Division of Nuclear Medicine, and Nuclear Medicine Residency Program, Washington Hospital Center , Washington, District of Columbia, USA.
Thyroid. 2009 Dec;19(12):1381-91. doi: 10.1089/thy.2009.1611.
I-131 has been used in the therapy of well-differentiated thyroid cancer for over 50 years. Although the benefits and risks of I-131 remain issues of controversy and research, our understanding of them continues to improve. This review presents an overview of the benefits of I-131 therapy for ablation, adjuvant treatment, and treatment of locoregional and/or metastasis of well-differentiated thyroid cancer and considers the risks of complications of I-131 therapy.
The benefits of I-131 remnant ablation include: [1] facilitating the interpretation of subsequent serum thyroglobulin levels, [2] increasing the sensitivity of detection of locoregional and/or metastatic disease on subsequent follow-up radioactive iodine whole-body scans, [3] maximizing the therapeutic effect of subsequent treatments, and [4] allowing a postablation scan to help identify additional sites of disease that were not identified on the preablation scan or when a preablation scan was not performed. The potential benefits of I-131 adjuvant treatment include decreasing recurrence and disease-specific mortality for unknown microscopic, locoregional, and/or distant metastatic disease. The potential benefits of I-131 treatment of known locoregional and/or distant metastases are [1] decreasing recurrence, and [2] decreasing disease-specific mortality and/or palliation. The more significant risks and side effects involve organ systems including eye/nasolacrimal, salivary, pulmonary, gastrointestinal, hematopoietic, and gonads as well as secondary primary malignancies.
Although there are never-ending controversies regarding I-131 therapy in well-differentiated thyroid cancer, the benefits and risks are becoming better understood. This in turn helps the treating physician and patient in making decisions regarding therapy.
碘-131 已在分化型甲状腺癌治疗中应用超过 50 年。尽管碘-131 的获益和风险仍然存在争议，相关研究也层出不穷，但我们对其的认识仍在不断深入。本文综述了碘-131 治疗分化型甲状腺癌的消融、辅助治疗、局部区域和/或远处转移的获益，以及考虑碘-131 治疗的并发症风险。
碘-131 残余消融的获益包括：[1]有助于后续甲状腺球蛋白水平的解读，[2]提高后续放射性碘全身扫描对局部区域和/或远处转移的检测灵敏度，[3]使后续治疗的疗效最大化，[4]在消融后扫描有助于识别消融前扫描或未进行消融前扫描时未发现的其他疾病部位。碘-131 辅助治疗的潜在获益包括降低未知的微小局部区域和/或远处转移疾病的复发和疾病特异性死亡率。碘-131 治疗已知局部区域和/或远处转移的潜在获益包括：[1]降低复发率，[2]降低疾病特异性死亡率和/或姑息治疗。更严重的风险和副作用涉及眼/鼻泪管、唾液腺、肺、胃肠道、造血和性腺等器官系统，以及继发性原发性恶性肿瘤。
尽管分化型甲状腺癌的碘-131 治疗存在无休止的争议，但获益和风险正逐渐被更好地理解。这反过来有助于治疗医生和患者在治疗决策方面做出决定。
