Systemic Radiopharmaceutical Therapy of Pheochromocytoma and Paraganglioma

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00

Outline

1. Introduction
2. General Considerations for Systemic RPT in Pheochromocytoma and Paraganglioma
3. Patient Preparation Before RPT
4. Post-RPT Radiation Protection
5. 131I-MIBG Therapy
   1. 131I-MIBG production
   2. Patient Selection and Preparation for 131I-MIBG RPT
   3. 131I-MIBG Administration
   4. Clinical Experience with 131I-MIBG in Pheochromocytoma and Paraganglioma
   5. Dosimetric Scans
   6. Side Effects and Toxicity Profile
   7. Summary
6. PRRT with Radiolabeled Somatostatin Analogs
   1. Patient Selection and Preparation
   2. PRRT Administration
   3. Clinical Experience with PRRT in Pheochromocytoma and Paraganglioma
   4. Dosimetry
   5. Response Evaluation with PRRT
   6. Side Effects and Toxicity Profile
   7. Summary
7. Conclusion

Objectives

Upon completion of this course, students will:

1. identify characteristics associated with pheochromocytoma
2. understand what tumors of sympathetic origin secrete
3. identify which radiopharmaceutical comes in HSA or LSA options
4. list variables that contribute to the survival rate of pheochromocytoma and paraganglioma
5. identify the FDA approved radiopharmaceutical for pheochromocytoma and paraganglioma
6. list medications used for catecholamine blockade prior to treatment
7. understand the NRC regulations that allows treatment on an outpatient basis
8. list the characteristics associated with ¹³¹I-MIBG
9. describe preparations with high mass MIBG that can cause pharmacologic effects
10. identify the patient screening tests needed prior to ¹³¹I-MIBG treatment
11. identify the recommended HSA ¹³¹I-MIBG dose based on patient weight
12. understand the dosimetry infusion rates with HSA ¹³¹I-MIBG
13. understand the dose ranges for LSA ¹³¹I-MIBG
14. understand LSA ¹³¹I-MIBG doses and organ toxicity
15. list the criteria for an outpatient treatment of LSA ¹³¹I-MIBG
16. identify variables associated with LSA ¹³¹I-MIBG infusion
17. describe the LSA ¹³¹I-MIBG treatment schedule for metastatic pheochromocytoma bone lesions
18. understand the biochemical response associated with HSA ¹³¹I-MIBG therapy
19. list functional imaging options following RPT to evaluate treatment response
20. describe when whole body dosimetry imaging is performed following ¹³¹I-MIBG
21. identify the most common adverse side effect following HSA ¹³¹I-MIBG therapy
22. understand how gastrointestinal toxicity is handled following LSA or HSA ¹³¹I-MIBG therapy
23. understand the steps required for patient eligibility and ¹³¹I-MIBG
24. list the current somatostatin imaging agents available
25. explain the dose limiting organs affected by PRRT
26. describe when amino acid pre treatment is administered prior to ¹⁷⁷Lu-DOTATATE
27. identify the FDA approved radiopharmaceutical for NET therapy
28. list imaging modalities used for disease regression following PRRT
29. understand renal absorbed dose toxicity limits with PRRT
30. describe the current accepted dose protocol for PRRT
31. describe changes that are frequently used to evaluate treatment response to PRRT
32. describe the higher risks patients with pheochromocytoma or paraganglioma may incur following PRRT
33. identify hematologic side effects following PRRT
34. identify the radiopharmaceutical for pheochromocytoma and paraganglioma recommended by the National Comprehensive Cancer Network
35. identify other considerations necessary prior to PRRT or ¹³¹I-MIBG therapy