Učinak različitih terapijskih aktivnosti radioaktivnog joda (131I) na ablaciju ostatnog tkiva štitnjače u bolesnika s diferenciranim karcinomom štitnjače [The effect of applying the different therapeutic activities of radioiodine (131I) on thyroid remnant ablation in patients with differentiated thyroid carcinoma]

Prpić, Marin (2012) Učinak različitih terapijskih aktivnosti radioaktivnog joda (131I) na ablaciju ostatnog tkiva štitnjače u bolesnika s diferenciranim karcinomom štitnjače [The effect of applying the different therapeutic activities of radioiodine (131I) on thyroid remnant ablation in patients with differentiated thyroid carcinoma]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Differentiated thyroid carcinoma accounts for about 85-95% of all cancers of the thyroid gland and the postoperative thyroid remnant ablation, which is performed by a wide variety of therapeutic activities 131I, is indicated in numerous patients. During the time period from 2004 to 2009, the research on a consecutive series of 259 patients with differentiated thyroid cancer was conducted. These patients underwent thyroid remnant ablation by different ablation activities of 131I, after total thyroidectomy had been preformed. In these cases the disease was confined to the thyroid bed, and no regional or distant metastases were confirmed by diagnostic tests during the course of the disease. The Kolmogorov - Smirnov test was used to show the distribution of values of certain variables, and in order of determining the differences in values of variables between the certain groups, the T-test and χ2 test were used. The ablation of residual thyroid tissue, in accordance with the applied activities, was evaluated as satisfactory. After the first application of 131I, the thyroid remnant ablation was significantly more effective in patients where high activities were applied 131I [3700 MBq (100 mCi)] than in cases where lower activities were applied [1110 – 1850 MBq (30 – 50 mCi) and 2775 MBq (75 mCi)]. There were no significant differences between the first application of 131I of low [1110 – 1850 MBq (30 – 50 mCi)] and intermediate [2775 MBq (75 mCi)] activities in terms of the success of thyroid remnant ablation. In comparison with the patients with multifocal tumors, the significantly more successful thyroid remnant ablation occurred in patients who had a tumor foci (unifocal tumors); the difference was clearly seen after the first application of 131I in the groups of [1110 – 1850 MBq (30 - 50mCi)] mCi and [2775 MBq (75 mCi)]. After the first application of 131I in the group of [2775 MBq (75 mCi)], and compared with the patients with multicentric tumors, the thyroid remnant ablation was more successful in patients with a tumor limited to a single thyroid lobe. Furthermore, it was concluded that, in most of the cases, it is reasonable that the low-activity 131I is applied, especially in patients with unifocal tumors. On the contrary, in patients with multifocal disease the application of high-activity 131I is justified. The application of intermediate activities and application of low activities were equally effective regarding the success of the thyroid remnant ablation.

Abstract in Croatian

Diferencirani karcinomi štitnjače čine oko 85-95 % svih karcinoma štitnjače, a u velikog broja bolesnika se postavlja indikacija za postoperacijsko provođenje ablacije različitim terapijskim aktivnostima 131I. Istraživanjem je obuhvaćena konsekutivna serija od 259 bolesnika s diferenciranim karcinomom štitnjače u kojih je učinjena totalna tireoidektomija te provedena ablacija s različitim aktivnostima 131I u šestogodišnjem razdoblju između 2004. i 2009. godine. U ispitivanih bolesnika bolest je bila ograničena na ležište štitnjače, a učinjenim dijagnostičkim pretragama nisu utvrđene regionalne odnosno udaljene metastaze u vrijeme prezentacije bolesti. Distribucija vrijednosti pojedinih varijabli utvrđena je Kolmogorovljev - Smirnov testom te su za utvrđivanje razlika u vrijednostima varijabli između pojedinih ispitivanih skupina korišteni nezavisni t-test te χ2 test. Uspješnost ablacije ostatnog tkiva štitnjače je s svim primijenjenim aktivnostima zadovoljavajuća. Ablacija s visokim aktivnostima 131I [3700 MBq (100 mCi)] je značajno uspješnija nakon prve aplikacije 131I od primjene nižih aktivnosti [1110 – 1850 MBq (30 - 50mCi) i 2775 MBq (75 mCi)]. Nema značajne razlike u uspješnosti ablacije nakon prve aplikacije 131I između niskih [1110 – 1850 MBq (30 - 50mCi)] te intermedijarnih aktivnosti [2775 MBq (75 mCi)]. Ispitanici koji su imali jedno tumorsko žarište (unifokalni tumori) su imali značajno uspješniju ablaciju nakon prve aplikacije 131I u skupini od [1110 – 1850 MBq (30 - 50mCi)] te u skupini od [2775 MBq (75 mCi)] u odnosu na ispitanike s multifokalnim tumorima. Ispitanici s tumorskim žarištem ograničenim na jedan režanj štitnjače su imali značajno uspješniju ablaciju nakon prve aplikacije 131I u skupini od [2775 MBq (75 mCi)] u odnosu na ispitanike s multicentričnim tumorima. U većine bolesnika opravdana je primjena niskih aktivnosti 131I, osobito u bolesnika s jednim žarištem tumora, a u bolesnika s multifokalnom bolesti opravdana je primjena visokih aktivnosti 131I. Primjena intermedijarnih aktivnosti nema opravdanje, jer nema značajne razlike u uspješnosti ablacije u odnosu na primjenu niskih aktivnosti.

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