放射性碘消融的差异：全甲状腺切除术后的决策制定
Variations in radioiodine ablation: decision-making after total thyroidectomy.
作者信息
Maas O, Forrer F, Maas M, Panje C M, Blautzik J, Brühlmeier M, Engel-Bicik I, Giovanella L, Haldemann A, Kamel M E, Kneifel S, Rottenburger C, Schaefer N, Walter M A, Weidner S, Putora P M
机构信息
Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
Department of Radiation Oncology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
出版信息
Eur J Nucl Med Mol Imaging. 2020 Mar;47(3):554-560. doi: 10.1007/s00259-019-04557-4. Epub 2019 Nov 9.
BACKGROUND
The role of radioiodine treatment following total thyroidectomy for differentiated thyroid cancer is changing. The last major revision of the American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer in 2015 changed treatment recommendations dramatically in comparison with the European Association of Nuclear Medicine (EANM) 2008 guidelines. We hypothesised that there is marked variability between the different treatment regimens used today.
METHODS
We analysed decision-making in all Swiss hospitals offering radioiodine treatment to map current practice within the community and identify consensus and discrepancies. RESULTS AND CONCLUSION: We demonstrated that for low-risk DTC patients after thyroidectomy, some institutions offered only follow-up, while RIT with significant activities is recommended in others. For intermediate- and high-risk patients, radioiodine treatment is generally recommended. Dosing and treatment preparation (recombinant human thyroid stimulation hormone (rhTSH) vs. thyroid hormone withdrawal (THW)) vary significantly among centres.
背景
全甲状腺切除术后放射性碘治疗在分化型甲状腺癌治疗中的作用正在发生变化。2015年美国甲状腺协会（ATA）发布的《甲状腺结节和分化型甲状腺癌患者管理指南》的最新主要修订版与欧洲核医学协会（EANM）2008年指南相比，治疗建议发生了巨大变化。我们推测，如今使用的不同治疗方案之间存在显著差异。
方法
我们分析了所有提供放射性碘治疗的瑞士医院的决策情况，以梳理社区内的当前实践，并确定共识和差异。结果与结论：我们证明，对于甲状腺切除术后的低风险分化型甲状腺癌患者，一些机构仅提供随访，而其他机构则推荐进行具有显著活性的放射性碘治疗（RIT）。对于中高风险患者，一般推荐进行放射性碘治疗。各中心之间的给药和治疗准备（重组人促甲状腺激素（rhTSH）与甲状腺激素撤减（THW））差异显著。
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