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Nuklearmedizin 1992; 31(04): 137-141
DOI: 10.1055/s-0038-1629614
Originalarbeiten
Schattauer GmbH

Late Cervical Lymph Node Recurrence in Differentiated Thyroid Carcinoma

An Inherent Problem of 131I Beta Dose Distribution in Small Tumor Deposits?
Marie-Luise Sautter-Bihl
1   From the Department of Radiooncology and Nuclear Medicine (Dir.: Prof. Dr. med. H. G. Heinze), Städt. Klinikum, Karlsruhe, FRG
,
G. Herbold
2   From the Department of Nuclear Medicine (Dir.: Priv.-Doz. Dr. Dr. med. H. Bihl), Katharinenhospital, Stuttgart, FRG
,
H. G. Heinze
1   From the Department of Radiooncology and Nuclear Medicine (Dir.: Prof. Dr. med. H. G. Heinze), Städt. Klinikum, Karlsruhe, FRG
,
H. Bihl
2   From the Department of Nuclear Medicine (Dir.: Priv.-Doz. Dr. Dr. med. H. Bihl), Katharinenhospital, Stuttgart, FRG
› Author Affiliations
Further Information

Publication History

Received: 23 December 1991

Publication Date:
04 February 2018 (online)

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Zusammenfassung

Die postoperative Radiojodtherapie ist unumstrittener Bestandteil der Gesamtbehandlungsstrategie beim differenzierten Schilddrüsenkarzinom. Gelegentlich werden jedoch Jahre nach Erstdiagnose und Therapie zervikale Lymphknotenmetastasen manifest, ohne daß ein Rezidiv des Primärtumors oder Fernmetastasen nachweisbar sind. In diesen Fällen war die Radiojodtherapie offensichtlich nicht ausreichend, um eine endgültige Tumorzellsterilisation zu bewirken. Die vorliegende Arbeit suchte eine Erklärung für dieses Phänomen, indem die räumliche Dosisverteilung von 131J bei sehr kleinen Tumormanifestationen im Modell mit der Monte-Carlo-Methode simuliert wurde. Dabei zeigte sich, daß für Tumorgrößen unterhalb 1 mm Radius nur noch ein kleiner Bruchteil der gesamten β-Energie innerhalb des Tumors deponiert wird und zur Tumorvernichtung beiträgt: Für Radien von 1,0, 0,5, 0,2, 0,1, 0,05 und 0,02 mm stehen bei homogener 131J-Speicherung intratumoral nur jeweils 86, 73, 39, 16, 8 bzw. 4% der Gesamtenergie zur Verfügung. Dies könnte einer wirksamen Tumorzellvernichtung in kleinen, bei Erstdiagnose klinisch nicht nachweisbaren Tumormanifestationen entgegenstehen und somit Ursache für späte zervikale Lymphknotenmetastasen sein.

Summary

In differentiated thyroid carcinoma, postoperative radioiodine therapy is an undisputed element of the integral therapeutic concept. Sometimes, however, and years after initial diagnosis and therapy, cervical lymph node metastases occur without any evidence of local relapse or distant metastases, indicating that radioiodine therapy has not achieved definite tumor cell sterilization. A Monte Carlo computer simulation of the spatial energy dose distribution of131I in small functioning tumor manifestations was performed to explain this phenomenon. It appeared that only a small fraction of the total β-energy dose can be deposited inside the tumor if the latter becomes smaller than 1 mm in diameter: for tumors with homogeneous 131I uptake and diameters of 1.0, 0.5, 0.2, 0.1, 0.05 and 0.02 mm, this value does not exceed 86, 73, 39, 16, 8 and 4%, respectively. These data suggest a potential therapeutic gap for small tumor manifestations not apparent at the time of initial diagnosis and could explain the occasional occurrence of late cervical lymph node metastases.

Schlüsselwörter

Schilddrüsenkarzinom - Monte-Carlo-Simulation - 131J-Beta-Dosimetrie

Key words

Thyroid cancer - Monte Carlo simulation - 131I beta dosimetry
 

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