Terapia empírica del cáncer de tiroides con I-131 como estrategia diagnóstica para identificar lesiones ocultas en pacientes con tiroglobulina elevada sin enfermedad estructural identificable

Autores/as

  • Augusto Llamas Olier Instituto Nacional de Cancerología
  • María Cristina Martínez Instituto Nacional de Cancerología
  • Amelia De los Reyes Instituto Nacional de Cancerología
  • Enrique Cadena Instituto Nacional de Cancerología
  • Leonardo Rojas Instituto Nacional de Cancerología
  • Humberto Varela Instituto Nacional de Cancerología
  • Alejandro Marti Instituto Nacional de Cancerología
  • Álvaro Calderón Instituto Nacional de Cancerología
  • Emperatriz Angarita Instituto Nacional de Cancerología

Palabras clave:

Neoplasias de la tiroides, Radioisótopos de yodo (uso diagnóstico), Tiroglobulina (uso diagnóstico)

Resumen

Objetivos: Establecer la prevalencia de resultados positivos en el rastreo posterapia empírica; determinar valores de corte para tiroglobulina estimulada y suprimida que predijeron el resultado del rastreo posterapia empírica y describir factores clínicos e histopatológicos asociados con rastreos positivos.
Métodos: Se revisaron historias clínicas de pacientes, del Instituto Nacional de Cancerología (INC) entre 2003 y 2009, con cáncer diferenciado de tiroides y que tuvieron una tiroglobulina estimulada ≥ 10 ng/ml en ausencia de enfermedad estructural identificable por ecografía de cuello y por otras imágenes diagnósticas obtenidas a discreción de los médicos tratantes. Se les practicó un rastreo posterapia después de recibir 100-200 mCi de I-131.
Resultados: Se incluyeron 40 pacientes (34 mujeres) con cáncer diferenciado de tiroides, de 14 a 74 años de edad, la mayoría con invasión local o compromiso de ganglios cervicales. El rastreo posterapia fue positivo en 24 pacientes. Los valores de corte de tiroglobulina suprimida y estimulada que mejor predijeron los resultados del rastreo posterapia fueron 1,89 ng/ml y 25 ng/ml, respectivamente. Factores como edad ≥ 45 años, sexo masculino, variantes agresivas y otras variables de mal pronóstico (tumor > 4 cm, primera cirugía extrainstitucional, tiroglobulina postoperatoria > 30 ng/ml y respuesta estructural incompleta (80%)) fueron más frecuentes en los pacientes con rastreo positivo.
Conclusiones: El rastreo posterapia empírica con I-131 es una estrategia diagnóstica que provee información localizadora, metabólica y pronóstica en la mayoría de los pacientes.

Biografía del autor/a

Augusto Llamas Olier, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia

María Cristina Martínez, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia

Amelia De los Reyes, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia

Enrique Cadena, Instituto Nacional de Cancerología

Grupo de Cirugía de Cabeza y Cuello, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Leonardo Rojas, Instituto Nacional de Cancerología

Grupo de Endocrinología Oncológica, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Humberto Varela, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Alejandro Marti, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia

Álvaro Calderón, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D. C., Colombia

Emperatriz Angarita, Instituto Nacional de Cancerología

Grupo de Medicina Nuclear, Instituto Nacional de Cancerología, Bogotá D.C., Colombia

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Cómo citar

[1]
Llamas Olier, A. et al. 2014. Terapia empírica del cáncer de tiroides con I-131 como estrategia diagnóstica para identificar lesiones ocultas en pacientes con tiroglobulina elevada sin enfermedad estructural identificable. Revista Colombiana de Cancerología. 18, 4 (dic. 2014), 157–165.

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01-12-2014

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