The success of ¹³¹I ablation in thyroid cancer patients is significantly reduced after a diagnostic activity of 40 MBq ¹³¹I

 

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Summary

Objective: Dosimetry studies have shown that activities of ¹³¹I as small as 10-20 MBq may cause a stunning effect. A result of this stunning effect may be a lower success rate of the ablative ¹³¹I therapy for differentiated thyroid carcinoma (DTC). The aim of this study was to determine whether pre-therapeutic uptake measurement with 40 MBq ¹³¹I causes a lower success rate of ablation. Design: retrospective chart review study. Patients, methods: In two hospitals the ablation protocols differed in one respect only: in the one hospital no diagnostic ¹³¹I was applied before ablation (group 1, n = 48), whereas in the other hospital a 24-h uptake-measurement with 40 MBq ¹³¹I was performed (group 2, n = 51). Included were all DTC patients without distant metastases who had undergone ¹³¹I ablation between July 2002 and December 2005, and who had returned for ¹³¹I follow-up. Successful ablation was defined as absence of pathological ¹³¹I uptake on diagnostic whole-body scintigraphy and undetectable thyroglobulin-levels under TSH stimulation. Results: Overall, ablation was successful in 31/48 patients (65%) in group 1 and in 17/51 patients (33%) in group 2 (p=0.002). Multivariate analysis showed that pre-therapeutic uptake measurement using 40 MBq ¹³¹I was an independant determinant for success of ablation (p = 0.002). Conclusions: After applying a diagnostic activity of 40 MBq ¹³¹I before ablation, the success rate of ablation is severely reduced. Consequently, the routine application of ¹³¹I for diagnostic scintigraphy or uptake measurement prior to ¹³¹I ablation is best avoided.

Zusammenfassung

Ziel: Dosimetrische Studien haben gezeigt, dass selbst geringe Aktivitäten wie 10-20 MBq ¹³¹I dazu führen können, dass ein Stunning des Schilddrüsenrestgewebes auftritt. Als Folge könnte die Erfolgsquote der ¹³¹I-Ablation bei differenziertem Schilddrüsenkarzinom (DTC) deutlich erniedrigt sein. Das Ziel dieser Studie war es, festzustellen, ob prätherapeutische Uptake-Messung mit 40 MBq ¹³¹I eine geringere Erfolgsquote der Ablation verursacht. Design: Retrospektive Studie anhand von Krankenakten. Patienten, Methoden: In zwei Krankenhäusern unterschieden sich die Ablationsprotokolle nur in einer Hinsicht: In einem Krankenhaus wurde kein diagnostischer Scan mit ¹³¹I vor Ablation durchgeführt (Gruppe 1, n = 48), im anderen Krankenhaus wurde hingegen ein 24-h-Uptake-Messung mit 40 MBq ¹³¹I gemacht (Gruppe 2, n = 51). In unserer Studie wurden alle Patienten mit DTC ohne Fernmetastasen eingeschlossen, die zwischen Juli 2002 und Dezember 2005 mittels einer ¹³¹I-Ablation behandelt wurden und für ein ¹³¹I-Follow-up erneut aufgenommen wurden. Erfolgreiche Ablation wurde definiert als Abwesenheit von pathologischen ¹³¹I-Speicherungen auf einer diagnostischen Ganz - körperszintigraphie und einer nicht nachweisbaren Thyreoglobulinkonzentration unter TSH-Stimulation. Ergebnisse: Insgesamt war die Ablation erfolgreich in 31/48 Patienten (65%) in Gruppe 1 und in 17/51 Patienten (33%) in Gruppe 2 (p = 0,002). Multivariate Analysen zeigten, dass die prätherapeutische Uptake-Messung mit 40 MBq ¹³¹I ein un - abhängiger Faktor für den Erfolg der Ablation war (p = 0,002). Schlussfolgerungen: Durch der Gabe einer diagnostischen Aktivität von 40 MBq ¹³¹I vor Ablation wird die Erfolgsrate der Ablation stark reduziert. Folglich sollte die routinemäßige diagnostische ¹³¹I-Szinti - graphie oder ¹³¹I-Up take- Messung vor ¹³¹IAblation am besten vermieden werden.

^* Both authors contributed equally.

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