Evolución del tratamiento con radioyodo en el carcinoma diferenciado de tiroides <span class="so-article-trans-title" dir="auto"> Translated title: Evolution of radioiodine treatment in differentiated thyroid carcinoma </span>

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Abstract

RESUMEN: En marzo de 2021 se ha celebrado el 80 aniversario de la primera aplicación terapéutica del radioyodo (RAI) por Saúl Hertz a una paciente con hipertiroidismo el 31 de marzo de 1936. El éxito alcanzado impulsó su utilización en el tratamiento del carcinoma diferenciado de tiroides (CDT) y supuso un cambio de paradigma en el manejo de las enfermedades tiroideas. Desde entonces, han cambiado las estrategias de administración de RAI a pacientes con CDT y aún hoy día existen controversias. En esta revisión vamos a comentar las diferentes estrategias adoptadas en la administración de RAI a pacientes con CDT a lo largo de estas 8 décadas y cuáles son las controversias actuales en cuanto a qué pacientes con CDT hay que administrar RAI y qué actividad de RAI se debe administrar.

Translated abstract

SUMMARY: March 2021 has marked the eightieth anniversary of targeted radionuclide therapy, recognizing the first use of radioactive iodine (RAI) to treat thyroid disease by Dr. Saul Hertz on March 31, 1941. Success with hyperthyroidism fueled a seamless, almost intuitive transition to the use of RAI in thyroid carcinoma and marked the beginning of a new paradigm for thyroid cancer diagnosis and management. Since then, several therapeutic strategies have been adopted in the management of patients with differentiated thyroid cancer (DTC) and there are still controversies today regarding which patients with DTC should be administered RAI and what RAI activity should be administered, issues that will be commented in this review.

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Most cited references 40

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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.

Bryan Haugen, Erik Alexander, Keith Bible … (2016)

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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Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy.

E Baudin, J D Lumbroso, N Haddy … (2006)

The goal of this study was to estimate the cumulative activity of (131)I to be administered to patients with distant metastases from thyroid carcinoma. A total of 444 patients were treated from 1953-1994 for distant metastases from papillary and follicular thyroid carcinoma: 223 had lung metastases only, 115 had bone metastases only, 82 had both lung and bone metastases, and 24 had metastases at other sites. Treatment consisted of the administration of 3.7 GBq (100 mCi) (131)I after withdrawal of thyroid hormone treatment, every 3-9 months during the first 2 yr and then once a year until the disappearance of any metastatic uptake. Thyroxine treatment was given at suppressive doses between (131)I treatment courses. Negative imaging studies (negative total body (131)I scans and conventional radiographs) were attained in 43% of the 295 patients with (131)I uptake; more frequently in those who were younger, had well-differentiated tumors, and had a limited extent of disease. Most negative studies (96%) were obtained after the administration of 3.7-22 GBq (100-600 mCi). Almost half of negative studies were obtained more than 5 yr after the initiation of the treatment of metastases. Among patients who achieved a negative study, only 7% experienced a subsequent tumor recurrence. Overall survival at 10 yr after initiation of (131)I treatment was 92% in patients who achieved a negative study and 19% in those who did not. (131)I treatment is highly effective in younger patients with (131)I uptake and with small metastases. They should be treated until the disappearance of any uptake or until a cumulative activity of 22 GBq has been administered. In the other patients, other treatment modalities should be used when tumor progression has been documented.

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Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.

Ernest Mazzaferri, Sissy M. Jhiang (1994)

To determine the long-term impact of medical and surgical treatment of well differentiated papillary and follicular thyroid cancer. Patients with papillary and follicular cancer (n = 1,355) treated either in U.S. Air Force or Ohio State University hospitals over the past 40 years were prospectively followed by questionnaire or personal examination to determine treatment outcomes. Outcomes were analyzed by Kaplan-Meier survival curves and Cox proportional-hazard regression model. Median follow-up was 15.7 years; 42% (568) of the patients were followed for 20 years and 14% (185) for 30 years. After 30 years, the survival rate was 76%, the recurrence rate was 30%, and the cancer death rate was 8%. Recurrences were most frequent at the extremes of age ( 59 years). Cancer mortality rates were lowest in patients younger than 40 years and increased with each subsequent decade of life. Thirty-year cancer mortality rates were greatest in follicular cancer patients, who were more likely to have adverse prognostic factors: older age, larger tumors, more mediastinal node involvement, and distant metastases. When patients with distant metastases at diagnosis were excluded, follicular and papillary cancer mortality rates were similar (10% versus 6%, P not significant [NS]). In a Cox regression model that excluded patients who presented with distant metastases, the likelihood of cancer death was (1) increased by age > or = 40 years, tumor size > or = 1.5 cm, local tumor invasion, regional lymph-node metastases, and delay in therapy > or = 12 months; (2) reduced by female sex, surgery more extensive than lobectomy, and 131I plus thyroid hormone therapy; and (3) unaffected by tumor histologic type. Following 131I therapy given only to ablate normal thyroid gland remnants, the recurrence rate was less than one third the rate after thyroid hormone therapy alone (P or = 1.5 cm that are not initially metastatic to distant sites, near-total thyroidectomy followed by 131I plus thyroid hormone therapy confers a distinct outcome advantage. This therapy reduces tumor recurrence and mortality sufficiently to offset the augmented risks incurred by delayed therapy, age > or = 40 at the time of diagnosis, and tumors that are much larger than 1.5 cm, multicentric, locally invasive, or regionally metastatic.

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Journal ID (publisher-id): orl

Title: Revista ORL

Abbreviated Title: Rev. ORL

Publisher: Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )

ISSN (Electronic): 2444-7986

Publication date (Print and electronic): June 2022

Volume: 13

Issue: 2

Pages: 97-109

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[3] Salamanca orgnameHospital Universitario de Salamanca orgdiv1Servicio de Física Médica España

[2] Salamanca orgnameInstituto de Investigación Biomédica de Salamanca España

[1] Salamanca orgnameHospital Universitario de Salamanca orgdiv1Servicio de Medicina Nuclear España

Article

Publisher ID: S2444-79862022000300001 Publisher ID: S2444-7986(22)01300200001

DOI: 10.14201/orl.28343

SO-VID: b88fc058-cce2-40b2-9f3b-07fa13cf13a9

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

History

Date accepted : 25 February 2022

Date received : 03 February 2022

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Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 13

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Evolución del tratamiento con radioyodo en el carcinoma diferenciado de tiroides Translated title: Evolution of radioiodine treatment in differentiated thyroid carcinoma

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Most cited references 40

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.

Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy.

Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer.

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