Dosimetry-Guided [<sup>131</sup>I]MIBG Therapy in a Hemodialysis-Dependent Paraganglioma Patient.

Winters, Celeste I; Yilmaz, Burcak; Mench, Anna M; Meyer, Catherine A L; Dodson, Evan; Wusirika, Raghav; Mallak, Nadine; Mittra, Erik S · J Nucl Med · 2025

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Abstract

High specific-activity <sup>131</sup>I-metaiodobenzylguanidine ([<sup>131</sup>I]MIBG) therapy is approved for patients with pheochromocytoma or paraganglioma. As [<sup>131</sup>I]MIBG is not effectively cleared through dialysis, the 2008 European Association of Nuclear Medicine guidelines list renal insufficiency requiring dialysis as a contraindication for [<sup>131</sup>I]MIBG treatment. <b>Methods:</b> We describe the clinical and dosimetry findings of a hemodialysis-dependent patient with metastatic paraganglioma who was treated with [<sup>131</sup>I]MIBG. <b>Results:</b> The patient tolerated the treatment with acceptable radiation doses to normal organs and effective treatment doses. Radiation safety precautions were followed, and radiation exposures stayed below safe limits for staff. <b>Conclusion:</b> Dosimetry-guided treatment with [<sup>131</sup>I]MIBG in patients requiring hemodialysis is feasible. With appropriate dose reduction, the treatment can be effective with limited side effects.

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