131-Joda terapijas efektivitātes novērtējums diferencēta vairogdziedzera vēža ārstēšanai
Date
2019
Authors
Šenterjakova, Nataļja
Journal Title
Journal ISSN
Volume Title
Publisher
Latvijas Universitāte
Abstract
Radioaktīvā joda terapija jeb 131-Joda (131-J) terapija pēc totālas vai gandrīz totālas tireoīdektomijas tiek indicēta pacientiem ar diferencētu vairogdziedzera vēzi vairogdziedzera atlieku audu ablācijai un reģionālu vai attālu metastāžu ārstēšanai.Darba mērķi bija izvērtēt 131-J terapijas efektivitāti atkarībā no dažādiem faktoriem un izmeklēšanas metodēm.Retrospektīvs pētījums iekļāva 309 pacientus, kuri saņēma 131-J terapiju no 2016. līdz 2017. gadam, no kuriem 214 pacienti atbilda iekļaušanas kritērijiem. Arī no 309 pacientiem tika atlasīti 34 pacienti, kuriem tika veikta kakla ultrasonogrāfija (USG), vairogdziedzera scintigrāfija, pēc terapijas visa ķermeņa scintigrāfija un vienfotona emisijas datortomogrāfija ar datortomogrāfiju (SPECT/CT). Mūsu rezultāti parādīja, ka 131-J terapijas pirmais kurss nebija efektīvs 29 pacientiem (13.6%), no kuriem 22 pacienti (75.9%) saņēma atkārtotu 131-J terapiju. 131-J terapijas efektivitāte bija atkarīga no dzimuma (p<0.001), tomēr netika saistīta ar pacientu vecumu (p=0.484). Statistiski ticama saistība tika atrasta starp 131-J terapijas efektivitāti un diferencēta vairogdziedzera vēža histoloģiskajiem tipiem (p=0.021), stadijām (p<0.001), recidīva riskiem (p=0.029), 131-J aktivitāti (p<0.001), pirms terapijas tireoglobulīna (Tg) līmeni (p<0.001). Statistiski ticama atšķirība 131-J terapijas iznākumā netika konstatēta starp endogēnu vai eksogēnu tireoīdstimulējošā hormona (TSH) stimulāciju (p=0.158). Pirms ablācijas TSH līmenis neietekmēja vairogdziedzera atlieku audu 131-J ablācijas iznākumu, salīdzinot pacientus, kuriem ablācija bija efektīva un kuriem nebija efektīva (p=0.197). Pēc terapijas visa ķermeņa scintigrāfijas jutība, specifitāte, pozitīva prognostiskā vērība (PPV), negatīva prognostiskā vērība (NPV), precizitāte vairogdziedzera atlieku audu izmeklēšanā bija attiecīgi 88%, 98%, 97%, 93%, 94%, salīdzinot ar kakla USG un vairogdziedzera scintigrāfiju (attiecīgi 50% un 55%, 97% un 96%, 93% un 90%, 72% un 76%, 76% un 79%). Mūsu darbs parādīja 131-J terapijas efektivitāte ir atkarīga no dažādiem faktoriem, bet netiek saistīta ar vecuma un TSH stimulācijas veidiem. Pirms ablācijas TSH līmenis neietekmē 131-J ablācijas iznākumu. Pēc terapijas visa ķermeņa diagnostiskā precizitāte vairogdziedzera atlieku audu izmeklēšanā ir pielīdzināma ar SPECT/CT.
Radioactive iodine therapy or 131-Iodine (131-I) therapy after total or near total thyroidectomy is indicated for the patients with differentiated thyroid cancer for ablation of remnants of thyroid tissue and for treatment of regional and distal metastases. The aim of the work was to evaluate the efficacy of 131-I therapy depending on different factors and imaging methods.The retrospective study included 309 patients who had received 131-I therapy from 2016 to 2017 of which 214 patients met inclusion criteria. Also, 34 patients were selected of 309 patients in whom neck ultrasound (US), thyroid scintigraphy, post therapy whole body scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) were performed.Our results showed that the first course of 131-I therapy was not effective in 29 patients (13.6%) of which 22 patients (75.9%) received repeated 131-I therapy. Efficacy of 131-I therapy was dependent on gender (p<0.001), however it was not associated with patients age (p=0.484). Statistically significant difference was found between efficacy of 131-I therapy and histological types of differentiated thyroid cancer (p=0.021), stages (p<0.001), risks of recurrence (p=0.029), 131-I activity (p<0.001) and pre-therapy thyroglobulin (Tg) level (p<0.001). Statistically significant difference in the outcome of 131-I therapy was not detected between endogenous and exogenous thyroid stimulating hormone (TSH) stimulation (p=0.158). Preablation TSH level did not influence the outcome of 131-I ablation comparing the patients in whom ablation was effective and in whom it was not effective (p=0.197). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of post therapy whole body scintigraphy in evaluation of remnants of thyroid tissue was 88%, 98%, 97%, 93%, 94%, respectively, comparing with neck US and thyroid scintigraphy (50% un 55%, 97% un 96%, 93% un 90%, 72% un 76%, 76% un 79%, respectively).Our work has showed that efficacy of 131-I therapy depends on different factors but it is not associated with patients age and types of TSH stimulation. Preablation TSH level does not influence the outcome of 131-I ablation. The diagnostic accuracy of post therapy has a high similarity to SPECT/CT for evaluation of remnants of thyroid tissue.
Radioactive iodine therapy or 131-Iodine (131-I) therapy after total or near total thyroidectomy is indicated for the patients with differentiated thyroid cancer for ablation of remnants of thyroid tissue and for treatment of regional and distal metastases. The aim of the work was to evaluate the efficacy of 131-I therapy depending on different factors and imaging methods.The retrospective study included 309 patients who had received 131-I therapy from 2016 to 2017 of which 214 patients met inclusion criteria. Also, 34 patients were selected of 309 patients in whom neck ultrasound (US), thyroid scintigraphy, post therapy whole body scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT) were performed.Our results showed that the first course of 131-I therapy was not effective in 29 patients (13.6%) of which 22 patients (75.9%) received repeated 131-I therapy. Efficacy of 131-I therapy was dependent on gender (p<0.001), however it was not associated with patients age (p=0.484). Statistically significant difference was found between efficacy of 131-I therapy and histological types of differentiated thyroid cancer (p=0.021), stages (p<0.001), risks of recurrence (p=0.029), 131-I activity (p<0.001) and pre-therapy thyroglobulin (Tg) level (p<0.001). Statistically significant difference in the outcome of 131-I therapy was not detected between endogenous and exogenous thyroid stimulating hormone (TSH) stimulation (p=0.158). Preablation TSH level did not influence the outcome of 131-I ablation comparing the patients in whom ablation was effective and in whom it was not effective (p=0.197). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy of post therapy whole body scintigraphy in evaluation of remnants of thyroid tissue was 88%, 98%, 97%, 93%, 94%, respectively, comparing with neck US and thyroid scintigraphy (50% un 55%, 97% un 96%, 93% un 90%, 72% un 76%, 76% un 79%, respectively).Our work has showed that efficacy of 131-I therapy depends on different factors but it is not associated with patients age and types of TSH stimulation. Preablation TSH level does not influence the outcome of 131-I ablation. The diagnostic accuracy of post therapy has a high similarity to SPECT/CT for evaluation of remnants of thyroid tissue.
Description
Keywords
Medicīna , Medicīna , 131-J terapija , TSH stimulācija , Pēc terapijas visa ķermeņa scintigrāfija