Diferansiye tiroid kanserli hastalarda postoperatif rezidüel tiroid dokusundaki I-131 tutulumu, MIRDOSE3 ile hesaplanan absorbe dozlar ve ablasyon öncesi tiroglobulin seviyeleri arasındaki ilişki: Bir retrospektif karşılaştırma çalışması
Öz
Amaç: Bu çalışmadaki amacımız,
I-131 ablasyon tedavisi uygulanan diferansiye tiroid kanserli hastalarda,
ablasyon öncesi ölçülen serum tiroglobulin değerleri ile ablasyon sonrası
rezidü tiroid dokudaki I-131 uptake değerleri ve MIRDOSE3 ile hesaplanan
absorbe dozları karşılaştırarak, aralarında rezidü doku miktarı tahmini ve
tedavi etkinliğine etkileri açısından bir ilişki olup olmadığını araştırmaktır.
Yöntem: Çalışmaya yetmiş dört
hasta dâhil edildi. Hastalarda ablasyon öncesi serum tiroglobulin ve tiroid
stimülan hormon düzeyleri ölçüldü. Ablasyon sonrası 8. gün I-131 tüm vücut
tarama sintigrafi görüntüleri de kullanılarak uptake değerleri hesaplandı.
Bulgular ablasyon sonrası 8.-12. ayda yapılan düşük doz I-131 ile tüm vücut
tarama sintigrafi görüntüleri ile birlikte değerlendirildi. Ayrıca her hastada
I-131’in efektif yarı ömrü, kümülatif aktivite ve I-131 kalım süresi
hesaplandı. Bulunan değerler MIRDOSE3 programında kullanılarak total vücut
absorbe dozlar hesaplandı ve parametreler arası karşılaştırılma yapıldı.
Bulgular:
Hastalarda; tiroglobulin değerleri ile uptake değerleri sperman
analizi ile karşılaştırıldığında, aralarında orta düzeyde korelasyon bulundu
(r=0.616, p=0.01). Hastaların ablasyon öncesi tiroid stimülan hormon düzeyleri
ile uptake değerleri karşılaştırıldığında, aralarında negatif yönde düşük
düzeyde korelasyon bulundu (r =-0.218, p=0.05). Yetmiş dört hastanın 8.-12. ay
tüm vücut tarama sintigrafileri ve tiroglobulin sonuçları değerlendirildiğinde,
3 (%4,1) hastada tam ablasyon yokken, 71 (%95,9) hastada tam ablasyon vardı.
Tam ablasyon sağlanamayan hastaların tedavi öncesindeki tiroglobulin düzeyleri
tam ablasyon sağlananlara göre istatistiksel olarak anlamlı düzeyde yüksek
bulundu (p=0.001). Absorbe dozlar ile tiroglobulin değerleri karşılaştırıldığında,
aralarında düşük düzeyde korelasyon bulundu (r=0.212, p=0.05).
Sonuç: Sonuç olarak, I-131
ablasyon tedavisi öncesinde ölçülen tiroglobulin değerlerinin cerrahi sonrası
kalan doku hakkında bilgi verebileceğini ve kalan doku boyutunun da tedavi
etkinliğini etkileyebileceğini gözlemledik. Ayrıca tedavi öncesi tiroglobulin
değerleri yüksek olan hastalarda tam ablasyon başarısı açısından tedavi ve
takip protokolüne dikkat edilmesi gerektiğini düşünüyoruz.
Anahtar Kelimeler
Kaynakça
- 1- Lind P, Igerc I, Kohlfürst S. Radioiodine Theraph.: Malignant Thyroid Disease. Biersack H, Freeman L, Zuckier LS, Grünwald F eds. Clinical Nuclear Medicine. 1st ed. Springer-Verlag Berlin Heidelberg; 2007. p. 418-32.
- 2- Mazzaferri EL, Kloos RT, Clinical Review, Current Approaches to Primary Therapy For Papillary And Follicular Thyroid Cancer. The Journal of Clin. Endocrinol & Metabolism, 2001; 86 (4):1447-63.
- 3- Brassard M, Borget I, Edet-Sanson A, Giraudet AL, Mundler O, Toubeau M, Bonichon F, Borson-Chazot F, Leenhardt L, Schvartz C, Dejax C, Brenot-Rossi I, Toubert ME, Torlontano M, Benhamou E, Schlumberger M. Long-Term Follow-Up of Patients with Papillary and Follicular Thyroid Cancer: A Prospective Study on 715 Patients, J Clin Endocrinol Metab, 2011; 96:1352–9.
- 4- Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, Haugen BR, Sherman SI, Cooper DS, Braunstein GD, Lee S, Davies TF, Arafah BM, Ladenson PW, Pinchera A. A Consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin. Endocrinol Metab, 2003; 88: 433–41.
- 5- Grande E, Díez JJ, Zafon C, Capdevila J. Thyroid cancer: molecular aspects and new therapeutic strategies. J Thyroid Res. 2012; 2102:847108.
- 6- Verburg FA, Mäder U, Tanase K, Thies ED, Diessl S, Buck AK, Luster M, Reiners C. Life Expectancy Is Reduced in Differentiated Thyroid Cancer Patients ≥ 45 Years Old with Extensive Local Tumor Invasion, Lateral Lymph Node, or Distant Metastases at Diagnosis and Normal in All Other DTC Patients. J Clin Endocrinol Metab, 2013; 98:172-80.
- 7- Bales SR, Chopra IJ. Targeted treatment of differentiated and medullary thyroid cancer. J Thyroid Res, 2011; 2011:102636.
- 8- Dobrenic M, Huic D, Zuvic M, Grosev D, Petrovic R, Samardzic T. Usefulness of low iodine diet in managing patients with differentiated thyroid cancer-initial results. Radiol Oncol, 2011; 45:189-95.
- 9- Fatima N, Zaman M, Ikram M, Akhtar J, Islam N, Masood Q, Zaman U, Zaman A. Baseline stimulated thyroglobulin level as a good predictor of successful ablation after adjuvant radioiodine treatment for differentiated thyroid cancers. Asian Pac J Cancer Prev, 2014; 15: 6443-47.
- 10- Shahbazi-Gahrouei D, Ayat S. Comparison of three methods of calculation, experimental and monte carlo simulation in investigation of organ doses (thyroid, sternum, cervical vertebra) in radioiodine therapy. J Med Signals Sens, 2012; 2: 149-52.
- 11- Ogilvie JB, Patel KN, Heller KS. Impact of the 2009 American Thyroid Association Guidelines on the choice of operation for well-differentiated thyroid microcarcinomas. Surgery, 2010; 148:1222-6.
- 12- Flux GD, Haq M, Chittenden SJ, Buckley S, Hindorf C, Newbold K, Harmer CL. A dose-effect correlation for radioiodine ablation in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging, 2010; 37: 270-5.
- 13- Pacini F, Capezzone M, Elisei R, Ceccarelli C, Taddei D, Pinchera A. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab, 2002; 87: 1499-501.
- 14- Grünwald F, Menzel C, Fimmers R, Zamora PO, Biersack HJ. Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer. J Nucl Med, 1996; 37:1962-4.
- 15- Verkooijen RB, Stokkel MP, Smit JW, Pauwels EK. Radioiodine-131 in differentiated thyroid cancer: a retrospective analysis of an uptake-related ablation strategy. Eur J Nucl Med Mol Imaging, 2004; 31: 499-506.
- 16- Ronga G, Filesi M, Ventroni G, Vestri AR, Signore A. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med, 1999; 26:1448-52.
- 17- Mcdougall IR, Bayer MF. Follow-Up of patients with differentiated thyroid cancer using serum thyroglobulin measured by an immunoradiometric assay. Comparison with 131I total body scans. J Nucl Med, 1980; 21: 741-44.
- 18- Samuel AM, Rajashekharrao B. Radioiodine therapy for well-differentiated thyroid cancer: a quantitative dosimetric evaluation for remnant thyroid ablation after surgery. J Nucl Med, 1994; 35:1944-50.
- 19- Amdur JA, Mazzaferri EL. Thyroid Hormone Withdrawal to Elevate TSH. In ‘Essentials of Thyroid Cancer Management’ AmdurJA, Mazzaferri EL (Ed). Springer Science+Business Media, 2005; pp: 229-31.
- 20- Hänscheid H, Lassmann M, Luster M, Kloos RT, Reiners C. Blood dosimetry from a single measurement of the whole body radioiodine retention in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2009; 16(4): 1283-9.
- 21- Lassmann M, Reiners C, LusterM. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer. 2010;17(3):161-72.
- 22- Verkooijen RB, Verburg FA, van Isselt JW, Lips CJ, Smit JW, Stokkel MP. The success rate of I-131 ablation in differentiated thyroid cancer: comparison of uptake-related and fixed-dose strategies. Eur J Endocrinol. 2008; 159(3): 301-7.
The relationship between I-131 uptake in postoperative residue thyroid tissue and absorbed doses calculated with MIRDOSE3 and pre-ablation thyroglobulin levels in patients with differential thyroid cancer: A retrospective comparison study
Öz
Objective: The aim of this
study was to compare I-131 uptake in postoperative residue thyroid tissue and
absorbed doses calculated with MIRDOSE3 and pre-ablation thyroglobulin levels
in patients with differential thyroid cancer and was to investigate whether
there is a relationship in terms of effectiveness to treatment efficacy.
Method: Seventy-four patients were included in the
study. Serum thyroglobulin and thyroid stimulating hormone levels before
ablation were measured in patients. Uptake values were calculated using I-131
whole body scan scintigraphy images taken on the 8th day after ablation. The
findings were evaluated with low dose I-131 whole body scan scintigraphy at
8th-12th months after ablation. Also the effective half-life of I-131,
cumulative activity and I-131 residence time were calculated for each patient.
The values found were used in the MIRDOSE3 program to calculate total body
absorptive doses and comparison was made between the parameters.
Results: Thyroglobulin values and uptake values
were compared with sperman analysis. There was intermediate correlation between
them (r = 0.616, p = 0.01). There was a low correlation in the negative
direction between thyroid stimulating hormone levels and uptake values of
patients before ablation (r =-0.218, p = 0.05). In 74 patients 8th-12th. Month
whole body scan scintigraphy and thyroglobulin results are evaluated; 3 (4.1%)
patients were not complete ablated and 71 patients (95.9%) were complete
ablated. There was a significant difference only in the thyroglobulin value
between complete ablated and non-ablated patient groups (p =0.001). There was a
low correlation between absorbed doses and thyroglobulin values (r = 0.212, p =
0.05).
Conclusions: As a result, we observed that
thyroglobulin values measured before I-131 treatment inform about residual
tissue after surgery and residual tissue size may affect treatment efficacy. We
also think that attention should be paid to the treatment and follow-up
protocol in terms of complete ablation success in patients with high
pre-treatment thyroglobulin values.
Anahtar Kelimeler
Kaynakça
- 1- Lind P, Igerc I, Kohlfürst S. Radioiodine Theraph.: Malignant Thyroid Disease. Biersack H, Freeman L, Zuckier LS, Grünwald F eds. Clinical Nuclear Medicine. 1st ed. Springer-Verlag Berlin Heidelberg; 2007. p. 418-32.
- 2- Mazzaferri EL, Kloos RT, Clinical Review, Current Approaches to Primary Therapy For Papillary And Follicular Thyroid Cancer. The Journal of Clin. Endocrinol & Metabolism, 2001; 86 (4):1447-63.
- 3- Brassard M, Borget I, Edet-Sanson A, Giraudet AL, Mundler O, Toubeau M, Bonichon F, Borson-Chazot F, Leenhardt L, Schvartz C, Dejax C, Brenot-Rossi I, Toubert ME, Torlontano M, Benhamou E, Schlumberger M. Long-Term Follow-Up of Patients with Papillary and Follicular Thyroid Cancer: A Prospective Study on 715 Patients, J Clin Endocrinol Metab, 2011; 96:1352–9.
- 4- Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, Haugen BR, Sherman SI, Cooper DS, Braunstein GD, Lee S, Davies TF, Arafah BM, Ladenson PW, Pinchera A. A Consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin. Endocrinol Metab, 2003; 88: 433–41.
- 5- Grande E, Díez JJ, Zafon C, Capdevila J. Thyroid cancer: molecular aspects and new therapeutic strategies. J Thyroid Res. 2012; 2102:847108.
- 6- Verburg FA, Mäder U, Tanase K, Thies ED, Diessl S, Buck AK, Luster M, Reiners C. Life Expectancy Is Reduced in Differentiated Thyroid Cancer Patients ≥ 45 Years Old with Extensive Local Tumor Invasion, Lateral Lymph Node, or Distant Metastases at Diagnosis and Normal in All Other DTC Patients. J Clin Endocrinol Metab, 2013; 98:172-80.
- 7- Bales SR, Chopra IJ. Targeted treatment of differentiated and medullary thyroid cancer. J Thyroid Res, 2011; 2011:102636.
- 8- Dobrenic M, Huic D, Zuvic M, Grosev D, Petrovic R, Samardzic T. Usefulness of low iodine diet in managing patients with differentiated thyroid cancer-initial results. Radiol Oncol, 2011; 45:189-95.
- 9- Fatima N, Zaman M, Ikram M, Akhtar J, Islam N, Masood Q, Zaman U, Zaman A. Baseline stimulated thyroglobulin level as a good predictor of successful ablation after adjuvant radioiodine treatment for differentiated thyroid cancers. Asian Pac J Cancer Prev, 2014; 15: 6443-47.
- 10- Shahbazi-Gahrouei D, Ayat S. Comparison of three methods of calculation, experimental and monte carlo simulation in investigation of organ doses (thyroid, sternum, cervical vertebra) in radioiodine therapy. J Med Signals Sens, 2012; 2: 149-52.
- 11- Ogilvie JB, Patel KN, Heller KS. Impact of the 2009 American Thyroid Association Guidelines on the choice of operation for well-differentiated thyroid microcarcinomas. Surgery, 2010; 148:1222-6.
- 12- Flux GD, Haq M, Chittenden SJ, Buckley S, Hindorf C, Newbold K, Harmer CL. A dose-effect correlation for radioiodine ablation in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging, 2010; 37: 270-5.
- 13- Pacini F, Capezzone M, Elisei R, Ceccarelli C, Taddei D, Pinchera A. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab, 2002; 87: 1499-501.
- 14- Grünwald F, Menzel C, Fimmers R, Zamora PO, Biersack HJ. Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer. J Nucl Med, 1996; 37:1962-4.
- 15- Verkooijen RB, Stokkel MP, Smit JW, Pauwels EK. Radioiodine-131 in differentiated thyroid cancer: a retrospective analysis of an uptake-related ablation strategy. Eur J Nucl Med Mol Imaging, 2004; 31: 499-506.
- 16- Ronga G, Filesi M, Ventroni G, Vestri AR, Signore A. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med, 1999; 26:1448-52.
- 17- Mcdougall IR, Bayer MF. Follow-Up of patients with differentiated thyroid cancer using serum thyroglobulin measured by an immunoradiometric assay. Comparison with 131I total body scans. J Nucl Med, 1980; 21: 741-44.
- 18- Samuel AM, Rajashekharrao B. Radioiodine therapy for well-differentiated thyroid cancer: a quantitative dosimetric evaluation for remnant thyroid ablation after surgery. J Nucl Med, 1994; 35:1944-50.
- 19- Amdur JA, Mazzaferri EL. Thyroid Hormone Withdrawal to Elevate TSH. In ‘Essentials of Thyroid Cancer Management’ AmdurJA, Mazzaferri EL (Ed). Springer Science+Business Media, 2005; pp: 229-31.
- 20- Hänscheid H, Lassmann M, Luster M, Kloos RT, Reiners C. Blood dosimetry from a single measurement of the whole body radioiodine retention in patients with differentiated thyroid carcinoma. Endocr Relat Cancer. 2009; 16(4): 1283-9.
- 21- Lassmann M, Reiners C, LusterM. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer. 2010;17(3):161-72.
- 22- Verkooijen RB, Verburg FA, van Isselt JW, Lips CJ, Smit JW, Stokkel MP. The success rate of I-131 ablation in differentiated thyroid cancer: comparison of uptake-related and fixed-dose strategies. Eur J Endocrinol. 2008; 159(3): 301-7.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Medical Science Research Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Mart 2018 |
| Kabul Tarihi | 6 Ocak 2018 |
| Yayımlandığı Sayı | Yıl 2018Cilt: 40 Sayı: 1 |