Department of Nuclear Medicine, University of Würzburg, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
Eur J Nucl Med Mol Imaging. 2010 May;37(5):896-903. doi: 10.1007/s00259-009-1303-x. Epub 2009 Dec 24.
In patients with advanced differentiated thyroid carcinoma (DTC), therapy with the highest safe (131)I activity is desirable to maximize the tumour radiation dose yet avoid severe myelotoxicity. Recently, the European Association of Nuclear Medicine (EANM) published a standard operational procedure (SOP) for pre-therapeutic dosimetry in DTC patients incorporating a safety threshold of a 2 Gy absorbed dose to the blood as a surrogate for the red marrow. We sought to evaluate the safety and effectiveness in everyday tertiary referral centre practice of treating advanced DTC with high (131)I activities chosen primarily based on the results of dosimetry following this SOP.
We retrospectively assessed toxicity as well as biochemical and scintigraphic response in our first ten patients receiving such therapy for advanced DTC.
The 10 patients received a total of 13 dosimetrically guided treatments with a median administered activity of 14.0 GBq (range: 7.0-21.4 GBq) (131)I. After 6 of 13 treatments in 6 of 10 patients, short-term side effects of (131)I therapy, namely nausea, vomiting or sialadenitis, were observed. Leukocyte and platelet counts dropped significantly in the weeks after (131)I treatment, but returned to pre-treatment levels by 3 months post-therapy. Serum thyroglobulin levels decreased after 12 of 13 treatments (median reduction: 58%) in 9 of 10 patients.
In our initial patient cohort, high-activity (131)I therapy for advanced DTC based on pre-therapeutic blood dosimetry following the EANM SOP was safe and well tolerated. Such treatment almost always produced a partial biochemical tumour response.
在晚期分化型甲状腺癌（DTC）患者中，采用最高安全（131）I 活度的治疗方法是理想的，以最大限度地提高肿瘤辐射剂量，同时避免严重的骨髓毒性。最近，欧洲核医学协会（EANM）发布了一份关于 DTC 患者治疗前剂量测定的标准操作程序（SOP），该 SOP 将 2 Gy 吸收剂量作为红骨髓替代物作为血液的安全阈值。我们试图评估在日常三级转诊中心实践中，根据该 SOP 后的剂量测定结果，主要选择高（131）I 活度治疗晚期 DTC 的安全性和有效性。
我们回顾性评估了 10 例接受这种治疗的晚期 DTC 患者的毒性以及生化和闪烁扫描反应。
10 例患者共接受了 13 次基于剂量测定的治疗，中位给予的（131）I 活度为 14.0GBq（范围：7.0-21.4GBq）。在 10 例患者中的 6 例中，有 6 次治疗中观察到（131）I 治疗的短期副作用，即恶心、呕吐或唾液腺炎。白细胞和血小板计数在（131）I 治疗后的数周内明显下降，但在治疗后 3 个月内恢复到治疗前水平。9 例患者中的 10 例患者中有 12 次治疗后血清甲状腺球蛋白水平下降（中位数降低：58%）。
在我们的初始患者队列中，基于 EANM SOP 进行治疗前血液剂量测定的晚期 DTC 高活性（131）I 治疗是安全且耐受良好的。这种治疗几乎总是产生部分生化肿瘤反应。
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