Dosimetric dependencies on target geometry and size in radioiodine therapy for differentiated thyroid cancer

Abstract

Purpose Radioiodine therapy is used in most disease stages for differentiated thyroid cancer. Its success depends on several factors, such as lesion size, completeness of surgery, extent of metastasis and tumoural iodine avidity. We aimed to investigate the importance of non-spherical geometries and size of metastases and thyroid remnants for the absorbed dose delivered. Methods Absorbed doses and energy depositions from homogeneously distributed iodine-131 in clinically relevant geometries and sizes were calculated using Monte Carlo simulations with MCNP6. A total of 162 volumes with different sizes and geometries corresponding to spheres, and prolate or oblate spheroids were simulated. Results Oblate and prolate spheroids had worse radiation coverage compared to spheres for equal masses, up to a difference of 38% for the most eccentric oblate spheroids and smallest masses simulated (a micrometastasis of mass 0.005 g). The differences in coverage could be explained by different volume - to - surface - area ratios of the spheroids. The impact of size alone caused up to 71% lower absorbed doses per decay in a spherical target mass of 0.005 g compared to 50 g. Conclusions While the iodine avidity, and therefore the total amount of decays, is the predominant contributing factor to absorbed dose in radioiodine therapy, eccentric spheroids and small target sizes can receive substantially lower absorbed doses from the same administration of radioiodine.

Keywords: Differentiated thyroid cancer; Geometry; Monte Carlo; Radioiodine therapy; Size.