Dosimetry-Guided [¹³¹I]MIBG Therapy in a Hemodialysis-Dependent Paraganglioma Patient

High specific-activity ¹³¹I-metaiodobenzylguanidine ([¹³¹I]MIBG) therapy is approved for patients with pheochromocytoma or paraganglioma. As [¹³¹I]MIBG is not effectively cleared through dialysis, the 2008 European Association of Nuclear Medicine guidelines list renal insufficiency requiring dialysis as a contraindication for [¹³¹I]MIBG treatment. Methods: We describe the clinical and dosimetry findings of a hemodialysis-dependent patient with metastatic paraganglioma who was treated with [¹³¹I]MIBG. Results: 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. Conclusion: Dosimetry-guided treatment with [¹³¹I]MIBG in patients requiring hemodialysis is feasible. With appropriate dose reduction, the treatment can be effective with limited side effects.