Radiation dose distributions in normal tissue adjacent to tumors containing (131)I or (90)Y: the potential for toxicity.
Given the relatively large tumor-absorbed doses reported for patients receiving radionuclide therapy, particularly radioimmunotherapy, and the relatively long pathlength of the nonpenetrating emissions of some radionuclides being used for these therapies, there exists the possibility of large absorbed doses to tissues adjacent to, surrounded by, or surrounding these tumors. Because tumors can occur adjacent to critical organs or tissues, such as arteries, nerves, pericardium, and the walls of the organs of the gastrointestinal tract, large absorbed doses to these normal tissues can lead to acute complications.


METHODS
In this study, the Monte Carlo radiation transport code MCNP4b was used to simulate the deposition of energy from emissions of 2 radionuclides of interest, (131)I and (90)Y, to assess the possible magnitude of the absorbed doses in tissues adjacent to tumors. Mathematic models were constructed to simulate situations that might occur, such as tumor wrapped around a small cylinder (e.g., a nerve or artery), tumor against a tissue (e.g., the pericardium or wall of any gastrointestinal tract organ), and tumor surrounded by any soft tissue. Tumor masses of 10, 20, and 40 g were used in each model. Depth dose distributions were calculated using Monte Carlo simulations of the radiation transport in these geometric models.


RESULTS
For tissues close to tumors containing (90)Y, the absorbed dose ranged from 24% of the absorbed dose in the tumor, for the case of tissues 1 mm from the tumor, to 103% of the absorbed dose in the tumor, for the case of small structures such as nerves or arteries surrounded by tumor. For tissues close to tumors containing (131)I, the absorbed dose ranged from 4% of the absorbed dose in the tumor, for the case of tissues 1 mm from the tumor, to 46% of the absorbed dose in the tumor, for the case of small structures such as nerves or arteries surrounded by tumor.


CONCLUSIONS
This study showed that when absorbed doses to tumors are large, the absorbed dose to adjacent tissues can also be large, potentially causing unexpected toxicities.
Sparks
Richard B
RB
CDE Dosimetry Services, Inc., Knoxville, Tennessee, USA. rsparks@creativedevelopment.com
Crowe
Eric A
EA
Wong
Franklin C
FC
Toohey
Richard E
RE
Siegel
Jeffry A
JA
D003198:Computer Simulation; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D009010:Monte Carlo Method; D009369:Neoplasms / Q000532:radiotherapy*; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D007457:Iodine Radioisotopes; D015021:Yttrium Radioisotopes