Odil Elizabeth E, Ward Katelyn R, Davis Ryan T, Reilly Jordan M, Sun Fionna, Elassar Heba, Lapkus Morta, Pastewski Jacquelyn, Studzinski Diane M, Callahan Rose E, Czako Peter F, Nagar Sapna
Department of Surgery, Corewell Health William Beaumont University Hospital, Royal Oak.
Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
Nucl Med Commun. 2025 Feb 1;46(2):113-119. doi: 10.1097/MNM.0000000000001936. Epub 2024 Nov 27.
The objective of this study is to investigate radioactive iodine therapy (RAIT) dose impact on survival and recurrence in patients with papillary thyroid cancer (PTC) with regional lymph node metastasis (N1).
A retrospective study of PTC patients with N1 disease from 2007 to 2011 at a tertiary academic hospital collected demographics, tumor characteristics, and RAIT treatment dose. RAIT dose was stratified by total dosage less than or greater than 150 mCi. Outcomes included recurrence, immediate RAIT side-effects, and mortality.
A total of 60 N1a and 21 N1b patients were studied with a median follow-up of about 9 years. No statistically significant differences were found between N1a PTC patients who received high-dose vs low-dose RAIT in recurrence rate (6.9% vs 6.7%, P > 0.999) or immediate RAIT side effects (6.9% vs 16.1%, P = 0.426). There were no mortalities in the N1a group. For patients with N1b PTC, there were no differences between high-dose and low-dose RAIT in recurrence rate (41.7% vs 44.4%, P > 0.999), mortality (0% vs 16.7%, P = 0.375), or immediate RAIT side effects (8.3% vs 11.1%, P > 0.999).
Dosages of RAIT ≥ 150 mCi do not appear to provide additional benefit in reducing recurrence compared to doses <150 mCi for N1a or N1b PTC patients. No differences in mortality or immediate RAIT side effects were observed between the two dosing regimens; however, interpretation is limited by low event rates. Large randomized trials are needed for further individualized recommendations regarding optimal RAIT dosage in N1 PTC.
本研究旨在调查放射性碘治疗（RAIT）剂量对伴有区域淋巴结转移（N1）的甲状腺乳头状癌（PTC）患者生存及复发的影响。
对2007年至2011年在一家三级学术医院就诊的N1期PTC患者进行回顾性研究，收集人口统计学资料、肿瘤特征及RAIT治疗剂量。RAIT剂量按总剂量小于或大于150毫居里分层。观察指标包括复发、RAIT即刻副作用及死亡率。
共研究了60例N1a患者和21例N1b患者，中位随访时间约9年。接受高剂量与低剂量RAIT的N1a期PTC患者在复发率（6.9%对6.7%，P>0.999）或RAIT即刻副作用（6.9%对16.1%，P=0.426）方面未发现统计学显著差异。N1a组无死亡病例。对于N1b期PTC患者，高剂量与低剂量RAIT在复发率（41.7%对44.4%，P>0.999）、死亡率（0%对16.7%，P=0.375）或RAIT即刻副作用（8.3%对11.1%，P>0.999）方面均无差异。
对于N1a或N1b期PTC患者，与小于150毫居里的剂量相比，RAIT剂量≥150毫居里在降低复发方面似乎未提供额外益处。两种给药方案在死亡率或RAIT即刻副作用方面未观察到差异；然而，由于事件发生率低，解释受到限制。需要进行大型随机试验，以便就N1期PTC患者的最佳RAIT剂量提供进一步的个体化建议。
