Lin Raymond, Malaroda Alessandra L, Ryder William J, Wong Veronica C K, Wong Nikki L
Nepean Kidney Research Centre, Nepean Hospital, Sydney, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
BMC Nephrol. 2025 Jul 28;26(1):420. doi: 10.1186/s12882-025-04348-0.
Radioiodine (I) therapy in treatment of thyroid cancer, has a biological clearance that is significantly reduced in end-stage kidney disease (ESKD), leading to increased radiation exposure and potential myelotoxicity. For ESKD patients on haemodialysis (HD), there is no standardized approach to I administration and subsequent HD schedule.
Two patients with ESKD on HD were treated with I therapy for thyroid cancer. Rationale for treatment and local I treatment protocol modifications are discussed. Modifications were made to existing infrastructure and additional patient and staff safety precautions were undertaken, including serum radioactivity measurements to monitor for myelotoxicity.
HD at 24-,72- and 144-hours post-I results in a retained radiation activity profile comparable to patients with normal renal function. Radiation dose to bone marrow throughout treatment was assessed at < 0.3 Gy for both patients, within safe limits. The highest contribution of radiation dose to bone marrow (60% and 47% for patient 1 and patient 2 respectively) was due to the radioactivity retained in blood before the first HD session. Cumulative radiation exposure to dialysis staff was well within local safety constraints (300μSv per year) at 7μSv and 23μSv for patient 1 and 2 respectively. At 24 months post-therapy, thyroglobulin levels remained undetectable for both patients.
I therapy can be safely administered in patients with ESKD on HD with low-risk thyroid cancer through modifications to existing infrastructure and protocols. Serum radioactivity measurements is a simple and minimally invasive method to assess bone marrow safety during treatment. Ongoing pooling of experiences is needed to inform a standardized protocol for therapy in this population.
放射性碘（I）治疗甲状腺癌时，其生物清除率在终末期肾病（ESKD）患者中显著降低，导致辐射暴露增加及潜在的骨髓毒性。对于接受血液透析（HD）的ESKD患者，目前尚无关于I给药及后续HD安排的标准化方法。
两名接受HD的ESKD患者接受了I治疗甲状腺癌。讨论了治疗的基本原理及当地I治疗方案的调整。对现有基础设施进行了改造，并采取了额外的患者和工作人员安全预防措施，包括测量血清放射性以监测骨髓毒性。
I治疗后24小时、72小时和144小时进行HD，其保留的辐射活性曲线与肾功能正常的患者相当。两名患者整个治疗过程中骨髓所受辐射剂量评估均<0.3 Gy，在安全范围内。骨髓所受辐射剂量的最大贡献（患者1和患者2分别为60%和47%）来自首次HD治疗前血液中保留的放射性。透析工作人员的累积辐射暴露分别为7μSv和23μSv，远低于当地安全限制（每年300μSv）。治疗后24个月，两名患者的甲状腺球蛋白水平均仍无法检测到。
通过对现有基础设施和方案进行调整，I治疗可安全用于患有低风险甲状腺癌且接受HD的ESKD患者。血清放射性测量是评估治疗期间骨髓安全性的一种简单且微创的方法。需要持续积累经验，以制定该人群治疗的标准化方案。
