Dosimetric Modeling of Extravasal Administration of Therapeutic Radiopharmaticals
https://doi.org/10.37174/2587-7593-2019-2-4-35-41
Abstract
With radionuclide therapy of cancer, there is a risk of extravasal administration of significant activity of the radiopharmaceutical. The ingress of the radiopharmaceutical not into the lumen of the ulnar vein, but into the surrounding soft tissues causes a significant local irradiation of these tissues with short-range beta particles, as a result of which radiation-induced skin lesions of one degree or another may occur. According to the conservative scenario, the Monte Carlo method performed dosimetric modeling of the internal irradiation of the dermal layer of the skin after extravasal administration of 4 beta and beta-gamma-emitting therapeutic radiopharmaceuticals. It was shown that, depending on the radiation-physical characteristics of the radiopharmaceutical and the effective time of resorption of the lesion formed after injection, the absorbed dose of internal skin irradiation varies from 0.2 to 182 Gy. In this dose range, clinical manifestations of radiation complications can occur from erythema to radiation necrosis. Recommendations are presented on the prevention and suppression of the negative medical consequences of extravasal administration of therapeutic radiopharmaceuticals.
About the Authors
B. Ya. Narkevich
Association of Medical Physicists of Russia; N.N. Blokhin National Medical Research Center of Oncology
Russian Federation
Moscow
Russian Federation
Moscow
Yu. V. Lysak
Association of Medical Physicists of Russia; LLC “Medskan”
Russian Federation
Moscow
Russian Federation
Moscow
S. A. Ryzhov
Association of Medical Physicists of Russia; Scientific and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Department of Health
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Hung J.C., Ponto J.A., Hammes R.J. Radiopharmaceutical-related pitfalls and artifacts // Semin. Nucl. Med. 1996. Vol. 26. P. 208–255.
2. Silberstein E.B., Buscombe. J.R., McEwan A. et al. Society of Nuclear Medicine Procedure Guideline for Palliative Treatment of Painful Bone Metastases // In: Society of Nuclear Medicine Procedure Guidelines Manual. 2003. P. 147–153.
3. Tennvall J., Fischer M., Bischof Delaloye A. et al. EANM procedure guideline for radioimmunotherapy for B-cell lymphoma with 90 Y-radiolabelled ibritumomab tiuxetan (Zevalin) // Eur. J. Nucl. Med. Mol. Imaging. 2007. Vol. 34. P. 616–623.
4. Рыжов С.А. Радиационные аварии и ошибки в медицине. Термины и определения. в мед физике // Медицинская физика. 2019. №1. С. 73-90.
5. van der Pol J., Vöö S., Bucerius J. et al. Consequences of radiopharmaceutical extravasation and therapeutic interventions: a systematic review // Eur. J. Nucl. Med. Mol. Imaging. 2017. Vol 44. P. 12–34.
6. Anon. European system for reporting of adverse reactions and drug defects: Third report 1984–1985. European Nuclear Medicine Society News Letter. 1988. Vol 9. P. 487–490.
7. Piers D.A., Beekhuis H. Local radiation dose from extravasal Tl-201 // J. Nucl. Med. 1987. Vol. P. 68–74.
8. Siebeneck B.M. Extravasation of yttrium-90 ibritumomab tiuxetan: a case study // Clin. J. Oncol. Nurs. 2008. Vol. 12. P. 275–278.
9. Bonta D.V., Halkar R.K., Alazraki N. Extravasation of a Therapeutic Dose of 131 I-Metaiodobenzylguanidine: Prevention, Dosimetry, and Mitigation // J. Nucl. Med. 2011. Vol. 52. P. 1418–1422.
10. Kawabe J., Higashiyama S., Kotani K. et al. Subcutaneous extravasation of Sr-89: usefulness of bremsstrahlung imaging in confirming Sr-89 extravasation and in the decision making for the choice of treatment strategies for local radiation injuries caused by Sr-89 extravasation // Asia Ocean J. Nucl. Med. Biol. 2013. № 1. P. 56–59.
11. ICRP Publication 89. Basic Anatomical and Physiological Data for Use in Radiological Protection: Reference Values. ICRP. 2002.
12. ICRU Report 44. Tissue Substitutes in Radiation Dosimetry and Measurement. ICRU. 1989.
13. Committee for Radionuclide Therapy of Japan Radioisotope Association Q2-6. Treatment of the Extravasation of Sr-89, Q&A of the Part of Safety Management in Manual of Palliative Treatment with Sr-89 for Painful Bone Metastases. Tokyo: Committee for Radionuclide Therapy of Japan Radioisotope Association, 2009.
14. Kobayashi M., Asada Y., Suzuki S. et al. Estimation of skin absorbed doses due to subcutaneous leakage of radioactive pharmaceuticals // Nihon Hoshasen Anzenkanrigakukaishi. 2003. № 2. P. 82–86.
15. ICRU Report 56. International Commission on Radiation Units and Measurements. Dosimetry of external beta rays for radiation protection. ICRU. 1997.
16. Wiseman G.A., Kornmehl E., Leigh B. et al. Radiation dosimetry results and safety correlations from 90 Y-ibritumomab tiuxetan radioimmunotherapy for relapsed or refractory non-Hodgkin’s lymphoma: Combined data from four clinical trials // J. Nucl. Med. 2003. Vol. 44. P. 465–468.
17. Yucha C.B., Hastings-Tolsma M., Szeverenyi N.M. Effect of elevation on intravenous extravasations // J. Intraven. Nurs. 1994. Vol. 17. P. 231–234.
18. ICRP Publication 85. Radiopathology of skin and eye and radiation risk. ICRP. 2000.
19. ICRP Publication 118. Statement on Tissue Reactions. Early and Late Effects of Radiation in Normal Tissues and Organs. Threshold Doses for Tissue Reactions in a Radiation Protection Context. ICRP. 2012.
20. Terwinghe C., Vanbilloen B., Van Binnebeek S. et al. Extravasation of 90 Y-DOTATOC: case report and discussion of potential effects, remedies and precautions in PRRT // Eur. J. Nucl. Med. Mol. Imaging. 2012. Vol. 39. P. 205–212.
Review
For citations:
Narkevich B.Ya., Lysak Yu.V., Ryzhov S.A. Dosimetric Modeling of Extravasal Administration of Therapeutic Radiopharmaticals. Journal of oncology: diagnostic radiology and radiotherapy. 2019;2(4):35-41. (In Russ.) https://doi.org/10.37174/2587-7593-2019-2-4-35-41
Views:
573
Email this article 