PubMed · 12524754
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
R Levandoski. 2000. Important points not addressed.. https://pubmed.ncbi.nlm.nih.gov/12524754/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
In high-activity rhenium-186 hydroxyethylidene diphosphonate ((186)Re-HEDP) treatment of bone metastatic disease from prostate cancer the dose-limiting factor is haematological toxicity. In this study, we examined the correlation of the injected activity and the whole-body absorbed dose with treatment toxicity and response. Since the best response is likely to be related to the maximum possible injected activity limited by the whole-body absorbed dose, the relationship between pre-therapy biochemical and physiological parameters and the whole-body absorbed dose was studied to derive an algorithm to predict the whole-body absorbed dose prior to injection of the radionuclide. The whole-body retention of radioactivity was measured at several time points after injection in a cohort of patients receiving activities ranging between 2,468 MBq and 5,497 MBq. The whole-body absorbed dose was calculated by fitting a sequential series of exponential phases to the whole-body time-activity data and by integrating this fit over time to obtain the whole-body cumulated activity. This was then converted to absorbed dose using the Medical Internal Radiation Dose (MIRD) committee methodology. Treatment toxicity was estimated by the relative decrease in white cell (WC) and platelet (Plt) counts after the injection of the radionuclide, and by their absolute nadir values. The criterion for a treatment response was a 50% or greater decrease in prostate-specific antigen (PSA) value lasting for 4 weeks. Alkaline phosphatase (AlkPh), chromium-51 ethylene diamine tetra-acetate ((51)Cr-EDTA) clearance rate and weight were measured before injection of the radionuclide. The whole-body absorbed dose showed a significant correlation with WC and Plt toxicity ( P=0.005 and 0.003 for the relative decrease and P=0.006 and 0.003 for the nadir values of WC and Plt counts respectively) in a multivariate analysis which included injected activity, whole-body absorbed dose, pre-treatment WC and Plt baseline counts, PSA and AlkPh values, and the pre-treatment Soloway score. The injected activity did not show any correlation with WC or Plt toxicity, but it did correlate with PSA response ( P=0.005). These results suggest that the administration of higher activities would be likely to generate a better response, but that the quantity of activity that can be administered is limited by the whole-body absorbed dose. We have derived and evaluated a model that estimates the whole-body absorbed dose on an individual patient basis prior to injection. This model uses the level of injected activity and pre-injection measurements of AlkPh, weight and (51)Cr-EDTA clearance. It gave good estimates of the whole-body absorbed dose, with an average difference between predicted and measured values of 15%. Furthermore, the whole-body absorbed dose predicted using this algorithm correlated with treatment toxicity. It could therefore be used to administer levels of activity on a patient-specific basis, which would help in the optimisation of targeted radionuclide therapy. We believe that algorithms of this kind, which use pre-injection biochemical and physiological measurements, could assist in the design of escalation trials based on a toxicity-limiting whole-body absorbed dose, rather than using the more conventional activity escalation approach.
Patient dosimetry data for intra-arterial()iodine-131 lipiodol therapy for hepatocellular carcinoma (HCC) are scarce. The aim of this study was to determine the absorbed dose (D) to the tumour and healthy tissues, as well as the effective dose (E), by different methods for 17 therapies in 15 patients who received a mean activity of 1.9 GBq (SD 0.2) (131)I-lipiodol. Eight patients received thyroid blocking by potassium iodide (KI). Patient dosimetry was performed based on bi-planar total body scans using the Monte Carlo simulation program MCNP-4B and the MIRDOSE-3 standard software program. CT images of each patient were used to determine liver and tumour volume and position. The total body dose to the patient was also determined by biological dosimetry with the in vitro micronucleus (MN) assay. From the increase in micronucleus yield after therapy, the equivalent total body dose (ETBD) was calculated. Results for D and E were comparable between MCNP and MIRDOSE (liver: mean 7.8 Gy, SD 1.8, lungs: 6.8 Gy, SD 2.9, E: 2.01 Gy, SD 0.58). MIRDOSE gave a systematic overestimation for the tumour dose, especially for tumours <3 cm (15%). The MCNP method is more accurate since the dose contributions from tumour to organs and vice versa can be accounted for. The absorbed dose to the thyroid was significantly lower for patients who received KI (7.2 Gy, SD 2.2) than for the other patients (13.8 Gy, SD 5.0). MN yields could be obtained for only 12 of the 17 therapies due to hypersplenism. A mean ETBD of 1.66 Gy (SD 0.73) was obtained, but the MN results showed no correlation between the ETBD and the total body dose values of the physical dosimetry. Also, in all except one of the patients, no further reduction in the number of thrombocytes was observed after therapy, probably due to the existing hypersplenism. It is concluded that in view of the high E values, patient dosimetry is necessary for patients receiving (131)I-lipiodol therapy. Except in the case of the smaller tumours, comparable results were obtained with MCNP and MIRDOSE. Due to hypersplenism, biological dosimetry results based on the MN assay are not reliable.
This case-control study was designed to investigate association between polychlorinated biphenyls (PCBs) and risk of breast cancer in an area of high environmental exposure in the Michalovce district of eastern Slovakia. Incident breast cancer cases from the Michalovce district diagnosed between May 1997 and May 1999 were recruited through the Oncology Department of the District Hospital. A total of 15 individual PCB congeners, 2,2'-bis(4-chlorophenyl)-1,1-dichloroethylene (DDE), 2,2-bis(4-chlorophenyl)-1,1,1-trichloroethane (DDT), and hexachlorobenzene (HCB) were measured in the serum of 24 breast cancer patients and 88 population controls in 1998-1999. The median levels of total PCBs were similar in cases (2586 ng/g of lipid) and controls (2682 ng/g of lipid). Higher serum levels (highest vs. lowest tertile) of total PCBs (odds ratio (OR)=0.42, 95% CI 0.10-1.82, p-for trend=0.31), group 1 congeners (OR=0.37, 95% CI 0.10-1.43, P-for trend=0.02), group 2 congeners (OR=0.32, 95% CI 0.07-1.56, P-for trend=0.60), and group 3 congeners (OR=0.49, 95% CI 0.12-2.04, P-for trend=0.51) were inversely associated with risk of breast cancer. Higher serum levels of DDE (OR=3.04, 95% CI 0.65-14.3, P-for trend=0.10) were positively associated with risk of breast cancer, while there was no association for DDT (OR=1.19, 95% CI 0.27-5.23, P-for trend=0.68), and an inverse association for HCB (OR=0.45, 95% CI 0.06-3.19, P-for trend=0.67). While generally not statistically significant, PCB and HCB levels were inversely associated with risk of breast cancer in this highly exposed population. DDE, but not DDT, was positively associated with risk.