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J Nucl Med. 2008; 49 (Supplement 1):102P
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Oncology-Basic Science: Therapy, Metrics & Intervention

Clinical Radionuclide Therapy

A phase I study using I-131 NaI to treat leptomeningeal metastases via intraventricular injection

Franklin Wong1, Morris Groves1, Nicholas Papadopoulos1, Farrah Chickerneo1, Richard Wendt1, Victor Levin1 and Edmund Kim1

1 Univ. of Texas M. D. Anderson Cancer Center, Houston, Texas

407

Objectives: The feasibility of I-131 NaI for nonspecific locoregional radionuclide therapy is evaluated in patients with leptomeningeal metastases. This project is to study pharmacokinetics, biodistribution, radiation dosimetry, potential toxicity and efficacy of I-131 NaI after intraventricular injection via an Ommaya reservoir.

Methods: 5 Groups (15, 30, 60, 90 and 120 mCi levels) of 3 patients each were recruited according to an IRB-approved protocol. After CSF patency was confirmed by In-111 DTPA Ommayagram and thyroid protection by oral Lugol solution, patients underwent intrventricular injection. Patient in dose levels 15, 30 and 60 mCi also underwent whole-body gamma scintigraph using a Seimens dual-headed Duet ECAM with serial urine and blood collection up to 48 Hrs afater injection. Patients in 90 and 120 dose levels were admitted for observation in the radiation protection unit. All patients were followed for potential toxicity and efficacy (eradication of tumor cells from CSF) to 6 months or death.

Results: A total of 16 patients were recruited. Whole-body gamma images showed prompt transit of I-131 from the CSF to the body and then urine. Image-derived radiation absorbed doses were 11.9, 4.8, 7.8, 2.8,2.9, 0.14, 0.12 and 0.12 cGy/mCi to the ventricular CSF, Cervical CSF, convexity CSF, thyroid, bladder, brain, red marrow and total body respectively. One possible treatment-related toxicity is noted on a patient with known pancytopenia. 5/16 study subjects had clearance of tumor from CSF in 4 weeks. Longer survival to more than 365 days is noted in the highest dose cohorts.

Conclusions: Intraventricular I-131 NaI as feasible for locoregional radionculide therapy. Although promising, its efficacy and safety need to be further evaluated in Phase II studies.

Research Support: NIH R21-CA89891





This Article
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PubMed
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Right arrow Articles by Kim, E.