A comparison of physical and cytogenetic estimates of radiation dose in patients treated with iodine-131 for thyroid carcinoma

Retrospective Evaluation of Cytogenetic Effects Induced by Internal Radioiodine Exposure: A 27-Year Follow-Up Study

Radioiodine (131I) is widely used in the treatment of hyperthyroidism and as an effective ablative therapy for differentiated thyroid cancer. Radioiodine (131I) constitutes 90% of the currently used therapies in the field of nuclear medicine. Here, we report the cytogenetic findings of a long-term follow-up study of 27 years on a male patient who received two rounds of radioiodine treatment within a span of 26 months between 1992 and 1994 for his papillary thyroid cancer. A comprehensive cytogenetic follow-up study utilizing cytokinesis blocked micronucleus assay, dicentric chromosome assay, genome wide translocations and inversions was initiated on this patient since the first administration of radioiodine in 1992. Frequencies of micronuclei (0.006/cell) and dicentric chromosomes (0.008/cell) detected in the current study were grossly similar to that reported earlier in 2019. The mFISH analysis detected chromosome aberrations in 8.6% of the cells in the form of both unbalanced and balanced translocations. Additionally, a clonal translocation involving chromosomes 14p; 15q was observed in 2 of the 500 cells analyzed. Out of the 500 cells examined, one cell showed a complex translocation (involving chromosomes 9, 10, and 16) besides 5 other chromosome rearrangements. Collectively, our study indicates that the past radioiodine exposure results in long-lasting chromosome damage and that the persistence of translocations can be useful for both retrospective biodosimetry and for monitoring chromosome instability in the lymphocytes of radioiodine exposed individuals.

Biodosimetry, can it find its way to the nuclear medicine clinic?

Personalised dosimetry based on molecular imaging is a field that has grown exponentially in the last decade due to the increasing success of Radioligand Therapy (RLT). Despite advances in imaging-based 3D dose estimation, the administered dose of a therapeutic radiopharmaceutical for RLT is often non-personalised, with standardised dose regimens administered every 4-6 weeks. Biodosimetry markers, such as chromosomal aberrations, could be used alongside image-based dosimetry as a tool for individualised dose estimation to further understand normal tissue toxicity and refine the administered dose. In this review we give an overview of biodosimetry markers that are used for blood dose estimation, followed by an overview of their current results when applied in RLT patients. Finally, an in-depth discussion will provide a perspective on the potential for the use of biodosimetry in the nuclear medicine clinic.

Cytogenetic study of radiation burden in thyroid disease patients treated with external irradiation or radioiodine

Where clinically permitted, either external irradiation or radioiodine therapy is usually recommended for the treatment of differentiated thyroid cancer patients. The choice depends on the treatment philosophy of the responsible physician. This paper describes an attempt to clarify the radiation burden on the lymphocytes in consequence of these two therapeutic modalities. An analysis was made of the extent to which exposure to local neck irradiation (25 x 2 Gy) or radioiodine therapy (1734-2600 MBq) causes chromosomal aberrations in the lymphocytes of thyroid disease patients after total or subtotal thyroidectomy. External irradiation caused many more chromosomal aberrations than 131I therapy did, but analysis of the distribution of the aberrations suggested a homogeneous dose distribution only in 131I-treated and thyroidectomized cancer patients. In thyrotoxic patients with intact thyroid glands, the lower therapy doses (185-595 MBq) caused a significantly higher frequency of aberrations than that observed in thyroid cancer patients, and the dose distribution in the lymphocytes was inhomogeneous. Thus, in the modelling of accidental environmental radioiodine exposure, thyroid patients with small if any residual thyroids are not a suitable group.

A cytogenetic follow-up study of thyroid cancer patients treated with 131I

To determine the genotoxic risk associated with therapeutic exposure to 131I, we studied the presence of micronuclei (MN) in binucleated peripheral blood lymphocytes of a group of 22 women, patients of thyroid cancer, who received 131I sodium iodide orally as an adjuvant after total thyroidectomy. The cytogenetic study was conducted following annual check-up, the patients having received the therapeutic dose between 1 and 5 years before the study. The results show that there are no significant differences in MN frequency between the patients and the control group, the latter composed of 19 unexposed women. These findings could indicate that any possible genetic damage induced by therapeutic exposure to 131I is eliminated after a period of 1 year.

Chromosome aberrations in Norwegian reindeer following the Chernobyl accident

Chromosome analyses were carried out on peripheral blood lymphocytes of semi-domestic reindeer in Norway which had been exposed to varying amounts of radiocesium emanating from the Chernobyl accident. The sampling was done in the period 1987-1990. The material included 192 reindeer, originating from four herds in central Norway, an area considerably affected by fallout from the Chernobyl accident, and from three herds in northern Norway which was unaffected by fallout from the accident. Significant heterogeneity in the distribution of chromosome aberrations between herds was observed. The pattern of chromosome aberration frequencies between herds was not related to the variation in radiocesium exposure from the Chernobyl accident. Other factors than the Chernobyl accident appear therefore to be of importance for the distribution of aberration frequencies found among present herds. Within the most contaminated area the reindeer born in 1986 showed significantly more chromosome aberrations than those born both before and after 1986. This could suggest that the Chernobyl accident fallout created an effect particularly among calves, during the immediate post-accident period in the most exposed areas.

Changes of the blood lymphocyte population following 131I treatment for nodular goiter

The blood lymphocyte population was examined in 34 patients who were treated with 131I for toxic or atoxic nodular goiter. The patients received one to three doses of 300-550 MBq of 131I administered at 1 week intervals. Lymphocyte counts were significantly reduced both 1 and 6 weeks after treatment. This reduction was accompanied by a changed composition of the lymphocyte population. The frequency of lymphocytes expressing membrane receptors for C'3 (EAC-rosette forming) was significantly reduced 1 and 6 weeks after 131I-administration. At 6 weeks there was a slight but statistically significant increase of the frequency of T-cells as identified by Leu 1 monoclonal antibodies. This was largely caused by an increased proportion of helper/induced T-cells as identified by Leu 3a monoclonals. 131I-treatment also reduced the capacity of lymphocytes to secrete immunoglobulins (Ig) upon PWM-stimulation. The most pronounced effect was observed for IgM. Secretion of IgG and IgA were less reduced. Mitogenic stimulations of lymphocytes with PHA and ConA were not significantly changed. We conclude that these changes observed, with the exception of mitogen reactivity, are essentially similar to those occurring after external radiation therapy for cancer. We speculate that blood lymphocytes passing through the continuously irradiated gland are damaged mainly by emitted beta-particles.

Chromosome aberrations in the peripheral lymphocytes induced by brachytherapy and external cobalt teletherapy

In the present study, the induction efficiencies of chromosome aberrations were analyzed in patients receiving various modalities of interstitial radiotherapy with small radiation sources in the oral cavity area and compared with those in patients treated with external telecobalt irradiation in the thoracic region. Further, as a local nonstochastic effect, the acute mucosal reaction was investigated. The mucosal reaction in the area treated by brachytherapy reached a maximum at two to three weeks after the implantation. The frequencies of dicentrics plus rings of peripheral lymphocytes, on the other hand, revealed rapid increases and approached plateau levels as early as two days after the implantation. The whole-body effects, evaluated on the basis of the chromosome aberration frequencies of peripheral lymphocytes in the patients who underwent brachytherapy, were compared with the effects observed in those patients treated with external radiotherapy or bleomycin injection and discussed with regard to their effectiveness in control of the tumor and side effects. The radiation doses used in the patients who received brachytherapy or a single external irradiation were found to exert the same effects on the chromosome aberration induction. However, even in the case of brachytherapy in which whole-body side effects were believed to be trivial, the peripheral lymphocyte count was temporarily reduced to one half or less of the preirradiation level. An equivalent whole-body dose of 50 cGy was obtained from the frequencies of dicentrics and rings.

Amount of peripheral reticulocytes as biologic dosimetry of ionizing radiation. Experiments in the rabbit

The amount of reticulocytes in peripheral blood generally reflect the bone-marrow status of erythropoiesis and may therefore be useful in evaluating radiation injury. The blood reticulocytes in rabbits exposed to various doses of ionizing radiation were examined using an apparatus capable of microfluorometric quantification of reticulocytes as well as the conventional technique of reticulocyte count. A dose-dependent decrease of reticulocytes was observed. The possibilities of further improvements of the technique using flow cytometry and its application for screening human population are discussed.

Radiotherapeutic agents: properties, dosimetry, and radiobiologic considerations

Radioactive nuclides for treatment have occupied an important but somewhat diminishing role in the total practice of nuclear medicine. Although theoretically they should have important potentialities, particularly in the treatment of various forms of cancer, their development in this field has not kept pace with the progress in other treatment modalities in radiation oncology. Indications for the selection of appropriate isotopes for therapy revolve about the emission of beta particles of sufficient energy, which are administered in a chemical form that reaches the tumor. Methods of calculation of doses delivered to sites of deposition are discussed in the text. Radiobiologic considerations include the possibility of early deleterious effects from overdosage, and consideration of chromosomal changes of circulating lymphocytes and their implications. Late effects that have been of great public concern are confined almost solely to possible carcinogenesis, and this effect has been minimal in patients receiving therapeutic levels of radioactive drugs. Genetic and developmental effects, also, have been negligible. Complications encountered more frequently have been leukemia after extensive therapy of thyroid carcinoma, and local fibrosis after direct injection of radioactive colloids into tumor tissue.