Radiation dose distributions in normal tissue adjacent to tumors containing ¹³¹I or ⁹⁰Y: 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, ¹³¹I and ⁹⁰Y, 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 gastro-intestinal 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 ⁹⁰Y, 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 ¹³¹I, 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. Conclusion: 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.