Rosário Pedro Weslley, Calsolari Maria Regina
1 Postgraduate Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil .
Thyroid. 2014 May;24(5):826-31. doi: 10.1089/thy.2013.0479. Epub 2014 Jan 24.
Little is known about the medium- and long-term outcomes of thyroid ablation with 1.1 GBq (30 mCi) ¹³¹I in patients with papillary thyroid carcinoma who have a tumor >4 cm or accompanied by extrathyroid invasion or clinically detected lymph node metastases (cN1). The objective of this study was to evaluate the efficacy of ablation with 30 mCi ¹³¹I in this subgroup of patients and to report the medium-term outcomes.
We studied 152 patients with papillary thyroid carcinoma submitted to total thyroidectomy with apparently complete tumor resection, who had a tumor >4 cm or 2-4 cm accompanied by extrathyroid invasion or lymph node metastases, or ≤2 cm accompanied by both extrathyroid invasion and lymph node metastases. Patients with extensive extrathyroid invasion by the primary tumor were excluded. Lymph node involvement was detected by ultrasonography or palpation (cN1).
Forty-two patients were prepared by administration of recombinant human thyrotropin and 110 by levothyroxine withdrawal. Posttherapy whole-body scanning revealed unequivocal ectopic uptake in three patients. When evaluated 9-12 months after ablation, 123 patients had achieved complete ablation (stimulated thyroglobulin [Tg] <1 ng/mL, negative anti-Tg antibodies, and neck ultrasonography); a new posttherapy whole-body scanning revealed persistent disease in 2 patients whose initial posttherapy whole-body scanning (obtained at the time of ablation) had already shown ectopic uptake; 12 patients presented with a Tg >1 ng/mL and 14 had positive anti-Tg antibodies without apparent metastases; 1 patient had metastases not detected at the time of ablation. Recurrence was observed in an additional 6 patients during follow-up (median 76 months). There was no case of death related to the disease. Therefore, an activity of 30 mCi failed in only 9 (6%) patients with persistent disease or recurrence after ablation. None of the variables analyzed (sex, age, tumor size, multicentricity, extrathyroid invasion, lymph node metastases, preparation [recombinant human thyrotropin or levothyroxine withdrawal]) was a predictor of ablation failure.
An activity of 30 mCi ¹³¹I is effective in thyroid ablation in patients with stage T3 and/or N1 papillary thyroid carcinoma.
对于肿瘤直径>4cm或伴有甲状腺外侵犯或临床检测到淋巴结转移（cN1）的乳头状甲状腺癌患者，采用1.1GBq（30mCi）¹³¹I进行甲状腺消融的中长期结局知之甚少。本研究的目的是评估30mCi¹³¹I对该亚组患者的消融疗效，并报告中期结局。
我们研究了152例接受甲状腺全切除术且肿瘤切除明显完整的乳头状甲状腺癌患者，这些患者肿瘤直径>4cm，或2 - 4cm且伴有甲状腺外侵犯或淋巴结转移，或直径≤2cm且同时伴有甲状腺外侵犯和淋巴结转移。原发性肿瘤有广泛甲状腺外侵犯的患者被排除。通过超声或触诊检测淋巴结受累情况（cN1）。
42例患者通过注射重组人促甲状腺素进行准备，110例通过停用左甲状腺素进行准备。治疗后全身扫描显示3例患者有明确的异位摄取。在消融后9 - 12个月进行评估时，123例患者实现了完全消融（刺激状态下甲状腺球蛋白[Tg]<1ng/mL、抗Tg抗体阴性且颈部超声检查结果正常）；新的治疗后全身扫描显示2例患者存在持续性疾病，其最初的治疗后全身扫描（在消融时获得）已显示异位摄取；12例患者的Tg>1ng/mL，14例抗Tg抗体阳性但无明显转移；1例患者在消融时未检测到转移灶。随访期间另外6例患者出现复发（中位随访时间76个月）。没有与疾病相关的死亡病例。因此，30mCi的活度仅在9例（6%）消融后出现持续性疾病或复发的患者中治疗失败。分析的所有变量（性别、年龄、肿瘤大小、多中心性、甲状腺外侵犯、淋巴结转移、准备方式[重组人促甲状腺素或停用左甲状腺素]）均不是消融失败的预测因素。
30mCi¹³¹I的活度对T3期和/或N1期乳头状甲状腺癌患者的甲状腺消融有效。
