Radioiodtherapie beim differenzierten Schilddrüsenkarzinom

Zusammenfassung

Die Verfahrensanweisung zur Radioiodtherapie beim differenzierten Schilddrüsenkarzinom (Version 4) wurde von einer repräsentativen Expertengruppe im informellen Konsens verabschiedet und entspricht damit einer Leitlinie der ersten Stufe (S1) nach den Kriterien der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Die Verfahrensanweisung ergänzt die S2-Leitlinie zur operativen Behandlung maligner Schilddrüsenerkrankungen um die nuklearmedizinischen Aspekte. Bezüglich der Indikationsstellung zur ablativen Radioiodtherapie beim kleinen papillären Schilddrüsenkarzinom und beim minimal invasiven follikulären Schilddrüsenkarzinom ohne Angioinvasion, bezüglich der empirischen Bemessung der ¹³¹I-Therapieaktivität sowie bezüglich der exogenen versus endogenen TSH-Stimulation bei der ablativen Radio-iodtherapie werden Handlungskorridore beschrieben. Der Text enthält die Auswertungen aus der National Cancer Database und der SEER-Database (jeweils USA), wonach die ablative Radioiodtherapie bereits in einer Niedrig-Risiko Konstellation die Überlebensrate verbessert. Der statistische Nachweis eines solchen Nutzens setzt ein nationales Krebsregister mit Langzeitdaten voraus.

Summary

The procedure guideline for radioiodine therapy of differentiated thyroid cancer (version 4) was developed in the consensus of a representative expert group. This fulfils the level S1 (first step) within the AWMF classification of Clinical Practice Guidelines (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Germany). This procedure guideline completed the guideline for surgical management of thyroid cancer (level S2) with the aspects from nuclear medicine. Controversies over ablative radioiodine therapy in small papillary thyroid cancers and in minimally invasive follicular cancer without angioinvasion, over empirical standard doses for ablative radioiodine therapy, and over the kind of TSH-stimulation were described and the guideline formulated a corridor of good clinical practice. The text has included the recent results from the National Cancer database and the SEER database (both from the USA), indicating that the ablative radioiodine therapy has improved the survival rate even in low risk patients. Such a statistically significant benefit can be detected only by a national cancer registry with long-term follow-up data.

Schlüsselwörter

Leitlinie - differenziertes Schilddrüsenkarzinom - Radioiodtherapie - Radioiodablation - Dosimetrie - rekombinantes humanes Thyrotropin

Keywords

Guideline - differentiated thyroid cancer - radio-iodine therapy - radioiodine ablation - dosimetry - recombinant human thyrotropin

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