Sunny S S, Hephzibah J, Shanthly N, Oommen R, Cherian A J, Mathew D
Department of Nuclear Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
World J Nucl Med. 2022 Apr 30;21(1):52-58. doi: 10.1055/s-0042-1746175. eCollection 2022 Mar.
Pulmonary metastases in papillary thyroid carcinoma have two common presentations-micro/miliary (MM) and macronodular metastases (MN). The mainstay of treatment, posttotal thyroidectomy, is multiple radioactive iodine ablations (RAIA) every 6 to 12 months. Response assessment is determined by decline in stimulated serum thyroglobulin levels (sTg), disease regression on chest x-ray (CXR), computed tomography thorax, or whole body iodine scintigraphy (TWBS). This study aims to assess the difference in response to RAIA based on the pattern of presentation. Retrospective analysis of patients from January 2008 to July 2017 was done. Patients with pulmonary metastases treated with RAIA (3700MBq per therapy as opposed to theAmerican Thyroid Association recommendation of 7400MBq per therapy) and a minimum follow-up of 8 months were included. The initial and the final sTg, TWBS, and CXR were analyzed for both groups. Final outcome in terms of complete response, disease regression, static disease, and disease progression was determined. Of the total of 1,793 patients, 71 were included. There were 43 females and 28 males. The median age was 39 years and the range was 14 to 79 years. Forty-five (63.3%) patients had MM and 26 (36.6%) patients had MN disease. The average number of therapies was three and maximum follow-up period was 15 years. Of the 45 MM patients, 1 had progression, 7 were static, 23 had regression, and 14 had complete response. Of the 26 MN patients, 22 had progression, 2 were static, 1 had regression, and 1 had complete response. MM metastases, when compared with MN disease, respond to RAIA with a better outcome. In addition to achieving comparable response with a lower dose per therapy, there were no radiation-related long-term complications reported.
甲状腺乳头状癌的肺转移有两种常见表现形式——微/粟粒性（MM）转移和大结节性转移（MN）。全甲状腺切除术后的主要治疗方法是每6至12个月进行多次放射性碘消融（RAIA）。反应评估通过刺激血清甲状腺球蛋白水平（sTg）的下降、胸部X线（CXR）、胸部计算机断层扫描或全身碘闪烁扫描（TWBS）上的疾病消退来确定。 本研究旨在评估基于表现形式的RAIA反应差异。 对2008年1月至2017年7月的患者进行了回顾性分析。纳入接受RAIA治疗（每次治疗3700MBq，与美国甲状腺协会推荐的每次治疗7400MBq相反）且至少随访8个月的肺转移患者。对两组患者的初始和最终sTg、TWBS和CXR进行分析。确定完全缓解、疾病消退、疾病稳定和疾病进展方面的最终结果。 在总共1793例患者中，71例被纳入。有43名女性和28名男性。中位年龄为39岁，范围为14至79岁。45例（63.3%）患者为MM转移，26例（36.6%）患者为MN转移。平均治疗次数为3次，最长随访期为15年。在45例MM患者中，1例病情进展，7例病情稳定，23例病情消退，14例完全缓解。在26例MN患者中，22例病情进展，2例病情稳定，1例病情消退，1例完全缓解。 与MN转移相比，MM转移对RAIA的反应更好。除了每次治疗以较低剂量获得可比反应外，未报告与辐射相关的长期并发症。
