Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Oncology. 2022;100(2):74-81. doi: 10.1159/000520938. Epub 2021 Nov 17.
The role of radioiodine therapy (RIT) (used as ablation therapy or adjuvant therapy) following total thyroidectomy for differentiated thyroid cancer (DTC) changed. Major revisions of the American Thyroid Association (ATA) Guidelines in 2015 resulted in significant differences in treatment recommendations in comparison to the European Association of Nuclear Medicine (EANM) 2008 guidelines. Recently, we presented the effects on daily practice for RIT among Swiss Nuclear Medicine centres. We now performed a study at the European level and hypothesized that there is also considerable variability among European experts. We performed a decision-tree-based analysis of management strategies from all members of the EANM thyroid committee to map current practice among experts. We collected data on whether or not RIT is administered, on which criteria these decisions are based and collected details on treatment activities and patient preparation. Our study shows discrepancies for low-risk DTC, where "follow-up only" is recommended by some experts, while RIT with significant doses is used by other experts. E.g., for pT1b tumours without evidence of metastases, the level of agreement for the use of RIT is as low as 50%. If RIT is administered, activities of I-131 range from 1.1 GBq to 3.0 GBq. In other constellations (e.g., pT1a), experts diverge from current clinical guidelines as up to 75% administer RIT in certain cases. For intermediate and high-risk patients, RIT is generally recommended. However, dosing and treatment preparation (rhTSH vs. thyroid hormone withdrawal) vary distinctly. In comparison to the Swiss study, the general level of agreement is higher among the European experts. The recently proposed approach on the use of RIT, based on integrated post-surgery assessment (Martinique article) and results of ongoing prospective randomized studies are likely to reduce uncertainty in approaching RIT treatment. In certain constellations, consensus identified among European experts might be helpful in formulating future guidelines.
放射性碘治疗（RIT）（用于消融治疗或辅助治疗）在分化型甲状腺癌（DTC）全甲状腺切除术后的作用发生了变化。美国甲状腺协会（ATA）指南在 2015 年的重大修订导致与欧洲核医学协会（EANM）2008 指南相比，治疗建议有显著差异。最近，我们介绍了瑞士核医学中心 RIT 对日常实践的影响。现在，我们在欧洲进行了一项研究，并假设欧洲专家之间也存在相当大的差异。我们对 EANM 甲状腺委员会的所有成员进行了基于决策树的管理策略分析，以描绘专家当前的实践情况。我们收集了是否进行 RIT 的数据，这些决策的依据是什么，并收集了治疗活动和患者准备的详细信息。我们的研究显示，对于低风险 DTC 存在差异，一些专家建议仅进行“随访”，而其他专家则使用放射性碘治疗剂量较大。例如，对于没有转移证据的 pT1b 肿瘤，使用放射性碘治疗的一致性水平低至 50%。如果进行 RIT，则 I-131 的活性范围为 1.1GBq 至 3.0GBq。在其他情况下（例如，pT1a），专家与当前的临床指南存在分歧，因为在某些情况下高达 75%的专家会进行 RIT。对于中高危患者，一般推荐使用 RIT。然而，剂量和治疗准备（rhTSH 与甲状腺激素停药）明显不同。与瑞士研究相比，欧洲专家之间的总体一致性水平较高。基于手术后综合评估（马提尼克文章）和正在进行的前瞻性随机研究结果的放射性碘治疗新方法可能会降低治疗放射性碘治疗的不确定性。在某些情况下，欧洲专家之间达成的共识可能有助于制定未来的指南。
