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Training Course JG - live
Context
Pediatric differentiated thyroid cancer (DTC) patients frequently present with lymph node and/or distant (lung) metastases. Such patients warrant an aggressive treatment consisting of surgical removal of all surgically accessible local metastases as well as further treatment with one or more courses of radioiodine therapy (RAI). It is still a subject of debate in literature how much I-131 should be administered to pediatric patients. Patients can either be given a fixed (possibly body weight adjusted) activity or a dosimetry based activity, which is often considerably higher.
Objective
Here, we will present a typical case of a pediatric patient who was treated using a dosimetric approach. Then we will discuss the basis of dosimetry and the procedures involved, followed by a discussion of when to use dosimetric RAI as well as the pros and cons of the various approaches in pediatric patients.
Results
In general, two opposite approaches to dosimetry exist: either the activity that is as high as safely administrable (AHASA) is determined based on the radiation exposure to the critical organs at risk (in pediatric patients these are the bone marrow and, in patients with lung metastases, the lungs), or a lesion-based approach in which the activity that is required to deliver a certain radiation dose to the metastatic lesion(s) is determined.
Conclusion
Because the latter approach requires an accurate volumetry of the target lesion(s), which is not possible in children with disseminated pulmonary metastases, which are often not visible with morphologic imaging techniques, we advocate using the AHASA approach in children with extensive metastatic DTC.
Frederik A. Verburg, Christoph Reiners, and Heribert Hänscheid
DOI: http://dx.doi.org/10.1210/jc.2013-2259
Received: May 16, 2013
Accepted: July 19, 2013
Published Online: December 04, 2013
Target Audience
Endocrinologists/Pediatric Endocrinologists
Radiologists
Learning Objectives
Learners will be able to:
- Have an understanding of different approaches to dosimetry of radioiodine therapy
- Determine best approach for treating patient
| Time | Speaker | Topic |
|---|---|---|
| 8:00 AM | Linda Meyer | In quis justo. Maecenas rhoncus aliquam lacus. Morbi quis tortor id nulla ultrices aliquet. Maecenas leo odio, condimentum id, luctus nec, molestie sed, justo. Pellentesque viverra pede ac diam. Cras pellentesque volutpat dui. Maecenas tristique, est et tempus semper, est quam pharetra magna, ac consequat metus sapien ut nunc. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Mauris viverra diam vitae quam. |
| 9:00 AM | Stephanie Franklin | Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Vivamus vestibulum sagittis sapien. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. |
| 10:00 AM | Daniel Harper | Cras pellentesque volutpat dui. Maecenas tristique, est et tempus semper, est quam pharetra magna, ac consequat metus sapien ut nunc. |
| 10:00 AM | Karen Bailey | Morbi odio odio, elementum eu, interdum eu, tincidunt in, leo. Maecenas pulvinar lobortis est. Phasellus sit amet erat. Nulla tempus. Vivamus in felis eu sapien cursus vestibulum. Proin eu mi. Nulla ac enim. In tempor, turpis nec euismod scelerisque, quam turpis adipiscing lorem, vitae mattis nibh ligula nec sem. |
| 10:00 AM | Jerry Adams | Pellentesque viverra pede ac diam. |
| 10:00 AM | Jeremy Harvey | Maecenas ut massa quis augue luctus tincidunt. Nulla mollis molestie lorem. Quisque ut erat. |
| 11:00 AM | Helen Wallace | Integer non velit. Donec diam neque, vestibulum eget, vulputate ut, ultrices vel, augue. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Donec pharetra, magna vestibulum aliquet ultrices, erat tortor sollicitudin mi, sit amet lobortis sapien sapien non mi. Integer ac neque. |
| 11:00 AM | Jessica Hicks | Ut at dolor quis odio consequat varius. Integer ac leo. |
| 11:00 AM | Norma West | Proin eu mi. Nulla ac enim. In tempor, turpis nec euismod scelerisque, quam turpis adipiscing lorem, vitae mattis nibh ligula nec sem. Duis aliquam convallis nunc. Proin at turpis a pede posuere nonummy. Integer non velit. |
| 11:00 AM | Bobby Ray | Quisque id justo sit amet sapien dignissim vestibulum. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Nulla dapibus dolor vel est. Donec odio justo, sollicitudin ut, suscipit a, feugiat et, eros. Vestibulum ac est lacinia nisi venenatis tristique. |
| 1:00 PM | Mark Brown | Phasellus sit amet erat. |
| 1:00 PM | Barbara Graham | In quis justo. Maecenas rhoncus aliquam lacus. Morbi quis tortor id nulla ultrices aliquet. Maecenas leo odio, condimentum id, luctus nec, molestie sed, justo. |
| 1:00 PM | Linda Garcia | Cras pellentesque volutpat dui. |
| 2:00 PM | Dennis Peters | Ut at dolor quis odio consequat varius. Integer ac leo. Pellentesque ultrices mattis odio. Donec vitae nisi. Nam ultrices, libero non mattis pulvinar, nulla pede ullamcorper augue, a suscipit nulla elit ac nulla. Sed vel enim sit amet nunc viverra dapibus. Nulla suscipit ligula in lacus. Curabitur at ipsum ac tellus semper interdum. |
| 2:00 PM | Willie Bishop | Donec semper sapien a libero. Nam dui. |
| 2:00 PM | Gloria Miller | Morbi sem mauris, laoreet ut, rhoncus aliquet, pulvinar sed, nisl. Nunc rhoncus dui vel sem. Sed sagittis. Nam congue, risus semper porta volutpat, quam pede lobortis ligula, sit amet eleifend pede libero quis orci. Nullam molestie nibh in lectus. Pellentesque at nulla. Suspendisse potenti. Cras in purus eu magna vulputate luctus. |
| 2:00 PM | Carlos Collins | Cras in purus eu magna vulputate luctus. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Vivamus vestibulum sagittis sapien. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus. Etiam vel augue. Vestibulum rutrum rutrum neque. Aenean auctor gravida sem. Praesent id massa id nisl venenatis lacinia. Aenean sit amet justo. |
| 3:00 PM | Joe King | Nulla nisl. Nunc nisl. Duis bibendum, felis sed interdum venenatis, turpis enim blandit mi, in porttitor pede justo eu massa. Donec dapibus. Duis at velit eu est congue elementum. In hac habitasse platea dictumst. Morbi vestibulum, velit id pretium iaculis, diam erat fermentum justo, nec condimentum neque sapien placerat ante. |
| 3:00 PM | Patrick Lawson | Phasellus id sapien in sapien iaculis congue. Vivamus metus arcu, adipiscing molestie, hendrerit at, vulputate vitae, nisl. Aenean lectus. Pellentesque eget nunc. Donec quis orci eget orci vehicula condimentum. Curabitur in libero ut massa volutpat convallis. Morbi odio odio, elementum eu, interdum eu, tincidunt in, leo. Maecenas pulvinar lobortis est. |
| 4:00 PM | Jimmy Mitchell | Integer a nibh. In quis justo. Maecenas rhoncus aliquam lacus. Morbi quis tortor id nulla ultrices aliquet. Maecenas leo odio, condimentum id, luctus nec, molestie sed, justo. Pellentesque viverra pede ac diam. Cras pellentesque volutpat dui. Maecenas tristique, est et tempus semper, est quam pharetra magna, ac consequat metus sapien ut nunc. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Mauris viverra diam vitae quam. |
With a state-of-the-art Convention Center located in the heart of the city (boasting the largest ballroom on the East Coast), plus world-class shopping, nightlife, culture, dining and thousands of hotel rooms all within a few blocks, there is nothing missing in this modern metropolis.
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Loews Philadelphia
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- 581 guestrooms, including 12 suites and 54 Club Rooms
- 47,000 square feet of indoor function space, with three ballrooms
- Located in the heart of Center City, close to the Liberty Bell
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- Bank & Bourbon restaurant serves traditional American fare with a modern twist
- Pool on site
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Travel
Please call Advantage Travel at 215-555-1212 and ask for the conference travel planner.
Authors, editors, and Endocrine Society staff involved in planning this JCEM Journal-based CME activity are required to disclose to The Endocrine Society and to learners any relevant financial relationship(s) of the individual or spouse/partner that have occurred within the last 12 months with any commercial interest(s) whose products or services are discussed in the CME content. The Endocrine Society has reviewed all disclosures and resolved all identified conflicts of interest.
The following authors reported relevant financial relationships:
Frederik A. Verburg, M.D., Ph.D., has received speakers' fees and research support from Genzyme Corp. and is a paid member of an advisory board for Roche Healthcare. Christoph Reiners, M.D., has received speakers' fees and research support from Genzyme Corp.
The following author reported no relevant financial relationships:
Heribert Hänscheid, M.D., has no relevant financial relationships.
The following JCEM Editors reported relevant financial relationships:
The Editor-in-Chief, Leonard Wartofsky, M.D., is a Consultant for Asurogen, Genzyme, and IBSA, and is on the Speaker's Bureau for Genzyme.
Kenneth Burman, M.D., is a Consultant for Medscape and UpToDate; a Reviewer for the Endocrine Fellows Foundation; and has received Institutional Grants for Research from Amgen, Eisei, and Pfizer.
Lynnette Nieman, M.D., is an Author/Editor for UpToDate, and receives Research Support from HRA-Pharmaceutical.
The following JCEM Editors reported no relevant financial relationships: Paolo Beck-Peccoz, M.D.; David Ehrmann, M.D.; David Handelsman, Ph.D.; Michael Kleerekoper, M.D.; Merrily Poth, M.D.; Constantine Stratakis, M.D.
Endocrine Society staff associated with the development of content for this activity reported no relevant financial relationships.
Acknowledgement of Commercial Support
JCEM Journal-based CME activities are not supported by grants, other funds, or in-kind contributions from commercial supporters.
AKH Inc is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Available Credit
- 2.00 EthosCE University