Differansiye Tiroid Karsinomlu Hastalarda Tekrarlayıcı Radyoiyot Tedavisi

Öz

Anahtar Kelimeler

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Differansiye Tiroid Karsinomlu Hastalarda Tekrarlayıcı Radyoiyot Tedavisi

Öz

Amaç: Diferansiye tiroid karsinomlu (DTK) hastalarda tekrarlanan değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ameliyat sonrası radyoaktif iyot tedavisi almak üzere refere edilen 945 DTK’lı hasta retrospektif olarak incelendi. Birden fazla 131I ile tedavi alan 77 hasta bu çalışma için seçildi. Bu çalışmada yeniden tedavi alanların endikasyonları ile demografik ve patolojik özellikleri değerlendirildi. Bulgular: Kiniğimizde 945 hastadan 77’si(% 8.1) yeniden tedavi edilmişti. Histolojik incelemeleri sonucunda 69 hastanın papiller tiroid karsinomlu, 8 hastanın ise foliküler tiroid karsinomlu olduğu ortaya kondu. 16 hasta (% 20.8) tamamlayıcı ablasyon için yeniden tedavi edildi. 28 hasta (%36.4) ilk radyoaktif iyot tedavisinden 6 ay sonra stimüle edilmiş Tg düzeylerinin yüksek olması nedeniyle ampirik olarak yeniden tedavi edildi. 29 hasta (% 37.6) uzak metastazları nedeniyle yeniden tedavi edildi. 4 hasta (% 5.2) takipte rekürrens tesbit edimesi üzerine yeniden tedavi edildi. Sonuç: Radyoaktif iyot tedavisi diferansiye tiroid karsinomunda cerrahi sonrası tedavide ana yöntemdir ve başarı oranı yüksektir. Bununla beraber bazı hastalarda, özellikle de metastatik hastalarda, tekrarlayıcı tedavilere ihtiyaç duyulmaktadır. Ayrıca radyoaktif iyot tedavisi diferansiye tiroid karsinomu tedavisinde temel pozisyonunu korumaktadır

Anahtar Kelimeler

• Tiroid karsinomu, Iyot-131 tedavisi, Yeniden tedavi

Kaynakça

1. Bal CS, Kumar A, Pant GS. Radioiodine dose for remnant ablation in differentiated thyroid carcinoma: a randomized clinical trial in 509 patients. J Clin Endocrinol Metab. 2004;89(4):1666-73
2. Mazzaferri EL, Robyn J. Postsurgical management of differentiated thyroid carcinoma. Otolaryngol Clin North Am. 1996;29(4):637–62.
3. Robbins RJ, Schlumberger MJ. The evolving role of (131)I for the treatment of differentiated thyroid carcinoma. J Nucl Med. 2005;46(1):28-37.
4. MazzafeRri EL. Treating differentiated thyroid carcinoma: where do we draw the line? Mayo Clin Proc 1991;66(1):105- 11.
5. Arslan N, Ilgan S, Serdengecti M, et al. Post-surgical ablation of thyroid remnants with high-dose (131)I in patients with differentiated thyroid carcinoma. Nucl Med Commun 2001;22(9):1021-27.
6. Logue JP, Tsang RW, Brierley JD, et al Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Br J Radiol 1994 ;67(803):1127-31.
7. Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine theraph. adenocarcinoma of thyroid. J Am Med Assoc 1946;132(14):838-47. functioning metastases of
8. Shen DHY, Kloos RT, Mazzaferri EL, et al. Sodium iodide symporter in health and disease. Thyroid 2001;11(5):415–25.

9. Simpson WJ, Panzarella T, Carruthers JS, et al. Papillary and follicular thyroid cancer: impact of treatment in 1578 patients. Int J Radiat Oncol Biol Phys 1998;14(6):1063–75.
10. Chow SM, Law SC, Mendenhall WM, et al. Papillary thyroid carcinoma: prognostic factors and the role of radioiodine and external radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52(3):784-95.
11. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998 Jan 29;338(5):297-306.
12. Sugg SL, Ezzat S, Rosen IB, et al. Distinct multiple RET/PTC gene rearrangements in multifocal papillary thyroid 1998;83(11):4116–22. Clin Endocrinol Metab
13. Samuel AM, Rajshekarrao B. Radioiodine therapy for well- differentiated thyroid cancer: a quantitative dosimetric evaluation for remnant thyroid ablation after surgery. J Nucl Med 1994;35(12):1944–50.
14. Lin JD, Kao PF, Chao TC. The effect of radioactive iodine in thyroid remnant ablation and treatment of well differentiated 1998;71(843):307–13. carcinoma. Br J Radiol
15. Verburg FA, de Keizer B, Lips CJM, et al. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol. 2005;152(1):33-7.
16. Grunwald F, Menzel C, Fimmers R, et al. Prognostic value of thyroglobulin after thyroidectomy before ablative radioiodine therapy in thyroid cancer. J Nucl Med 1996;37(12):1962–64.
17. Ronga G, Filesi M, Ventroni G, et al. Value of the first serum thyroglobulin level after total thyroidectomy for the diagnosis of metastases from differentiated thyroid carcinoma. Eur J Nucl Med 1999;26(11):1448–52.
18. Kalender E, Celen YZ, Elboga U, et al. The relationship between thyroglobulin (Tg) levels and distant metastases before radioiodine (RAI) treatment in differentiated thyroid carcinomas. Gaziantep Med J 2012;18(1):11-3.
19. Pacini F, Ladenson PW, Schlumberger M, et al. Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study. J Clin Endocrinol Metab. 2006;91(3):926– 32.
20. Schlumberger M, Baudin E. Serum thyroglobulin determination in the follow-up of patients with differentiated thyroid carcinoma. Eur J Endocrinol. 1998;138(3):249–52.
21. Pacini F. Follow-up of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2002;29(2):492–6.
22. Ozata M, Suzuki S, Miyamoto T, et al. Serum thyroglobulin in the follow-up of patients with treated differentiated thyroid cancer. J Clin Endocrinol Metab.1994;79(1):98 –105.
23. Beierwaltes WH, Nishiyama RH, Thompson NW, et al. Survival time and “cure” in papillary and follicular thyroid carcinoma with distant metastases: statistics following University of Michigan therapy. J Nucl Med. 1982;23 (7):561–68.
24. Pacini F, Cetani F, Miccoli P, et al. Outcome of 309 patients with metastatic differentiated thyroid carcinoma treated with radioiodine. World J Surg. 1994;18(4):600–4.
25. Durante C, Haddy N, Baudin E, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine 2006;91(8):2892–9. Clin Endocrinol Metab.
26. Mazzaferri EL, Jhiang SM. Long-term impact of initial
27. surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.