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[分化型甲状腺癌放射性碘治疗程序指南(第3版)]

[Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 3)].

作者信息

Dietlein M, Dressler J, Eschner W, Grünwald F, Lassmann M, Leisner B, Luster M, Moser E, Reiners Chr, Schicha H, Schober O

机构信息

Kliniken und Polikliniken für Nuklearmedizin der Universität zu Köln, 50924 Köln.

出版信息

Nuklearmedizin. 2007;46(5):213-9.

Abstract

The procedure guideline for radioiodine therapy (RIT) of differentiated thyroid cancer (version 3) is the counterpart to the procedure guideline for (131)I whole-body scintigraphy (version 3) and specify the interdisciplinary guideline for thyroid cancer of the Deutsche Krebsgesellschaft concerning the nuclear medicine part. Recommendation for ablative (131)I therapy is given for all differentiated thyroid carcinoma (DTC) >1 cm. Regarding DTC < or =1 cm (131)I ablation may be helpful in an individual constellation. Preparation for (131)I ablation requires low iodine diet for two weeks and TSH-stimulation by withdrawal of thyroid hormone medication or by use of recombinant human TSH (rhTSH). The advantages of rhTSH (no symptoms of hypothyroidism, lower blood activity) and the advantages of endogenous TSH-stimulation (necessary for (131)I-therapy in patients with metastases, higher sensitivity of (131)I whole-body scan) are discussed. In most centers standard activities are used for (131)I ablation. If pretherapeutic dosimetry is planned, the diagnostic administration of (131)I should not exceed 1-10 MBq, alternative tracers are (123)I or (124)I. The recommendations for contraception and family planning are harmonized with the recommendation of ATA and ETA. Regarding the best possible protection of salivary glands the evidence is insufficient to recommend a specific setting. To minimize the risk of dental caries due to xerostomia patients should use preventive strategies for dental hygiene.

摘要

分化型甲状腺癌放射性碘治疗(RIT)程序指南(第3版)与(131)I全身闪烁扫描程序指南(第3版)相对应,并规定了德国癌症协会关于甲状腺癌核医学部分的跨学科指南。对于所有直径>1 cm的分化型甲状腺癌(DTC),均推荐进行消融性(131)I治疗。对于直径≤1 cm的DTC,在个别情况下(131)I消融可能会有帮助。(131)I消融的准备工作需要两周的低碘饮食,并通过停用甲状腺激素药物或使用重组人促甲状腺激素(rhTSH)来刺激促甲状腺激素(TSH)。讨论了rhTSH的优点(无甲状腺功能减退症状,血液活性较低)和内源性TSH刺激的优点(对于有转移的患者进行(131)I治疗是必要的,(131)I全身扫描的敏感性较高)。在大多数中心,标准活度用于(131)I消融。如果计划进行治疗前剂量测定,(131)I的诊断性给药不应超过1 - 10 MBq,替代示踪剂为(123)I或(124)I。避孕和计划生育的建议与美国甲状腺协会(ATA)和欧洲甲状腺协会(ETA)的建议一致。关于唾液腺的最佳保护,现有证据不足以推荐特定的方案。为了将口干导致龋齿的风险降至最低,患者应采取预防口腔卫生的策略。

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