Ehrhardt John Dennis, Güleç Seza
Miami Cancer Research Center, Miami, USA
Aventura Hospital and Medical Center, Miami, USA
Mol Imaging Radionucl Ther. 2020 Oct 19;29(3):88-97. doi: 10.4274/mirt.galenos.2020.83703.
Studies on the first years of radioactive iodine (RAI) use in thyroid diseases have focused on hyperthyroidism. Saul Hertz's success with RAI in thyrotoxicosis fueled a seamless transition to Samuel Seidlin's investigations with RAI in thyroid cancer. These landmark events embody nuclear ontology, a philosophical foundation for the creation and existence of radio-therapeutic principles that continue to influence clinical practices today. Laying this ontological foundation, Dr. Saul Hertz who is the founding director of Massachusetts General Hospital Thyroid Clinic, affiliated with Harvard University created a framework for RAI theranostics with preclinical experiments and clinical cases from 1937 to 1942. The first thyroid cancer treatment with RAI was applied in 1942 by Samuel Seidlin. The sensational effect of the first application was interestingly powerful enough to overshadow scientific data. Seidlin and colleagues assembled a sixteen-patient series showcasing a unique entity: functional thyroid metastases that respond to RAI. Other investigations at the time demonstrated that RAI had little efficacy as a therapeutic agent, mainly because most thyroid tumors do not form colloid, and therefore cannot concentrate RAI. These findings were soon overshadowed by a mainstream article in the October 1949 issue of Life that portrayed RAI as a lifesaving therapy for thyroid cancer. The paradigm was set, and later writings by William H. Beierwaltes and other prominent nuclear medicine physicians established the primary goals and principles of RAI therapy. The developments in theoretical physics and nuclear instrumentation and the scientists who made these developments in the early years contributed greatly to the development of the concept. In the field of nuclear medicine, William H. Beierwaltes has gone down in our history as a clinical researcher with his most important contributions. The classical paradigm that started with him has carried us to today's molecular theranoistic viewpoint. This paper examines controversial topics in the advent of thyroid theranostics, and applies historical significance to current discussions on the role of RAI in thyroid cancer management. Another paradigm shift is on the horizon as thyroidology enters the age of genomics. The molecular theranostic profiles will soon be incorporated into a dynamic clinical decision-making and management algorithm for thyroid surgery and RAI therapy. From now on, nuclear oncology will gain a new ontological identity with molecular pathology and new theranostic expansions.
关于放射性碘（RAI）用于甲状腺疾病最初几年的研究主要集中在甲状腺功能亢进症上。索尔·赫兹（Saul Hertz）使用RAI治疗甲状腺毒症的成功推动了向塞缪尔·塞德林（Samuel Seidlin）用RAI研究甲状腺癌的无缝过渡。这些具有里程碑意义的事件体现了核本体论，这是一种为放射治疗原则的创立和存在奠定的哲学基础，至今仍在影响临床实践。奠定这一本体论基础的是马萨诸塞州总医院甲状腺诊所的创始主任索尔·赫兹博士，该诊所隶属于哈佛大学，他在1937年至1942年期间通过临床前实验和临床病例为RAI诊疗学创建了一个框架。1942年，塞缪尔·塞德林首次将RAI应用于甲状腺癌治疗。首次应用所产生的轰动效应强大到足以掩盖科学数据。塞德林及其同事收集了一个16例患者的系列病例，展示了一个独特的实体：对RAI有反应的功能性甲状腺转移瘤。当时的其他研究表明，RAI作为一种治疗药物疗效甚微，主要是因为大多数甲状腺肿瘤不形成胶体，因此无法摄取RAI。1949年10月《生活》杂志上的一篇主流文章将RAI描绘成甲状腺癌的救命疗法，这些发现很快就被掩盖了。这种模式就此确立，后来威廉·H·拜尔瓦尔特斯（William H. Beierwaltes）和其他著名核医学医生的著作确立了RAI治疗法的主要目标和原则。理论物理学和核仪器的发展以及早年取得这些发展的科学家们为这一概念的发展做出了巨大贡献。在核医学领域，威廉·H·拜尔瓦尔特斯作为一名临床研究人员在我们的历史上留下了重要贡献。从他开始的经典模式引领我们走向了当今的分子诊疗学观点。本文探讨了甲状腺诊疗学出现过程中的争议性话题，并将历史意义应用于当前关于RAI在甲状腺癌治疗中作用的讨论。随着甲状腺学进入基因组学时代，另一场范式转变即将到来。分子诊疗学特征很快将被纳入甲状腺手术和RAI治疗的动态临床决策与管理算法中。从现在起，核肿瘤学将通过分子病理学和新的诊疗学扩展获得一种新的本体论身份。
