OBJECTIVE: To investigate the feasibility of using thyroid ^99mTcO₄^- imaging ROI ratio instead of 24 h radioactive iodine uptake (RAIU) for estimating ¹³¹I dose in individualized treatment of hyperthyroidism. METHODS: We retrospectively analyzed the clinical data of 132 patients receiving ¹³¹I treatment in our department between January and June, 2019. According to their 3 h/24 h RAIU peak ratio, the patients were divided into peak forward (≥80%) group and no peak forward (< 80%) group. In the former group, the therapeutic ¹³¹I dose was calculated based the Marinelli formula (¹³¹I dose=thyroid mass×planned amount/24 h RAIU), and in the latter group, the correlation between the ROI ratio and the 24 h RAIU was analyzed, and the ¹³¹I dose was calculated using a modified Marinelli formula where 24 h RAIU was replaced by a converted ROI ratio. The two groups of patients were compared for antithyroid drug type and discontinuation time, thyroid hormones and related antibodies, thyroid area, thyroid mass and ¹³¹I dose. All the patients were and followed up for one year to analyze the treatment efficacy. The ROI ratios after the treatment were analyzed in the two groups using ROC curves. RESULTS: There was a significant positive correlation between the ROI ratio and 24 h RAUI in the no peak forward group (Y=58.13 + 0.2X, R²=0.118, P < 0.05), and the formula for calculating ¹³¹I dose was converted into: ¹³¹I dose=thyroid mass× planned amount/(58.13+0.2×ROI ratio)%. Before the treatment, therapeutic ¹³¹I dose, thyroid hormone levels, TRAb, 3 h and 24 h RAIU, thyroid area, thyroid mass, and ROI ratio all differed significantly between the two groups (P < 0.05). At 3 months after treatment, thyroid hormone levels, TRAb, TPOAb, thyroid area, thyroid mass, ROI ratio, response rate, hypothyroidism rate, cure rate, remission rate, and nonresponse rate were similar between two groups (P>0.05). At the 1-year follow-up, the composition ratios of hyperthyroidism, hypothyroidism and cured cases remained similar between two groups (P>0.05). ROC curve analysis showed that at 3 months after treatment, the optimal cutoff values of ROI ratio for predicting hyperthyroid recurrence and hypothyroidism were 15.79 and 6.33, respectively. CONCLUSION Thyroid ^99mTcO₄^- imaging ROI ratio can be used for calculating ¹³¹I dose in individualized treatment of hyperthyroidism and for prognostic evaluation of the patients.
Humans ; Iodine Radioisotopes/therapeutic use* ; Retrospective Studies ; Thyroid Neoplasms ; Hypothyroidism

OBJECTIVE: We wanted to evaluate the effectiveness of intraluminal irradiation with Holmium-166 (166Ho) for reducing the pseudointimal hyperplasia (PIH) in the transjugular intrahepatic portosystemic shunt (TIPS) tract in a swine model. MATERIALS AND METHODS: TIPS was performed in 12 domestic pigs, after the creation of portal hypertension by intraportal injection of a mixture of N-butyl-2-cyanoacrylate (NBCA) and lipiodol. Five pigs first underwent intraluminal irradiation (30 Gy) in the parenchymal tract with using a 166Ho solution-filled balloon catheter, and this was followed by the placement of a nitinol stent in the TIPS tract. For the seven control pigs, the balloon was filled with saline and contrast media mixture. Two weeks later, follow-up portography and histological analysis were performed. RESULTS: TIPS was successfully performed in all twelve pigs with achieving artificially induced portal hypertension. Portography performed two weeks after TIPS showed the patent tracts in the TIPS tracts that were irradiated with 166Ho (5/5, 100%), whereas either completely (5/6, 83.3%) or partially (1/6, 16.7%) occluded TIPS were seen in the seven pigs of the nonirradiated control group, except in one pig that experienced periprocedural death due to bleeding. Histological analysis showed a statistically significant difference for the maximal PIH (irradiated: 32.8%, nonirradiated: 76.0%, p < 0.001) between the two groups. CONCLUSION: Intraluminal irradiation with 30 Gy of 166Ho for TIPS significantly improved the TIPS patency in a swine model of portal hypertension during a 2-week period of follow-up.
Alloys ; Animals ; Constriction, Pathologic/*radiotherapy ; Holmium/*therapeutic use ; Hypertension, Portal/therapy ; Portasystemic Shunt, Transjugular Intrahepatic ; Radioisotopes/*therapeutic use ; Stents ; Swine

Bone metastases are the main driver of morbidity and mortality in advanced prostate cancer. Targeting the bone microenvironment, a key player in the pathogenesis of bone metastasis, has become one of the mainstays of therapy in men with advanced prostate cancer. This review will evaluate the data supporting the use of bone-targeted therapy, including (1) bisphosphonates such as zoledronic acid, which directly target osteoclasts, (2) denosumab, a receptor activator of nuclear factor-kappa B (RANK) ligand inhibitor, which targets a key component of bone stromal interaction, and (3) radium-223, an alpha-emitting calcium mimetic, which hones to the metabolically active areas of osteoblastic metastasis and induces double-strand breaks in the DNA. Denosumab has shown enhanced delay in skeletal-related events compared to zoledronic acid in patients with metastatic castration-resistant prostate cancer (mCRPC). Data are mixed with regard to pain control as a primary measure of efficacy. New data call into question dosing frequency, with quarterly dosing strategy potentially achieving similar effect compared to monthly dosing for zoledronic acid. In the case of radium-223, there are data for both pain palliation and improved overall survival in mCRPC. Further studies are needed to optimize timing and combination strategies for bone-targeted therapies. Ongoing studies will explore the impact of combining bone-targeted therapy with investigational therapeutic agents such as immunotherapy, for advanced prostate cancer. Future studies should strive to develop biomarkers of response, in order to improve efficacy and cost-effectiveness of these agents.
Bone Density Conservation Agents/therapeutic use* ; Bone Neoplasms/secondary* ; Denosumab/therapeutic use* ; Diphosphonates/therapeutic use* ; Endothelins/antagonists & inhibitors* ; Humans ; Male ; Prostatic Neoplasms/pathology* ; Protein Kinase Inhibitors/therapeutic use* ; Radioisotopes/therapeutic use* ; Radiopharmaceuticals/therapeutic use* ; Radium/therapeutic use* ; Samarium/therapeutic use* ; Strontium Radioisotopes/therapeutic use*

Carcinoma ; radiotherapy ; Carcinoma, Papillary ; radiotherapy ; Humans ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Thyroid Neoplasms ; radiotherapy

Strontium-89 (Sr-89) is a pure emitter with maximum beta energy of 1.46 MeV, average beta energy of 0.58 MeV, and a physical half-life of 50.5 days. It is rapidly taken up by bone and preferentially retained at the sites of osseous metastases. Its biological half-life is >50 days at the metastatic sites, but about 14 days only in the normal bone. The dose of its absorption in the tumor-bearing bone ranges from 21 +/- 4 to 231 +/- 56 cGy/MBq, 2-25 times higher than in the normal bone. Strontium-89 therapy is an effective palliative treatment of bone metastases from prostate cancer, with analgesic effectiveness in 80%.
Bone Neoplasms ; radiotherapy ; secondary ; Humans ; Male ; Neoplasm Metastasis ; Prostatic Neoplasms ; pathology ; radiotherapy ; Strontium Radioisotopes ; therapeutic use

OBJECTIVETo investigate the effect on the dose distribution of source position displacement with the target region margin in catheter-based 192Ir line source endovascular brachytherapy.

METHODDose rate distribution along longitudinal axes was estimated by the formula recommended by AAPM No.60 and No. 43.

RESULTSIn the two cases of source displacement (1.1 and 5 mm) doses of target region margin was decreased dramatically (at most 53.9% and 565.8% respectively) were compared to that of no source displacement, and the affected range was 6 mm and 9 mm respectively.

CONCLUSIONSource displacement will lead to the decrease of dose in target region margin.

Animals ; Brachytherapy ; methods ; Coronary Restenosis ; radiotherapy ; Coronary Vessels ; radiation effects ; Iridium Radioisotopes ; therapeutic use ; Radiotherapy Dosage

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.
Adult ; Antithyroid Agents/adverse effects/therapeutic use ; Cetirizine/adverse effects/therapeutic use ; Graves Disease/*radiotherapy ; Hepatitis B, Chronic/complications ; Humans ; Iodides/therapeutic use ; Iodine Radioisotopes/*therapeutic use ; Male ; Methimazole/adverse effects/therapeutic use ; Plasmapheresis/*methods ; Thyroid Gland/*pathology ; Thyrotoxicosis/*therapy

OBJECTIVETo investigate the shielding effect of distance in radioactive iodine treatment in patients with differentiated thyroid cancer (DTC).

METHODSEighty-seven DTC patients underwent postoperative radioactive iodine treatment at the therapeutic doses ranging from 2.96 GBq to 7.4 GBq. The patients were divided into two groups to receive high-dose therapy (≥3.7 GBq, 48 patients) and low-dose therapy (<3.7 GBq, 39 patients). The radiation doses at 0.05 m, 1 m, and 3 m were recorded at different days; the doses at 1 m and 3 m on the third day, the dose of standard radioactivity source of 1.11GBq (131)I, and the natural background radioactivity were also recorded.

RESULTSThe radiation dose at a 1-meter distance was significantly higher in the high-dose group than in the low-dose group (P<0.05). The radiation doses in different dose groups at the other distances or at different time points showed no significant differences (P>0.05). On the third day after therapy, the radiation dose at 1 m was significantly lower than the reference radioactivity source of 1.11 GBq (131)I (P=0.000), but still higher than the natural background radioactivity at 3 m (P=0.000).

CONCLUSIONIn DTC patients who receive radioactive iodine therapy, the radioactive radiation dose decreases rapidly after 3 days. The radioactive radiation dose on the third day is significantly lower than the reference radioactive radiation dose, so that the patients can be discharged with safety for contact at a distance beyond one meter.

Adult ; Female ; Humans ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Radiation Dosage ; Radiation Protection ; Thyroid Neoplasms ; radiotherapy

BACKGROUNDPostoperative preablative stimulated thyroglobulin (ps-Tg) has been evaluated in predicting prognosis and success of ablation regarding differentiated thyroid cancer (DTC); however, its relationship with recurrence risk and radioiodine decision-making remains uncertain, especially in Chinese DTC patients. We aimed to evaluate the association between ps-Tg and recurrence risk stratification in DTC, to provide incremental values for ps-Tg in postoperative assessment and radioiodine management.

METHODSSeven hundred and seven patients with DTC were included; low-risk (L; n = 90), intermediate-risk (I; n = 283), and high-risk (H; n = 334, 117 with distant metastasis [M1]) patients were divided according to recurrence risk stratification. The M1 group was further analyzed regarding evidence of metastasis. Cut-off values of ps-Tg were obtained using receiver operating characteristic analysis.

RESULTSPatients with more advanced disease at initial risk stratification were more likely to have higher ps-Tg levels (I vs. L: P < 0.05; H vs. I: P < 0.001; H vs. L: P < 0.001). The corresponding cut-off value of ps-Tg for distinguishing sensitivity and specificity in each of the two groups was 2.95 ng/ml (I vs. L: 61.5%, 63.3%), 29.5 ng/ml (H vs. I: 41.9%, 92.6%), 47.1 ng/ml (M1 vs. M0 in the H group: 79.5%, 88.9%) and 47.1 ng/ml (M1 vs. M0 in all patients: 79.5%, 93.7%). With the cut-off value at 47.1 ng/ml, ps-Tg was the only factor that could be used to identify distant metastases, and consequently if measured before radioiodine therapy would prevent 10.26% of patients with M1 from undertreatment.

CONCLUSIONSPs-Tg, as an ongoing reassessment marker, favors differential recurrence risk grading and provides incremental values for radioiodine treatment decision-making.

Adult ; Female ; Humans ; Iodine Radioisotopes ; therapeutic use ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Thyroglobulin ; Thyroid Neoplasms ; blood ; pathology ; radiotherapy

OBJECTIVETo study the effects of implantation brachytherapy with delayed-release particles of 32P-chromic phosphate-poly (L-lactide) (32P-CP-PLLA) on prostate cancer (PCa) in nude mice.

METHODSWe established a subcutaneous transplantable PCa model in nude mice, and randomly divided them into six groups, Groups A, B and C implanted intratumorally with 32P-CP-PLLA delayed-release particles at 3.7, 7.4 and 14.8 MBq, Groups D, E and F with 125I particles at the same doses as the former three, and another six nude mice were included in Group G as the blank control. Then we killed the mice at 21 days after the treatment, observed the effects of the particles on the morphology of the tumor and their inhibition of tumor growth, counted WBCs and platelets (PLTs) in the peripheral blood, and detected the toxic reaction of the blood.

RESULTSAt 21 days after the treatment, the solid tumor tissues exhibited bleeding and necrotic changes, and the rates of tumor inhibition were positively correlated with the doses of administration. Groups A, B and C showed statistically significant differences from Groups D, E, F and G in the rate of tumor inhibition ([ 65.72 +/- 6.95]%, [77.58 +/- 4.32]% and [82.64 +/- 4.03]% versus [35.61 +/- 5.61]%, [43.30 +/- 6.94]% and [69.01 +/- 4.98]%), WBC count ([1.72 +/- 0.37] x 10(9)/L, [1.23 +/- 0.27] x 10(9)/L and [0.86 +/- 0.25] x 10(9)/L versus [1.45 +/- 0.40] x 10(9)/L, [0.51 +/- 0.24] x 10(9)/L, [0.37 +/- 0.26] x 10(9)/L and [3.96 +/- 0.26] x 10(9)/L), PLT count ([1.18 +/- 0.11] x 10(11)/L, [0.97 +/- 0.10] x 10(11)/L and [0.72 +/- 0.11] x 10(11)/L versus [0.97 +/- 0.15] x 10(11)/L, [0.76 +/- 0.16] x 10(11)/L, [0.64 +/- 0.12] x 10(11)/L and [2.89 +/- 0.21] x 10(11)/L) and body weight ([18.60 +/- 0.66] g, [17.60 +/- 0.39] g and [16.90 +/- 0.68] g versus [17.86 +/- 0.60] g, [15.56 +/- 0.39] g, [14.61 +/- 0.65] g and [19.95 +/- 0.73] g) (P < 0.01).

CONCLUSIONIntratumoral implantation of 32P-CP-PL-LA is a safe, simple and effective radionuclide interventional therapy for prostate cancer.

Animals ; Brachytherapy ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Phosphorus Radioisotopes ; therapeutic use ; Prostatic Neoplasms ; radiotherapy