered in two fractions at two weeks apart, aiming for a total whole-body radiation-absorbed dose of 4 Gy. The131I-mIBG activity for the 2nd administration was calculated on the basis of the measured whole-body dose followingthe 1st administration. Patients were isolated in a lead-shielded room, and all caregivers and staff received radiationsafety training, and carried an electronic personal dosimeter.Results: The total administered activity ranged from 5.1 to 28.6 GBq (median: 22.9 GBq), resulting in effectivewhole-body doses ranging from 2.1 to 4.3 Gy (median: 3.8 Gy). Two out of five patients deviated from theanticipated dose exposure defined by the treatment protocol; one patient received 4.3 Gy after a singleadministration, and for one patient the total whole-body dose was lower than anticipated (2.1 Gy). Radiation dose tofamily caregivers ranged from 0.1 to 8.0 mSv. For staff members, the overall radiation dose was low, and providedno concern regarding personal dosimetry.Conclusion: High-dose 131I-mIBG treatment of children with NB has been successfully established at ourinstitution. Radiation doses to caregivers and hospital staff are acceptable and in compliance with national andinternational guidelines. Two out of five patients deviated from the anticipated dose exposure, hence, accuratedosimetry-guidance during administration of high dose 131I-mIBG treatment is necessary