Radioiodtherapie beim differenzierten Schilddrüsenkarzinom

Zusammenfassung

Die Radioiodtherapie des differenzierten Schilddrüsenkarzinoms hat eine 70-jährige Tradition. Sie wird sehr gut toleriert, ist nebenwirkungsarm und trägt einen substanziellen Anteil zur guten Prognose der Erkrankung bei. An den Grundprinzipien der Therapie hat sich nichts geändert. Voraussetzung für den Erfolg ist die gute Aufnahme des Iods in die Schilddrüsenkarzinomzelle und die möglichst lange Retention. In den letzten Jahren sind verschiedene Innovationen zu verzeichnen. Die für die Iodaufnahme für erforderlich gehaltene TSH-Stimulation ist seit einigen Jahren auch mittels rhTSH-Injektionen möglich, wodurch die durch den Schilddrüsenhormonentzug bedingten hypothyreoten Beschwerden vermieden werden können. Eine zuverlässige und vorhersagbar positive (im Sinne einer höheren Läsionsstrahlendosis) Beeinflussung der Iodkinetik ist derzeit jedoch weiterhin nicht bekannt. Die Gabe von Li⁺ könnte ebenso hilfreich sein wie andere Modalitäten zur Beeinflussung der Iodkinetik, die von der Behandlung gutartiger Schilddrüsenerkrankungen her bekannt sind. Die Identifizierung von Patienten, bei denen eine kurative Radioiodtherapie nicht zu erwarten ist, wird durch die Dosimetrie mit ¹²⁴I – PET/CT möglich und darüber hinaus mittels der prätherapeutischen Dosimetrie auch die individuelle Festsetzung der ¹³¹I-Therapieaktivität. Durch die Einführung der SPECT/CT steht eine Gammakamera-basierte Schnittbilddiagnostik mit anatomischer Korrelation auch mit dem Therapienuklid ¹³¹I zur Verfügung, wodurch die Aussagekraft der Post-Therapie-Szintigrafie gesteigert wird.

Abstract

There is 70 years history of radioiodine therapy of differentiated thyroid carcinoma (DTC). The therapy is well tolerated and side effects are rare. It significantly contributes to the good prognosis of DTC. Within the last 70 years the fundamental aspects of the therapy remained unchanged. Prequisite for the successful therapy are high iodine uptake into the thyroid cancer cell and a long retention. Only during the last few years, some innovations became available. The high TSH level, which is believed to be necessary for high iodine uptake, may now be reached by rhTSH-injections, avoiding the inconvenience of short term hypothyroidism. A reliable procedure that influences iodine kinetics positively (in term of increasing lesion dose) and predictably, however, is still not available. The application of Li⁺ might be helpful as well as any other modality to influence iodine kinetics in benign thyroid disease as known from the treatment of benign thyroid disease. ¹²⁴I-PET/CT allows not only to identify the patients which might potentially be cured by radioiodine therapy but-by pretherapeutic dosimetry-also allows to determine the necessary ¹³¹I activity. The introduction of SPECT/CT offers gamma camera based cross sectional imaging for ¹³¹I including anatomical correlation. In consequence the diagnostic precision of posttherapeutic imaging is increased.

Schlüsselwörter

differenziertes Schilddrüsenkarzinom - Radioiodtherapie - Dosimetrie - Diagnostik

Key words

differentiated thyroid cancer - radioiodine therapy - dosimetry - diagnostics

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