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首页> 外文期刊>Biomedicine & pharmacotherapy =: Biomedecine & pharmacotherapie >Iodine-131 radio-guided surgery in differentiated thyroid cancer: outcome on 31 patients and review of the literature.
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Iodine-131 radio-guided surgery in differentiated thyroid cancer: outcome on 31 patients and review of the literature.

机译：碘131放射导向手术治疗分化型甲状腺癌：31例患者的预后及文献复习。

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In the present study we investigated the role of radio-guided surgery with Iodine-131 (I-131) in a group of 31 patients with differentiated thyroid cancer (DTC) and loco-regional recurrent disease. The principal inclusion criterion for I-131 radio-guided surgery in our protocol was the presence of an I-131 positive loco-regional disease relapse after previous total thyroidectomy and at least 2 ineffective conventional I-131 treatments. The protocol we used consisted of the following steps. Day 0: all patients were hospitalized and received a therapeutic 3.7 GBq (100 mCi) dose of I-131 after thyroid hormone therapy withdrawal in condition of overt hypothyroidism (serum TSH levels>30 microUI/ml). Day 3: a whole body scan following the therapeutic I-131 dose (TxWBS) administration was acquired. Day 5: neck surgery was performed through a wide bilateral neck exploration using a 15-mm collimated gamma probe, measuring the absolute intra-operative counts and calculating the lesion to background (L/B) ratio. Day 7: post-surgery TxWBS was performed using the remaining radioactivity to evaluate the completeness of tumoral lesions extirpation. The final histologic examination showed the presence of 184 metastatic foci; among them, 98 (53.2%) were evident by both TxWBS and gamma probe evaluation, 76 (41.3%) were demonstrated only by gamma probe, and 10 (5.4%) were negative by both TxWBS and gamma probe evaluation. During follow-up (8 months to 4.9 years, mean 2.8 years), DxWBS, serum Tg levels off l-T4, and US showed absence of loco-regional disease in 25 patients (80.6%) while 6 patients had persistent disease. In conclusion, this protocol allowed us to identify neoplastic foci with high sensitivity and specificity, enabling us to remove loco-regional I-131 disease recurrences resistant to previous conventional I-131 therapies. Furthermore, the gamma probe allowed detection of some additional tumoral foci in sclerotic areas or located behind vascular structures that were not visualized at the pre-surgery TxWBS evaluation.
机译：在本研究中，我们调查了31例分化型甲状腺癌（DTC）和局部区域复发性疾病患者中使用碘131（I-131）进行的放射性引导手术的作用。在我们的方案中，I-131放射性引导手术的主要纳入标准是在先前的全甲状腺切除术和至少2例无效的常规I-131治疗后，存在I-131阳性局部区域疾病复发。我们使用的协议包括以下步骤。第0天：所有患者均住院治疗，并且在甲状腺功能减退（血清TSH水平> 30 microUI / ml）的情况下停用甲状腺激素治疗后接受了3.7 GBq（100 mCi）剂量的I-131治疗。第3天：获得I-131治疗剂量（TxWBS）给药后的全身扫描。第5天：使用15毫米准直伽马探针，通过宽阔的双侧颈部探查进行颈部手术，测量术中绝对计数并计算病变与背景（L / B）的比率。第7天：手术后使用剩余的放射性进行TxWBS，以评估肿瘤病灶切除的完整性。最终的组织学检查显示有184个转移灶。其中，TxWBS和γ探针评估均显示98（53.2％），仅γ探针显示76（41.3％），而TxWBS和γ探针评估均为阴性。在随访期间（8个月至4.9年，平均2.8年），DxWBS，1-T4血清Tg水平升高和US显示25例患者（80.6％）无局部区域性疾病，而6例患有持续性疾病。总之，该方案使我们能够以高灵敏度和特异性鉴定肿瘤灶，从而使我们能够消除对以前的常规I-131治疗有抵抗力的局部I-131疾病复发。此外，γ探针还可以检测出硬化区域或位于血管结构后面的一些其他肿瘤灶，而这些在手术前TxWBS评估中是看不到的。

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