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      Actualización del tratamiento del cáncer de tiroides con radioyodo Translated title: Update on radiactive iodine treatment of differentiated thyroid cancer

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          Abstract

          RESUMEN: El tratamiento del carcinoma diferenciado de tiroides (CDT) con radioyodo (RAI) se viene realizando durante más de 70 años. Sin embargo, no existe consenso en cuanto a indicaciones, dosis y otros aspectos relacionados con el cuidado de los pacientes. Es más, en los últimos años se ha cuestionado la necesidad de terapia adicional con RAI en los pacientes con carcinoma diferenciado de tiroides (CDT) tras la cirugía, como lo ha hecho la guía ATA 2015. Cuestionamiento que no ha sido suscrito por las sociedades europea y americana de Medicina Nuclear (EANM y SNMIM, respectivamente), lo que ha dado lugar a se produzcan encuentros (Encuentros de La Martinica) entre la EANM, la SNMIM y las Sociedades Americana (ATA) y Europea de Tiroides (ETA). Se han celebrado dos encuentros, en 2018 y 2019, en los que se establecieron unos principios (Principios de La Martinica). Estos principios y los resultados de las publicaciones más recientes, en cuanto a la potencialidad de la terapia con RAI en pacientes con CDT, van a ser objeto de desarrollo en este trabajo para llevar a cabo una actualización del tratamiento del CDT con RAI.

          Translated abstract

          SUMMARY: Radioiodine (RAI) therapy of differentiated thyroid carcinoma (DTC) has been used for more than seventy years. However, there is no consensus regarding indications, doses, procedures, and other aspects related to the clinical care of the patients considered for 131I therapy. Furthermore, in recent years the need for additional therapy with RAI in patients with DTC after surgery has been questioned, as has been done by the 2015 American Thyroid Association (ATA) guidelines. Guidelines that were not endorsed by the European and American Nuclear Medicine Societies (EANM and SNMIM, respectively), which led to meetings (Martinique Encounters) between EANM, SNMIM and the American (ATA) and European Thyroid (ETA) Societies. Two meetings have been held, in 2018 and 2019, in which some principles were established (Principles of Martinique). These principles and the results of the most recent publications, regarding the potential of RAI therapy in patients with DTC, will be the object of development in this work to carry out an update on the treatment of DTC with RAI.

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          Most cited references29

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          2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

          Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.
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            Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association

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              Strategies of radioiodine ablation in patients with low-risk thyroid cancer.

              It is not clear whether the administration of radioiodine provides any benefit to patients with low-risk thyroid cancer after a complete surgical resection. The administration of the smallest possible amount of radioiodine would improve care. In our randomized, phase 3 trial, we compared two thyrotropin-stimulation methods (thyroid hormone withdrawal and use of recombinant human thyrotropin) and two radioiodine ((131)I) doses (i.e., administered activities) (1.1 GBq and 3.7 GBq) in a 2-by-2 design. Inclusion criteria were an age of 18 years or older; total thyroidectomy for differentiated thyroid carcinoma; tumor-node-metastasis (TNM) stage, ascertained on pathological examination (p) of a surgical specimen, of pT1 (with tumor diameter ≤1 cm) and N1 or Nx, pT1 (with tumor diameter >1 to 2 cm) and any N stage, or pT2N0; absence of distant metastasis; and no iodine contamination. Thyroid ablation was assessed 8 months after radioiodine administration by neck ultrasonography and measurement of recombinant human thyrotropin-stimulated thyroglobulin. Comparisons were based on an equivalence framework. There were 752 patients enrolled between 2007 and 2010; 92% had papillary cancer. There were no unexpected serious adverse events. In the 684 patients with data that could be evaluated, ultrasonography of the neck was normal in 652 (95%), and the stimulated thyroglobulin level was 1.0 ng per milliliter or less in 621 of the 652 patients (95%) without detectable thyroglobulin antibodies. Thyroid ablation was complete in 631 of the 684 patients (92%). The ablation rate was equivalent between the (131)I doses and between the thyrotropin-stimulation methods. The use of recombinant human thyrotropin and low-dose (1.1 GBq) postoperative radioiodine ablation may be sufficient for the management of low-risk thyroid cancer. (Funded by the French National Cancer Institute [INCa] and the French Ministry of Health; ClinicalTrials.gov number, NCT00435851; INCa number, RECF0447.).
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                December 2021
                : 12
                : 4
                : 371-380
                Affiliations
                [2] Salamanca orgnameInstituto de Investigación Biomédica de Salamanca (IBSAL) España
                [1] orgnameHospital Universitario de Salamanca orgdiv1Servicio de Medicina Nuclear España
                Article
                S2444-79862021000400009 S2444-7986(21)01200400009
                10.14201/orl.25746
                56eff4d4-59f1-4a79-b3cc-cd0ad85bfcc1

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 06 February 2021
                : 06 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 10
                Product

                SciELO Spain

                Categories
                Artículo de revisión

                radioactive iodine treatment,tratamiento adyuvante,cáncer de tiroides refractario al radioiodo,131I,tratamiento con radioyodo,carcinoma diferenciado de tiroides,adjuvant therapy,radioiodine refractory thyroid cancer,I-131,differentiated thyroid cancer

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