Intervention Review

Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases

  1. Chao Ma1,*,
  2. Anren Kuang2,
  3. Jiawei Xie3

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 30 MAY 2008

DOI: 10.1002/14651858.CD006988.pub2


How to Cite

Ma C, Kuang A, Xie J. Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006988. DOI: 10.1002/14651858.CD006988.pub2.

Author Information

  1. 1

    Affiliated Hospital of Medical College Qingdao University, Department of Nuclear Medicine , Qingdao, Shandong Province, China

  2. 2

    The First Affiliated Hospital / West China University of Medical Sciences, Department of Nuclear Medicine, Chengdu, China

  3. 3

    Affiliated Hospital , Stomatology, Qingdao, Shandong, China

*Chao Ma, Department of Nuclear Medicine , Affiliated Hospital of Medical College Qingdao University, Jiangsu Road 16, Qingdao, Shandong Province, 266003, China. machaopony@hotmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases has been observed in follow-up studies. The management of this condition remains controversial. Most studies support blind radioactive iodine treatment while others negate this approach.

Objectives

To assess the effects of radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases.

Search methods

Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese.

Selection criteria

Randomised controlled clinical trials and prospective controlled clinical trials.

Data collection and analysis

Two authors independently extracted data and interviewed authors of all potentially relevant studies by electronic mail to verify randomisation procedures. One author entered data into a data extraction form and the second one verified the results of this procedure.

Main results

Because of the absence of any suitable randomised or prospective controlled trial in this area, results currently cannot be presented.

Authors' conclusions

The currently available evidence is insufficient to reliably assess the potential of radioiodine treatment for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases

The main method for the treatment of differentiated thyroid carcinomas (a cancer of the thyroid gland) is total or near-total thyroidectomy (surgical removal of the thyroid) followed by radioactive iodine therapy (iodine-131) and treatment with thyroid hormones (mainly thyroxin). The metastatic disease of this thyroid carcinoma or spread of the tumour includes local recurrence and distant metastases. Metastatic disease is a factor that worsens prognosis of patients with differentiated thyroid carcinoma. After surgery or as the primary treatment, located metastases should, if possible, be removed by an experienced surgeon. For unremovable metastases which can gather radioiodine, iodine-131 therapy is an accepted procedure.

Differentiated thyroid carcinoma is typically able to produce thyroglobulin, the protein in the thyroid gland from which the thyroid hormones thyroxine and triiodotyrosine are synthesized, and gather radioiodine. Thyroglobulin is produced only by thyroid cells. If all normal and malignant thyroid tissue is successfully removed, any thyroglobulin subsequently detected in a patient with differentiated thyroid carcinoma is thought to be the product of recurrent malignancy. Thus, radioiodine diagnostic whole-body scanning and measurement of serum thyroglobulin levels are the two main methods for detecting metastatic disease of differentiated thyroid carcinoma. Undetectable thyroglobulin levels with negative radioiodine whole body scan suggest complete remission, whereas detectable or elevated thyroglobulin is associated with the presence of radioiodine uptake in local or distant metastases.

Up to now, to treat or not to treat these patients who have thyroglobulin positive and radioactive iodine negative metastases with radioiodine remains controversial. Some doctors advocate blind iodine-131 treatment for thyroglobulin positive and radioactive iodine negative metastases. Radioiodine therapy may be especially justified in patients with higher thyroglobulin levels (greater than 10 mg/L) and negative iodine-131 whole body scan and who are at high risk of any recurrence. However, high-dose radioactive iodine therapy is not without risk; especially an increased prevalence of cancers of the bladder, salivary gland, colon and female breast has been reported.

Unfortunately, no firm evidence from randomised or prospective controlled trials for or against radioiodine treatment for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases could be found. Further prospective controlled trials of high-quality and large scale are needed to guide clinical practice.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

放射性碘(radioiodine)在甲狀腺球蛋白(thyroglobulin)陽性與放射性碘掃描陰性之甲狀腺分化癌(differentiated thyroid carcinoma)轉移(metastases)的治療

在一些追蹤研究中,有觀察到甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移。其治療方式仍具爭議性。多數研究支持使用放射性碘治療,而一些研究否定這種做法。

目標

評估放射性碘治療對於甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移的治療效果。

搜尋策略

研究蒐集自網路,包括MEDLINE, EMBASE, 考科藍實證醫學資料庫, 中國知識基礎設施工程與在華人舉行的會議所收集的文章。

選擇標準

隨機對照臨床試驗和前瞻性對照臨床試驗。

資料收集與分析

由兩位作者獨立選用資料數據,經由電子郵件與所有可能有相關研究的作者訪談來驗證其隨機化的程序。一位作者輸入資料數據到數據摘錄表中,而第二位作者驗證此程序的結果。

主要結論

在這個領域由於沒有任何合適的隨機或前瞻性對照試驗,因此結果目前還無法呈現。

作者結論

目前現有的證據不足以可靠地評估放射性碘對於有甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移的治療潛力。

翻譯人

本摘要由臺灣大學附設醫院吳婉禎翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

放射性碘在甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移的治療:對甲狀腺分化癌(甲狀腺的一種癌症)的主要治療方式為全部或近全甲狀腺切除術(手術切除甲狀腺),然後給予放射性碘治療(碘 −131)和甲狀腺激素治療(主要是甲狀腺素)。甲狀腺癌轉移或腫瘤擴散,包括局部復發和遠處轉移。轉移是甲狀腺分化癌一個預後不良的因子。若情況許可,局部轉移病灶應在手術後或一開始手術時由有經驗的外科醫生將它移除。對於會吸收放射性碘並且無法清除的轉移,碘 −131治療是可以被接受的方式。甲狀腺分化癌通常能夠製造產生甲狀腺球蛋白,在甲狀腺中此蛋白會合成三碘甲狀腺素和甲狀腺素,聚集放射性碘。甲狀腺球蛋白只會由甲狀腺細胞所產生。在甲狀腺分化癌患者中,如果所有正常的和惡性的甲狀腺組織全被成功地移除後,後續追蹤中偵測到甲狀腺球蛋白被認為是惡性腫瘤復發的產物。因此,診斷性放射性碘全身掃描與血清甲狀腺球蛋白值測量是偵測甲狀腺分化癌轉移的兩個主要方法。偵測不到甲狀腺球蛋白和陰性的碘 −131全身掃描結果代表完全緩解;而偵測到甲狀腺球蛋白或其數值上升與局部或遠處轉移的陽性放射性碘攝取相關。到目前為止,是否以放射性碘治療甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移仍具爭議性。有些醫生主張以碘 −131來治療這些有甲狀腺球蛋白陽性與放射性碘掃描陰性之轉移病灶,在甲狀腺球蛋白數值較高(大於10毫克/升)和碘 −131全身掃描陰性以及被認為易復發之高風險族群,使用放射性碘治療尤其合理的。然而,高劑量的放射性碘治療並非沒有風險,尤其是已有報告指出會增加包括膀胱、唾液腺、大腸和女性乳房癌症的發生率。可惜以現今所有的前瞻性隨機對照試驗沒有確切證據支持或反對使用放射性碘來治療甲狀腺球蛋白陽性與放射性碘掃描陰性之甲狀腺分化癌轉移。因此需要更進一步高品質、大規模的前瞻性對照試驗作為臨床實務的指引。