Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2017; 56(06): 211-218
DOI: 10.3413/Nukmed-0922-17-08

Original Article

Schattauer GmbH

Effectiveness of Reduced Radioiodine Activity for Thyroid Remnant Ablation after Total Thyroidectomy in Patients with Low to Intermediate Risk Differentiated Thyroid Carcinoma

Effektivität einer reduzierten Radiojottherapie zur Tyreodektomie bei Patienten mit niedrigem bis intermediärem Risiko für ein differenziertes Schilddrüsenkarzinom

Andrei Todica

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Sabine Haidvogl

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Wolfgang Peter Fendler

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Harun Ilhan

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Axel Rominger

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Alexander Robert Haug

²Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria

,

Peter Bartenstein

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

,

Sebastian Lehner

¹Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany

³Ambulatory Healthcare Center Dr. Neumaier & Colleagues, Radiology, Nuclear Medicine, Radiation Therapy, Regensburg, Germany

› Author Affiliations

Summary

Aim: To compare the success rates of radioiodine therapy (RIT) for thyroid remnant ablation (TRA) after the administration of a high-standard activity (3700 MBq; 100 mCi) to a lower-activity regimen of 2000 MBq (54 mCi) I-131 in a cohort of differentiated thyroid carcinoma (DTC) patients (papillary, follicular, mixed, pT1a(m) – pT3, N0 – NX, R0). Methods: 135 patients received approx. 2000 MBq I-131 (54 mCi) for thyroid remnant ablation after total thyroidectomy for DTC, 137 patients received approx. 3700 MBq (100 mCi) I-131. Ablation success was defined as thyroglobulin (TG) levels < 0.5 ng/ml after stimulation, negative I-131 whole-body scan and inconspicuous results on neck ultrasonography approximately 6 months after initial RIT. Results: In the follow-up 84.4 % of patients in the reduced-activity group and 87.6 % of the patients in the standard-activity group did not show any relevant residual I-131 uptake in the thyroid bed (p = 0.454). 90 % in the reduced-activity group and 91 % in the standard-activity group demonstrated a stimulated TG level < 0.5 ng/ml (p = 0.969). All patients were unre-markable in cervical ultrasonography. The success rate was comparable in both groups (81.5 % in the reduced-activity group vs. 83.9 % in the standard-activity group, p = 0.592). No re-therapy was required in 85.2 % of the patients in the low-activity group as compared to 87.6 % of the patients in the standard-activity group (p = 0.563). Conclusions: We could demonstrate that irrespective of the activity administered, the patients had comparable success rates with regard to TRA as defined by our criteria. We thus consider the use of a reduced-activity regimen for TRA safe and feasible in the patient cohort examined in this study.

Zusammenfassung

Ziel: Vergleich der Erfolgsrate für die Radio-jodtherapie (RIT) zur Beseitigung von Schilddrüsenrestgewebe (TRA) nach der Gabe einer hohen Standardaktivität (3700 MBq; 100 mCi) und einer niedrigen Aktivität (2000 MBq; 54 mCi) I-131 bei Patienten mit differenziertem Schilddrüsenkarzinom (DTC; papillär, follikulär, gemischt, pT1a(m) – pT3, N0 – NX, R0).

Methoden: 135 Patienten wurden etwa 2000 MBq I-131 (54 mCi) zur Beseitigung von Schilddrüsenrestgewebe nach vollständiger Thyreoidektomie bei DTC verabreicht, 137 Patienten erhielten etwa 3700 MBq (100 mCi) I-131. Der Therapieerfolg wurde wie folgt definiert: Thyreoglobulinspiegel (TG) < 0,5 ng/ ml nach Stimulation, unauffällige I-131 Ganzkörperszintigraphie und unauffälliger zervikaler Ultraschall ca. 6 Monate nach der initialen RIT. Ergebnisse: Im Follow-up zeigten 84,4 % der Patienten aus der Niedrigaktivität-Therapiegruppe und 87,6 % der Patienten aus der Standardaktivität-Therapiegruppe keinen relevanten residuellen I-131 Uptake im Schilddrüsenbett (p = 0,454). 90 % in der Gruppe mit niedriger Dosis und 91 % in der Gruppe mit Standardosis zeigten einen TG Spiegel < 0,5 ng/ml unter Stimulation (p = 0,969). Alle Patienten zeigten einen unauffälligen zervikalen Ultraschall. Die Erfolgsrate war vergleichbar in beiden Gruppen (81,5 % in der Niedrigaktivität-Gruppe vs. 83,9 % in der Standardaktivität-Gruppe, p = 0,592). 85,2 % der Patienten in der Gruppe mit niedriger Aktivität und 87,6 % der Patienten in der Gruppe mit hoher Aktivität benötigten keine Retherapie (p = 0,563). Schlussfolgerung: Es konnte gezeigt werden, dass die Patienten entsprechend unseren Kriterien unabhängig von der verabreichten Aktivität vergleichbare Erfolgsraten hinsichtlich der Beseitigung des Schilddrüsenrestgewebes aufwiesen. Die Verwendung eines Therapieregimes mit reduzierter Aktivität kann daher als sicher und zulässig betrachtet werden.

Keywords

Keywords

Differentiated thyroid carcinoma - remnant ablation - radioiodine - reduced activity - outcome

Schlüsselwörter

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - Schilddrüsenrestgewebe - Radiojod - reduzierte Dosis - Therapieerfolg

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