Guidelines on radioiodine therapy for differentiated thyroid carcinoma

M. Biermann; M. K. Pixberg; U. Dörr; M. Dietlein; H. Schlemmer; J. Grimm; T. Zajic; U. Nestle; S. Ladner; S. Sepehr-Rezai; S. Rosenbaum; C. Puskás; P. Fostitsch; A. Heinecke; A. Schuck; N. Willich; K. W. Schmid; H. Dralle; O. Schober; for the MSDS study group

doi:10.1055/s-0038-1625319

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2005; 44(06): 229-237
DOI: 10.1055/s-0038-1625319

Original Articles

Schattauer GmbH

Guidelines on radioiodine therapy for differentiated thyroid carcinoma^[*]

Impact on clinical practiceLeitlinien zur Radioiodtherapie des differenzierten SchilddrüsenkarzinomsEinfluss auf die klinische Praxis^[*]

Authors

M. Biermann

¹Departments of Nuclear Medicine, Univ.-Prof. Dr. Dr. O. Schober, Münster University, Münster
M. K. Pixberg

¹Departments of Nuclear Medicine, Univ.-Prof. Dr. Dr. O. Schober, Münster University, Münster
U. Dörr

²Departments of Nuclear Medicine, PD Dr. Dr. H. Bihl, Katharinenhospital, Stuttgart
M. Dietlein

³Departments of Nuclear Medicine, Univ.-Prof. Dr. H. Schicha, Cologne University, Cologne
H. Schlemmer

⁴Departments of Nuclear Medicine, Univ.-Prof. Dr. H. Lerch, Helios-Klinikum Wuppertal
J. Grimm

⁵Departments of Nuclear Medicine, Univ.-Prof. Dr. T. Mende, University Halle-Wittenberg, Halle
T. Zajic

⁶Departments of Nuclear Medicine, Univ.-Prof. Dr. mult. E. Moser, Freiburg University, Freiburg
U. Nestle

⁷Departments of Nuclear Medicine, Univ.-Prof. Dr. C.-M. Kirsch, Saarland University, Homburg/Saar
S. Ladner

⁸Departments of Nuclear Medicine, Univ.-Prof. Dr. Chr. Reiners, Würzburg University, Würzburg
S. Sepehr-Rezai

⁹Departments of Nuclear Medicine, Univ.-Prof. Dr. Dr. R. Bauer, Gießen University, Gießen
S. Rosenbaum

¹⁰Departments of Nuclear Medicine, Univ.-Prof. Dr. Dr. A. Bockisch, Essen University, Essen
C. Puskás

¹¹Departments of Nuclear Medicine, Prof. Dr. F.-D. Maul, Klinikum Karlsruhe
P. Fostitsch

¹²Departments of Nuclear Medicine, Univ.-Prof. Dr. H.-J. Otto, Magdeburg University, Magdeburg
A. Heinecke

¹³Biometrics (Univ.-Prof. Dr. W. Köpcke), Münster University
A. Schuck

¹⁴Radiooncology (Univ.-Prof. Dr. N. Willich), Münster University, Münster
N. Willich

¹⁴Radiooncology (Univ.-Prof. Dr. N. Willich), Münster University, Münster
K. W. Schmid

¹⁵Institute of Pathology (Univ.-Prof. Dr. K. W. Schmid), Essen University, Essen, Germany
H. Dralle

¹⁶General Surgery (Univ.-Prof. Dr. H. Dralle), University Halle-Wittenberg, Halle
O. Schober

¹Departments of Nuclear Medicine, Univ.-Prof. Dr. Dr. O. Schober, Münster University, Münster

for the MSDS study group

Abstract

Summary

Aim: For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing Multicenter Study Differentiated Thyroid Carcinoma (MSDS) were analyzed. Patients, methods: Patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pN0/1/x M0/x (UICC, 5th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic ¹³¹I whole-body scintigraphy (WBS) 3-4 months after RIT. Results: Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4–6 weeks), in 33% and 84% with regard to ¹³¹I activity for RIT (1-3 vs. 1-4 GBq; ± 10%), and in 16% and 60% with regard to ¹³¹I activity for WBS (15319-300 vs. 15319-400 MBq; ± 10%). Conclusions: The 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes.

Zusammenfassung

Ziel: Um den Effekt der Leitlinien zur Therapie des differenzierten Schilddrüsenkarzinoms (DTC) zu untersuchen, wurden die Behandlungsdaten der laufenden Multizentrischen Studie Differenziertes Schilddrüsenkarzinom (MSDS) analysiert. Patienten, Methoden: Patienten in den TNM-Stadien pT4 pN0/1/x M0/x (UICC, 5. Aufl. 1997) erhielten per Randomisierung eine perkutane Strahlentherapie (RTx) oder keine RTx zusätzlich zur Standardtherapie. Letztere bestand aus Thyroidektomie, ablativer Radioiodtherapie (RIT) und einer diagnostischen ¹³¹I-Ganzkörperszintigraphie (WBS) 3-4 Monate nach RIT. Ergebnisse: Von 339 Patienten zwischen 1/2000 und 3/2004 konnten 273 ausgewertet werden. Die Leitlinien der Deutschen Gesellschaft für Nuklearmedizin von 1999 und 1992 wurden befolgt in 28% und 82% in Bezug auf den Zeitraum zwischen Operation und RIT (4 bzw. 4-6 Wochen), in 33% und 84% in Bezug auf die ¹³¹I-Aktivität für die RIT (1-3 bzw. 1-4 GBq; ± 10%) und 16% bzw. 60% in Bezug auf die ¹³¹I-Aktivität für die Ganzkörperszintigraphie (15319-300 bzw. 15319-400 MBq; ± 10%). Schlussfolgerung: Die Revision der Leitlinien von 1999 hatte wenig Effekt auf die klinische Praxis. Die Nachbeobachtung des Studienkollektivs wird zeigen, ob die Umsetzung der Leitlinien Einfluss auf die Behandlungsergebnisse nimmt.

Keywords

Thyroid carcinoma - clinical practice guideline - radioiodine therapy - iodine-131

Schlüsselwörter

Schilddrüsenkarzinom - klinische Leitlinien - Radioiodtherapie - Iod-131

Full Text

References

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Guidelines on radioiodine therapy for differentiated thyroid carcinoma[*]

Authors

Guidelines on radioiodine therapy for differentiated thyroid carcinoma^[*]