分化型甲状腺癌和终末期肾病中的碘-131治疗

(131)I treatment in Differentiated Thyroid Cancer and End-Stage Renal Disease.

作者信息

Ortega A J M, Vázquez R G, Cuenca J I C, Brocca M A M, Castilla J, Martínez J M M, González E N

机构信息

Unidad de Gestión Clínica de Endocrinología y nutrición, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Avenida Manuel Siurot s/n, CP 41013 Sevilla, Spain.

Unidad de Medicina Nuclear y Radiofísica, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Avenida Manuel Siurot s/n, CP 41013 Sevilla, Spain.

出版信息

Rev Esp Med Nucl Imagen Mol. 2016 Jan-Feb;35(1):29-33. doi: 10.1016/j.remn.2015.05.008. Epub 2015 Jul 3.

DOI:10.1016/j.remn.2015.05.008

PMID:26144699

Abstract

PURPOSE

Radioiodine (RAI) is a cornerstone in the treatment of Differentiated Thyroid Cancer (DTC). In patients on haemodialysis due to End-Stage Renal Disease (ESRD), it must be used cautiously, considering the renal clearance of this radionuclide. Also, the safety of the procedure and subsequent long-term outcome is still not well defined. In 2001, we described a dosimetric method and short-term results in three patients, with a good safety profile. We hypothesize that our method is safe in a long-term scenario without compromising the prognosis of both renal and thyroid disease.

MATERIAL AND METHODS

Descriptive-retrospective study. A systematic search was carried out using our clinical database from 2000 to 2014.

INCLUSION CRITERIA

DTC and radioiodine treatment while on haemodialysis.

EXCLUSION CRITERIA

peritoneal dialysis.

RESULTS

Final sample n=9 patients (n=5 males), age 48 years (median age 51 years males, 67 years female group); n=8 papillary thyroid cancer, n=1 follicular thyroid cancer; n=5 lymph node invasion; n=1 metastatic disease. Median RAI dose administered on haemodialysis 100mCi. 7.5 years after radioiodine treatment on haemodialysis, n=7 deemed free of thyroid disease, n=1 persistent non-localised disease. No complications related to the procedure or other target organs were registered. After 3.25 years, n=4 patients underwent successful renal transplantation; n=4 patients did not meet transplantation criteria due to other conditions unrelated to the thyroid disease or its treatment. One patient died due to ischemic cardiomyopathy (free of thyroid disease).

CONCLUSIONS

Radioiodine treatment during haemodialysis is a long-term, safe procedure without worsening prognosis of either renal or thyroid disease.

摘要

目的

放射性碘（RAI）是分化型甲状腺癌（DTC）治疗的基石。对于因终末期肾病（ESRD）而接受血液透析的患者，鉴于该放射性核素的肾清除情况，必须谨慎使用。此外，该治疗过程的安全性及后续长期结果仍未明确界定。2001年，我们描述了一种剂量测定方法及3例患者的短期结果，安全性良好。我们推测，在不影响肾脏和甲状腺疾病预后的长期情况下，我们的方法是安全的。

材料与方法

描述性回顾性研究。使用我们2000年至2014年的临床数据库进行系统检索。

纳入标准

血液透析期间的DTC及放射性碘治疗。

排除标准

腹膜透析。

结果

最终样本n = 9例患者（n = 5例男性），年龄48岁（男性中位年龄51岁，女性组67岁）；n = 8例乳头状甲状腺癌，n = 1例滤泡状甲状腺癌；n = 5例有淋巴结侵犯；n = 1例有转移性疾病。血液透析时给予的放射性碘中位剂量为100mCi。血液透析放射性碘治疗7.5年后，n = 7例被认为无甲状腺疾病，n = 1例有持续性非局限性疾病。未记录到与治疗过程或其他靶器官相关的并发症。3.25年后，n = 4例患者成功进行了肾移植；n = 4例患者因与甲状腺疾病或其治疗无关的其他情况未达到移植标准。1例患者因缺血性心肌病死亡（无甲状腺疾病）。