Stunning effects in radioiodine therapy of thyroid carcinoma

W. Koch; P. Knesewitsch; K. Tatsch; K. Hahn

doi:10.1055/s-0038-1623899

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2003; 42(01): 10-14
DOI: 10.1055/s-0038-1623899

Original Article

Schattauer GmbH

Stunning effects in radioiodine therapy of thyroid carcinoma

existence, clinical effects and ways out^[*] Stunningeffekte bei der Radioiodtherapie des SchilddrüsenkarzinomsExistenz, klinische Auswirkungen und Auswege

Authors

W. Koch

¹Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München
P. Knesewitsch

¹Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München
K. Tatsch

¹Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München
K. Hahn

¹Klinik und Poliklinik für Nuklearmedizin, Ludwig-Maximilians-Universität München

Abstract

Summary

In radioiodine therapy for malignant thyroid disease, the pre-therapeutically administered iodine-131-dose can reduce the potential of thyroid or thyroid carcinoma cells to absorb the following therapeutic iodine-131-dose, possibly leading to its failure. This so called stunning effect is controversially discussed in the scientific community. Here we summarize and evaluate publications with regard to the existence and the effects of stunning as well as possible countermeasures.

Zusammenfassung

Bei der Radioiodtherapie maligner Schilddrüsenerkrankungen kann die im Rahmen der Vordiagnostik verabreichte Iod-131-Aktivität die Fähigkeit von Schilddrüsenund Schilddrüsenkarzinomzellen mindern, die nachfolgende therapeutische Iod-131-Aktivität aufzunehmen und somit zum Therapieversagen beitragen. Dieser so genannte Stunningeffekt wird in der Literatur kontrovers diskutiert. Die vorliegende Arbeit gibt einen Überblick unter Wertung der vorhandenen Literatur, um den aktuellen Kenntnisstand zur Existenz von Stunning, deren Auswirkungen und möglichen Gegenmaßnahmen aufzuzeigen.

Keywords

Radioiodine therapy - stunning - iodine-123-scintigraphy

Schlüsselwörter

Radioiodtherapie - Stunning - Iod-123-Szintigraphie

Full Text

References

Literatur
1 Cailleux AF, Baudin E, Travagli JP. et al. Is diagnostic iodine-131 scanning useful after total thyroid ablation for differentiated thyroid cancer?. J Clin Endocrinol Metab 2000; 85: 175-8.
2 Cholewinski SP, Yoo KS, Klieger PS. et al. Absence of thyroid stunning after diagnostic whole-body scanning with 185 MBq ¹³¹I. J Nucl Med 2001; 42: 531-3.
3 Chopra S, Wastie ML, Chan S. et al. Assessment of completedness of thyroid ablation by estimation of neck uptake of ¹³¹I on whole-body scans: comparison of quantification and visual assessment of thyroid bed uptake. Nucl Med Commun 1996; 17: 687.
4 David A, Blotta A. Bondanelli et al. Serum thyroglobulin concentrations and ¹³¹I whole-body scan results in patients with differentiated thyroid carcinoma after administration of recombinant human thyroid-stimulating hormone. J Nucl Med 2001; 42: 1470-5.
5 Dietlein M, Dressler J, Farahati J. et al. Leitlinie zur Radioiodtherapie (RIT) beim differenzierten Schilddrüsenkarzinom. Nuklearmedizin 1999; 38: 221-2.
6 Dörr U, Bach D, Langer T. et al. Stunning-Phänomen der Schilddrüse – ist eine Änderung des diagnostischen Konzeptes bei differenzierten Schilddrüsenkarzinomen angezeigt?. DGN-Abstracts 2002; 64.
7 Gerard S, Cavalieri R. I-123 diagnostic thyroid tumor whole-body scanning with imaging at 6, 24, and 48 hours. Clin Nucl Med 2002; 27: 1-8.
8 Hermanska J, Karny M, Zimak J. et al. Improved prediction of therapeutic absorbed doses of radioiodine in the treatment of thyroid carcinoma. J Nucl Med 2001; 42: 1084-90.
9 Hilditch TE, Dempsey MF, Bolster AA. et al. Self-stunning in thyroid ablation: evidence from comparative studies of diagnostic ¹³¹I and ¹²³I. Eur J Nucl Med Mod Imaging 2002; 29: 783-8.
10 Huic D, Medvedec M, Dodig D. et al. Radioiodine uptake in thyroid cancer patients after diagnostic application of low-dose ¹³¹I. Nucl Med Commun 1996; 17: 839.
11 Jeevanram RK, Shah DH, Sharma SM. et al. Influence of large dose on subsequent uptake of therapeutic radioiodine in thyroid cancer patients. Nucl Med Biol 1986; 13: 277-9.
12 Kao CH, Yen TC. Stunning effects after a diagnostic dose of iodine-131. Nuklearmedizin 1998; 37: 23-5.
13 Lees W, Mansberg R, Roberts J. et al. The clinical effects of thyroid stunning after diagnostic whole-body scanning with 185 MBq ¹³¹I. Eur J Nucl Med 2002; 29: 1421-7.
14 Leger FA, Izembart M, Dagousset F. et al. Decreased uptake of therapeutic doses of iodine-131 after 185-MBq iodine-131 diagnostic imaging for thyroid remnants in differentiated thyroid carcinoma. Eur J Nucl Med 1998; 25: 242-6.
15 Mandel SJ, Shankar LK, Benard F. et al. Superiority of iodine-123 compared with iodine-131 scanning for thyroid remnants in patients with differentiated thyroid cancer. Clin Nucl Med 2001; 26: 6-9.
16 Maxon III HR, Thomas SD, Washburn LC. et al. High activity ¹²³I for the diagnostic evaluation of patients with thyroid cancer. J Nucl Med 1993; 25: 242-6.
17 Mazzaferri EL, Kloos RT. Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation?. J Clin Endocrinol Metab 2002; 87: 1490-8.
18 McDougall IR. 74 MBq radioiodine ¹³¹I does not prevent uptake of therapeutic doses of ¹³¹I (i.e. it does not cause stunning) in differentiated thyroid cancer. Nucl Med Commun 1997; 18: 505-12.
19 McMenemin RM, Hilditch TE, Dempsey MF. et al. Thyroid stunning after ¹³¹I diagnostic whole-body scanning. J Nucl Med 2001; 42: 986.
20 Medvedec M, Grosev D, Loncaric S. et al. As soon as possible is already too late. J Nucl Med 2001; 42: 322P.
21 Medvedec M. Thyroid stunning. J Nucl Med 2001; 42: 1129.
22 Morris LF, Waxman AD, Braunstein GD. The nonimpact of thyroid stunning: remnant ablation rates in I-131-scanned and nonscanned individuals. J Clin Endocrinol Metab 2001; 86: 3507-11.
23 Muratet JP, Daver A, Minier JF. et al. Influence of scanning doses of iodine-131 on subsequent first ablative treatment outcome in patients operated on for differentiated thyroid carcinoma. J Nucl Med 1998; 39: 1546-50.
24 Pacini F, Capezzone M, Elisei R. et al. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum tg levels after initial treatment. J Clin Endocrinol Metab 2002; 87: 1499-501.
25 Park HM, Park YH, Zhou XH. Detection of thyroid remnant/metastasis without stunning: an ongoing dilemma. Thyroid 1997; 7: 277-80.
26 Park HM, Perkins OW, Edmondson JW. et al. Influence of diagnostic radioiodines on the uptake of ablative dose of iodine-131. Thyroid 1994; 4: 49-54.
27 Postgard P, Himmelman J, Lindencrona U. et al. Stunning of iodine transport by ¹³¹I irradiation in cultured thyroid epithelial cells. J Nucl Med 2002; 43: 828-34.
28 Robbins RJ, Chon JT, Fleisher M. et al. Is the serum thyroglobulin response to recombinant human thyrotropin sufficient, by itself, to monitor for residual thyroid carcinoma. J Clin Endocrinol Metab 2002; 87: 3242-7.
29 Shankar L, Yamamoto A, Alavi A. et al. Comparison of ¹²³I scintigraphy at 5 and 24 hours in patients with differentiated thyroid cancer. J Nucl Med 2001; 43: 72-6.
30 Siddiqi A, Foley R, Britton K. et al. The role of ¹²³I-diagnostic imaging in the follow-up of patients with differentiated thyroid carcinoma as compared to ¹³¹I-scanning: avoidance of negative therapeutic uptake due to stunning. Clin Endocrinol 2001; 55: 515-21.
31 Stabin MG, Stubbs JB, Toohey RE. NUREG/ CR-6345 Radiation dose estimates for radio-pharmaceuticals. Oak Ridge, TN: Radiation internal dose information center. Oak Ridge Institute for Science and Education 1996
32 Waxman A, Ramanna L, Chapman N. et al. The significance of I-131 scan dose in patients with thyroid cancer: determination of ablation: concise communication. J Nucl Med 1981; 22: 861-5.
33 Yeung HW, Humm JL, Larson SM. Radioiodine uptake in thyroid remnants during therapy after tracer dosimetry. J Nucl Med 2000; 41: 1082.