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Nuklearmedizin 2009; 48(04): 138-142
DOI: 10.3413/nukmed-0225
Original Article
Schattauer GmbH

The success of 131I ablation in thyroid cancer patients is significantly reduced after a diagnostic activity of 40 MBq 131I

Die Gabe einer diagnostischen Aktivität von 40 MBq 131I mindert bei Schilddrüsenkarzinom-Patienten den Erfolg der Radioiodablation
F. A. Verburg   *
1   Department of Nuclear Medicine, University Medical Center Utrecht
2   Department of Nuclear Medicine, University Hospital Würzburg
,
R. B. T. Verkooijen   *
3   Division of Nuclear Medicine, Department of Radiology, Leiden University Medical Center
4   Department of Nuclear Medicine, Maxima Medical Centre
,
M. P. M. Stokkel
3   Division of Nuclear Medicine, Department of Radiology, Leiden University Medical Center
,
J. W. van Isselt
1   Department of Nuclear Medicine, University Medical Center Utrecht
› Author Affiliations
Further Information

Publication History

received: 11 November 2008

accepted in revised form: 17 March 2009

Publication Date:
22 January 2018 (online)

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Summary

Objective: Dosimetry studies have shown that activities of 131I as small as 10-20 MBq may cause a stunning effect. A result of this stunning effect may be a lower success rate of the ablative 131I therapy for differentiated thyroid carcinoma (DTC). The aim of this study was to determine whether pre-therapeutic uptake measurement with 40 MBq 131I causes a lower success rate of ablation. Design: retrospective chart review study. Patients, methods: In two hospitals the ablation protocols differed in one respect only: in the one hospital no diagnostic 131I was applied before ablation (group 1, n = 48), whereas in the other hospital a 24-h uptake-measurement with 40 MBq 131I was performed (group 2, n = 51). Included were all DTC patients without distant metastases who had undergone 131I ablation between July 2002 and December 2005, and who had returned for 131I follow-up. Successful ablation was defined as absence of pathological 131I uptake on diagnostic whole-body scintigraphy and undetectable thyroglobulin-levels under TSH stimulation. Results: Overall, ablation was successful in 31/48 patients (65%) in group 1 and in 17/51 patients (33%) in group 2 (p=0.002). Multivariate analysis showed that pre-therapeutic uptake measurement using 40 MBq 131I was an independant determinant for success of ablation (p = 0.002). Conclusions: After applying a diagnostic activity of 40 MBq 131I before ablation, the success rate of ablation is severely reduced. Consequently, the routine application of 131I for diagnostic scintigraphy or uptake measurement prior to 131I ablation is best avoided.

Zusammenfassung

Ziel: Dosimetrische Studien haben gezeigt, dass selbst geringe Aktivitäten wie 10-20 MBq 131I dazu führen können, dass ein Stunning des Schilddrüsenrestgewebes auftritt. Als Folge könnte die Erfolgsquote der 131I-Ablation bei differenziertem Schilddrüsenkarzinom (DTC) deutlich erniedrigt sein. Das Ziel dieser Studie war es, festzustellen, ob prätherapeutische Uptake-Messung mit 40 MBq 131I eine geringere Erfolgsquote der Ablation verursacht. Design: Retrospektive Studie anhand von Krankenakten. Patienten, Methoden: In zwei Krankenhäusern unterschieden sich die Ablationsprotokolle nur in einer Hinsicht: In einem Krankenhaus wurde kein diagnostischer Scan mit 131I vor Ablation durchgeführt (Gruppe 1, n = 48), im anderen Krankenhaus wurde hingegen ein 24-h-Uptake-Messung mit 40 MBq 131I gemacht (Gruppe 2, n = 51). In unserer Studie wurden alle Patienten mit DTC ohne Fernmetastasen eingeschlossen, die zwischen Juli 2002 und Dezember 2005 mittels einer 131I-Ablation behandelt wurden und für ein 131I-Follow-up erneut aufgenommen wurden. Erfolgreiche Ablation wurde definiert als Abwesenheit von pathologischen 131I-Speicherungen auf einer diagnostischen Ganz - körperszintigraphie und einer nicht nachweisbaren Thyreoglobulinkonzentration unter TSH-Stimulation. Ergebnisse: Insgesamt war die Ablation erfolgreich in 31/48 Patienten (65%) in Gruppe 1 und in 17/51 Patienten (33%) in Gruppe 2 (p = 0,002). Multivariate Analysen zeigten, dass die prätherapeutische Uptake-Messung mit 40 MBq 131I ein un - abhängiger Faktor für den Erfolg der Ablation war (p = 0,002). Schlussfolgerungen: Durch der Gabe einer diagnostischen Aktivität von 40 MBq 131I vor Ablation wird die Erfolgsrate der Ablation stark reduziert. Folglich sollte die routinemäßige diagnostische 131I-Szinti - graphie oder 131I-Up take- Messung vor 131IAblation am besten vermieden werden.

Keywords

Differentiated thyroid cancer - 131I ablation - stunning

Schlüsselwörter

Differenzieres Schilddrüsenkarzinom - 131IAblation - Stunning

* Both authors contributed equally.


 

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