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Nuklearmedizinische Therapie und Nachsorge des differenzierten Schilddrüsenkarzinoms: Status quo

Nuclear medicine therapy of differentiated thyroid cancer: status quo

  • Leitthema
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Zusammenfassung

Differenzierte (papilläre und follikuläre) Schilddrüsenkarzinome haben eine gute Prognose. Therapie der Wahl ist die totale Thyroidektomie und ggf. Lymphknotendissektion mit anschließender Radioiodablation. Nur sehr kleine solitäre papilläre Karzinome mit einem Durchmesser ≤10 mm ohne Lymphknoten- und Fernmetastasen können mit einer Lobektomie ausreichend behandelt werden. Zur Vorbereitung auf die nach der Thyroidektomie folgende ablative Iod-131- (131I-)Therapie bietet sich heute rekombinantes humanes Thyrotropin (rhTSH) an. Damit lassen sich die Nachteile einer ansonsten erforderlichen iatrogenen Hypothyrose vermeiden, und die Strahlenexposition des Restkörpers bei der Radioiodtherapie wird reduziert. Auch bei der selten kurativ, meistens jedoch palliativ recht wirksamen 131I-Therapie von Metastasen kann die Vorbereitung mit rhTSH hilfreich sein. Allerdings ist rhTSH bei der Vorbereitung der Metastasentherapie derzeit nur im Rahmen individueller Heilversuche einsetzbar. Aktuelle Konzepte zur Therapie distanter Metastasen beruhen oft auf dosimetrischen Abschätzungen zur Vermeidung einer Knochenmarktoxizität bei Steigerung der eingesetzten Aktivitätsmenge im Sinne einer personalisierten Behandlung. Bei der mikronodulären Lungenmetastasierung führt die 131I-Therapie häufig zu einer kompletten Remission; in einer solchen Konstellation ist die endogene TSH-Stimulation durch Schilddrüsenhormonentzug weiterhin Standard bei der Vorbereitung auf die Radioiodtherapie.

Abstract

Differentiated thyroid cancers (papillary and follicular cancers) have a good prognosis. The treatment of choice consists of total thyroidectomy and if necessary lymph node dissection followed by ablative radioiodine treatment. Only very small solitary papillary thyroid cancers with a diameter of ≤10 mm without lymph node and distant metastases may be treated sufficiently with lobectomy only. Nowadays, recombinant human thyrotropin (rhTSH) can be useful in the preparation for ablative radioiodine treatment. This protocol prevents the drawbacks of iatrogenic hypothyroidism and reduces the radiation exposure to the remainder of the body. Even in cases of distant metastases, which can be rarely cured but mostly treated effectively with a palliative approach, preparation with recombinant TSH is helpful. However, exogenous TSH stimulation is not yet approved for preparation of radioiodine treatment of metastases and can only be administered on a compassionate use basis. Current concepts for therapy of distant metastases often include dosimetric evaluations to avoid bone marrow toxicity while increasing the administered activity in an attempt to personalize the treatment. High rates of complete remission are reported in patients with pulmonary micrometastases and in this constellation endogenous TSH stimulation after thyroid hormone withdrawal is still the standard preparation for radioiodine treatment.

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Interessenkonflikt

Die Autoren M.D., M.L. und C.R. erhielten Vortragshonorare von Genzyme GmbH. C.R. war als Principle Investigator an Zulassungsstudien von Genzyme GmbH zum rekombinanten humanen TSH beteiligt.

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    M. Dietlein

  2. Centrum für Integrierte Onkologie Köln/Bonn, Universitätsklinikum Köln, Köln, Deutschland

    M. Dietlein

  3. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Ulm, Ulm, Deutschland

    M. Luster

  4. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Deutschland

    C. Reiners

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  1. M. Dietlein
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Correspondence to M. Dietlein.

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Dietlein, M., Luster, M. & Reiners, C. Nuklearmedizinische Therapie und Nachsorge des differenzierten Schilddrüsenkarzinoms: Status quo. Onkologe 16, 678–689 (2010). https://doi.org/10.1007/s00761-010-1869-8

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