การเปรียบเทียบประสิทธิผลของไอโอดีน-131 ปริมาณต่ำ และปริมาณสูงต่อการบรรลุภาวะปลอดโรคในผู้ป่วยมะเร็งไทรอยด์ชนิดดิฟเฟอเรนชิเอเต็ดระดับความเสี่ยงปานกลาง

Sangrawee Laddachayaporn

Authors

Sangrawee Laddachayaporn Lampang Cancer Hospital

Keywords:

Differentiated thyroid cancer, Radioiodine-131, Intermediate risk, Disease-free status

Abstract

Background: Thyroid cancer is the most common endocrine malignancy, with differentiated thyroid cancer accounting for 90-95%. For intermediate-risk patients according to the 2015 American Thyroid Association Management Guidelines (ATA 2015), treatment can begin with either low-dose 30 mCi or high-dose 100-150 mCi. Objective: To compare cumulative radioiodine-131 doses required to achieve disease-free status and time to achieve disease-free status between low-dose and high-dose radioiodine-131 groups. Methods: A retrospective study of 177 intermediate-risk differentiated thyroid cancer patients at Lampang Cancer Hospital between 2018-2022. Inclusion criteria were: age 18 years or older, diagnosed with differentiated thyroid cancer, and intermediate-risk level according to ATA 2015 criteria. Exclusion criteria were patients with low-risk or high-risk differentiated thyroid cancer and patients who had not yet achieved disease-free status. Data collection was performed using case record forms. Data analysis was conducted using Stata version 18.0 (StataCorp, College Station, TX, USA) with statistical significance set at .05. Results: The low-dose iodine-131 group (30 mCi) included 91 patients, and the high-dose group (100-150 mCi) included 86 patients. The high-dose iodine-131 group had significantly higher total cumulative iodine-131 dose until achieving disease-free status compared to the low-dose group (237.21±148.71 mCi vs. 135.27±132.27 mCi, p < .001). After controlling for confounding factors, the mean difference was 111.063 mCi (95%CI: 66.426, 155.699, p < .001). However, treatment duration until achieving disease-free status was not significantly different (577.24±443.35 days vs. 537.35±341.01 days, p = .502). Conclusion: Low-dose iodine-131 treatment can achieve disease-free status using lower cumulative radiation dose with similar treatment duration compared to high-dose treatment. Therefore, it should be considered as the first-line option for intermediate-risk differentiated thyroid cancer patients.

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