{"id":1600,"date":"2020-09-11T11:45:11","date_gmt":"2020-09-11T08:45:11","guid":{"rendered":"https:\/\/www.intheranostics.com\/prof\/?page_id=1600"},"modified":"2020-09-11T11:45:15","modified_gmt":"2020-09-11T08:45:15","slug":"radyoaktif-iyot-tedavisi","status":"publish","type":"page","link":"https:\/\/www.intheranostics.com\/prof\/radyoaktif-iyot-tedavisi\/","title":{"rendered":"Radyoaktif \u0130yot Tedavisi"},"content":{"rendered":"

[et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”4.4.8″ background_color=”rgba(0,0,0,0)” background_image=”https:\/\/www.intheranostics.com\/wp-content\/uploads\/2020\/06\/metastatik_prostat_kanseri.jpg” custom_padding=”100px||100px||false|false” locked=”off”][et_pb_fullwidth_header title=”Radyoaktif \u0130yot Tedavisi” text_orientation=”center” content_max_width_last_edited=”off|desktop” _builder_version=”4.4.8″ title_font_size=”50px” content_font_size=”41px” subhead_font=”|700|||||||” subhead_font_size=”38px” subhead_line_height=”1.1em” background_enable_color=”off” background_enable_image=”off” custom_margin=”||||false|false” custom_padding=”||||false|false” animation_style=”slide” animation_direction=”bottom” hover_enabled=”0″][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.4.8″ custom_margin=”0px||0px||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_row _builder_version=”4.4.8″ custom_margin=”0px||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ _builder_version=”4.4.8″][et_pb_divider divider_weight=”0px” _builder_version=”4.4.8″ use_background_color_gradient=”on” background_color_gradient_start=”#8dd2e1″ background_color_gradient_end=”#23afca” background_color_gradient_direction=”90deg” width=”50%” module_alignment=”center” height=”10px”][\/et_pb_divider][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”section” _builder_version=”3.22″][et_pb_row admin_label=”row” _builder_version=”4.4.8″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”||||false|false” custom_padding=”0px|0px|0px|0px|false|false”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.4.8″ hover_enabled=”0″]<\/p>\n

Radyoaktif \u0130yot Tedavisi<\/b><\/span><\/h2>\n

Endikasyon<\/b><\/span><\/p>\n

Radyoaktif iyot<\/b>\u00a0(I-131, radyoiyot veya atom tedavisi), diferansiye tiroid kanserli hastalarda;<\/span><\/p>\n

1) Total veya totale yak\u0131n tiroidektomi sonras\u0131 rezid\u00fcel sa\u011fl\u0131kl\u0131 tiroid dokusunun ablasyonu<\/span><\/p>\n

2) Subklinik mikroskobik hastal\u0131\u011f\u0131n adjuvan tedavisi<\/span><\/p>\n

3) Makroskobik rezid\u00fcel\/n\u00fcks veya metastatik hastal\u0131\u011f\u0131n tedavisinde endikedir.<\/span><\/p>\n

Radyoaktif \u0130yot Tedavisi Nedir, Nas\u0131l Tedavi Eder?<\/b><\/span><\/h3>\n

Teranostik t\u0131p d\u00fcnyas\u0131nda yeni geli\u015fmekte olan bir aland\u0131r. T\u00fcm\u00f6re \u00f6zg\u00fcl bir ila\u00e7 ile g\u00f6r\u00fcnt\u00fcleme yaparak saptanan t\u00fcm\u00f6r ve metastazlar\u0131n\u0131n, nereye gidece\u011fi, ne kadar gidece\u011fi ve hastal\u0131kl\u0131 dokuyu etkileme g\u00fcc\u00fc \u00f6nceden bilinen yine \u00f6zg\u00fcl bir ila\u00e7 ile tedavi edilebildi\u011fi bir yakla\u015f\u0131md\u0131r. Bu yakla\u015f\u0131m, geleneksel t\u0131ptan ki\u015fiye \u00f6zg\u00fc \u00e7a\u011fda\u015f t\u0131p uygulamalar\u0131na ge\u00e7i\u015f yap\u0131lmas\u0131n\u0131 sa\u011flamaktad\u0131r.<\/span><\/p>\n

Diferansiye tiroid kanserinde; bir yandan tan\u0131sal ama\u00e7la d\u00fc\u015f\u00fck doz radyoaktif iyot (I-131\u00a0<\/span>veya I-123)<\/span>\u00a0ile t\u00fcm\u00f6ral dokular\u0131n y\u00fcksek duyarl\u0131l\u0131k ve \u00f6zg\u00fcll\u00fckte g\u00f6r\u00fcnt\u00fclenebilmesi, di\u011fer yandan da y\u00fcksek doz radyoaktif iyot (I-131) ile bu t\u00fcm\u00f6ral dokular\u0131n \u00f6zg\u00fcl ve hedefe y\u00f6nelik tedavisi, teranostik uygulamalar i\u00e7in bilinen en eski \u00f6rnektir.<\/span><\/p>\n

Radyoaktif iyot tedavisi, 1940\u2019l\u0131 y\u0131llardan bu yana tiroidin benign ve malign hastal\u0131klar\u0131n\u0131n tedavisinde s\u0131kl\u0131kla tercih edilen, diferansiye tiroid kanserli hastalarda sa\u011f kal\u0131ma etkisi g\u00f6sterilmi\u015f standart bir uygulamad\u0131r.<\/span><\/p>\n

Tiroid dokusu, v\u00fccuttaki iyotun tamam\u0131n\u0131 kandan alarak kendi i\u00e7erisinde biriktirme konusunda e\u015fsiz bir yetene\u011fe sahiptir. Radyoaktif iyot da t\u0131pk\u0131 iyot gibi, sodyum-iyot simporter (NIS) membran proteinleri arac\u0131l\u0131\u011f\u0131yla tiroid bezine al\u0131narak, tiroid folik\u00fcler h\u00fccrelerinde depolanmaktad\u0131r. Papiller ve folik\u00fcler tip diferansiye tiroid kanserlerinde de, sa\u011fl\u0131kl\u0131 tiroid dokusuna g\u00f6re daha d\u00fc\u015f\u00fck d\u00fczeyde olmakla birlikte, NIS membran proteinleri bulunmaktad\u0131r. I-131 fiziksel yar\u0131 \u00f6mr\u00fc 8.1 g\u00fcn olan bir radyon\u00fcklid olup, g\u00f6r\u00fcnt\u00fclemede yararland\u0131\u011f\u0131m\u0131z 364 keV\u2019luk temel gama radyasyonu ile tedavide kulland\u0131\u011f\u0131m\u0131z ortalama 0.192 MeV enerjiye ve dokuda ortalama 0.4 mm menzile sahip temel beta par\u00e7ac\u0131\u011f\u0131 yay\u0131mlamaktad\u0131r.<\/span><\/p>\n

Anaplastik (andiferansiye) ve med\u00fcller tiroid kanserleri ile lenfoma gibi tiroidin nadir g\u00f6r\u00fclen di\u011fer malign hastal\u0131klar\u0131 ise iyot tutulumu g\u00f6stermediklerinden, radyoaktif iyot tedavisi bu hastalarda kullan\u0131lmamaktad\u0131r.<\/span><\/p>\n

\u00c7o\u011fu hasta i\u00e7in diferansiye tiroid kanserleri \u00e7ok iyi bir prognoza sahip olsa da, hastal\u0131\u011f\u0131n n\u00fcks veya sebat etme oran\u0131 %20-30\u2019a kadar ula\u015fabilir ve n\u00fcks ilk tedaviden on y\u0131llar sonra bile ortaya \u00e7\u0131kabilir. Bu nedenle, kanserin tekrarlay\u0131p tekrarlanmad\u0131\u011f\u0131n\u0131 anlayabilmek i\u00e7in hastalar\u0131n d\u00fczenli takip edilmesi \u00f6nemlidir ve bu izleme hayat boyu devam edilmelidir.<\/span><\/p>\n

Radyoaktif \u0130yot Tedavisi Kimlere Uygulan\u0131r?<\/b><\/span><\/h3>\n

Radyoaktif iyot (I-131, radyoiyot veya atom tedavisi) diferansiye tiroid kanserli hastalarda, total veya totale yak\u0131n tiroidektomi sonras\u0131 rezid\u00fcel normal tiroid dokusunun ablasyonu, subklinik mikroskobik hastal\u0131\u011f\u0131n adjuvan tedavisi ve makroskobik rezid\u00fcel\/n\u00fcks veya metastatik hastal\u0131\u011f\u0131n tedavisinde endikedir.\u00a0<\/span><\/p>\n

Cerrahi Sonras\u0131 Radyoaktif \u0130yot Ablasyonu<\/b><\/span><\/p>\n

Ameliyattan birka\u00e7 hafta sonra, cerrahi sonras\u0131 kalan tiroid kanseri h\u00fccrelerini veya normal tiroid dokusunu ortadan kald\u0131rma amac\u0131yla yap\u0131lan radyoaktif iyot uygulamas\u0131d\u0131r. Ablasyon ile ayr\u0131ca v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131lm\u0131\u015f tiroid kanseri h\u00fccrelerinin de ortadan kald\u0131r\u0131lmas\u0131 ama\u00e7lanmaktad\u0131r. Normal tiroid dokusu kal\u0131nt\u0131lar\u0131n\u0131n ortadan kald\u0131r\u0131lmas\u0131, olas\u0131 n\u00fcks hastal\u0131\u011f\u0131n izlemeni kolayla\u015ft\u0131racakt\u0131r. Bu katk\u0131ya ek olarak radyoaktif iyot ablasyonunun, kanserin boyun veya v\u00fccudun di\u011fer b\u00f6lgelerine yay\u0131ld\u0131\u011f\u0131 durumlarda sa\u011f kal\u0131m oranlar\u0131n\u0131 da iyile\u015ftirdi\u011fi g\u00f6sterilmi\u015ftir.<\/span><\/p>\n

Amerikan Tiroid Birli\u011fi (ATA) risk s\u0131n\u0131flama sistemi ve AJCC\/TNM evreleme sistemine g\u00f6re cerrahi sonras\u0131\u00a0<\/b><\/span>g\u00fcncel<\/b><\/span>\u00a0radyoaktif iyot (RA\u0130) ablasyon tedavisi \u00f6nerileri \u015fu \u015fekildedir:<\/b><\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

ATA risk eveleme<\/span><\/p>\n<\/td>\n

\n

Tan\u0131m<\/span><\/p>\n<\/td>\n

\n

RA\u0130 ablasyon endikasyonu<\/b><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck risk<\/span><\/p>\n

T1a<\/span><\/p>\n

N0, Nx<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

T\u00fcm\u00f6r boyutu \u22641 cm (tek odak veya multifokal)<\/span><\/p>\n<\/td>\n

\n

Yok<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck risk<\/span><\/p>\n

T1b, T2<\/span><\/p>\n

N0, Nx<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

T\u00fcm\u00f6r boyutu >1-4 cm<\/span><\/p>\n<\/td>\n

\n

D\u00fc\u015f\u00fcn\u00fclebilir. Rutin de\u011fil, agresif histolojisi veya vask\u00fcler invazyonu olan hastalar i\u00e7in d\u00fc\u015f\u00fcn\u00fclebilir.<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n

T3<\/span><\/p>\n

N0, Nx<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

T\u00fcm\u00f6r boyutu >4 cm<\/span><\/p>\n<\/td>\n

\n

Genellikle tercih edilir.<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n

T3<\/span><\/p>\n

N0, Nx<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

Mikroskobik ekstratiroidal yay\u0131l\u0131m, herhangi t\u00fcm\u00f6r boyutunda<\/span><\/p>\n<\/td>\n

\n

Genellikle tercih edilir.<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n

T1-3<\/span><\/p>\n

N1a<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

Santral servikal kompartman lenf nodu metastaz\u0131<\/span><\/p>\n<\/td>\n

\n

Genellikle tercih edilir.<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA d\u00fc\u015f\u00fck ila orta risk<\/span><\/p>\n

T1-3<\/span><\/p>\n

N1b<\/span><\/p>\n

M0, Mx<\/span><\/p>\n<\/td>\n

\n

Lateral servikal kompartman veya mediastinal servikal lenf nodu metastaz\u0131<\/span><\/p>\n<\/td>\n

\n

Genellikle tercih edilir.<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA y\u00fcksek risk<\/span><\/p>\n

T4<\/span><\/p>\n

Herhangi N<\/span><\/p>\n

Herhangi M<\/span><\/p>\n<\/td>\n

\n

Geni\u015f ekstratiroidal yay\u0131l\u0131m, herhangi t\u00fcm\u00f6r boyutunda<\/span><\/p>\n<\/td>\n

\n

Evet<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

ATA y\u00fcksek risk<\/span><\/p>\n

M1<\/span><\/p>\n

Herhangi T<\/span><\/p>\n

Herhangi N<\/span><\/p>\n<\/td>\n

\n

Uzak metastaz<\/span><\/p>\n<\/td>\n

\n

Evet<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Amerikan Tiroid Birli\u011fi (ATA) risk s\u0131n\u0131flama sistemi:<\/b><\/span><\/p>\n\n\n\n\n\n
\n

D\u00fc\u015f\u00fck Risk<\/b><\/span><\/p>\n<\/td>\n

\n

Lokal veya uzak metastaz yok.<\/span><\/p>\n

Makroskopik t\u00fcm\u00f6r\u00fcn tamam\u0131 \u00e7\u0131kart\u0131lm\u0131\u015f.<\/span><\/p>\n

\u00c7evre doku ve yap\u0131lara t\u00fcm\u00f6r invazyon yok.<\/span><\/p>\n

Agresif t\u00fcm\u00f6r histolojisi yok (tall cell varyant, hobnail varyant, kolumnar h\u00fccreli karsinom gibi).<\/span><\/p>\n

RA\u0130 verilmi\u015f ise tedavi sonras\u0131 taramada tiroid yata\u011f\u0131 d\u0131\u015f\u0131nda tutulum yok.<\/span><\/p>\n

Vask\u00fcler invazyon yok.<\/span><\/p>\n

Klinik olarak N0 veya \u22645 patolojik N1 mikrometastazlar ( en b\u00fcy\u00fck \u00e7ap\u0131 <0.2cm)<\/span><\/p>\n

\u0130ntratiroidal, enkaps\u00fcle follik\u00fcler varyant papiller tiroid kanseri<\/span><\/p>\n

\u0130ntratiroidal, iyi diferansiye follik\u00fcler tiroid kanseri, kaps\u00fcl invazyonlu ve vask\u00fcler invazyon olmaks\u0131z\u0131n veya minimal vask\u00fcler invazyon ile (<4 odak)<\/span><\/p>\n

\u0130ntratiroidal papiller mikrokarsinom, tek veya multifokal, V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Orta Risk<\/span><\/p>\n<\/td>\n

\n

Peritiroidal yumu\u015fak dokulara mikroskopik t\u00fcm\u00f6r invazyonu<\/span><\/p>\n

Vask\u00fcler invazyon olan PTK<\/span><\/p>\n

RA\u0130 tedavisi sonras\u0131 ilk t\u00fcm v\u00fccut iyot taramas\u0131nda tiroid yata\u011f\u0131 d\u0131\u015f\u0131nda boyunda tutulum<\/span><\/p>\n

Agresif t\u00fcm\u00f6r histolojisi (tall cell varyant, hobnail varyant, kolumnar h\u00fccreli karsinom gibi)<\/span><\/p>\n

Klinik olarak N1 veya en b\u00fcy\u00fck \u00e7ap\u0131 <3cm olan >5 patolojik N1<\/span><\/p>\n

\u0130ntiroidal papiller tiroid kanseri, primer t\u00fcm\u00f6r 1-4cm, V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n

Multifokal pailler mikrokarsinom, tiroid d\u0131\u015f\u0131na yay\u0131l\u0131m ve V600E BRAF mutasyonu (biliniyorsa)<\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Y\u00fcksek Risk<\/span><\/p>\n<\/td>\n

\n

Peritiroidal yumu\u015fak dokulara makroskopik t\u00fcm\u00f6r invazyonu (geni\u015f ekstratiroidal yay\u0131l\u0131m)<\/span><\/p>\n

\u0130nkomplet t\u00fcm\u00f6r rezeksiyonu<\/span><\/p>\n

Uzak metastaz<\/span><\/p>\n

Uzak metastaz d\u00fc\u015f\u00fcnd\u00fcren, postoperatif serum Tg y\u00fcksekli\u011fi<\/span><\/p>\n

Herhangi birinde en b\u00fcy\u00fck \u00e7ap\u0131 >3cm olan patolojik N1 metastatik lenf nodu<\/span><\/p>\n

Yayg\u0131n vask\u00fcler invazyon g\u00f6steren follik\u00fcler tiroid kanseri (>4 odak)<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

N\u00fcks veya Rezid\u00fcel\u00a0\u00a0<\/span>Diferansiye Tiroid Kanserinin Radyoaktif \u0130yot ile Tedavisi<\/b><\/span><\/p>\n

Kanser dokusu ameliyatla \u00e7\u0131kar\u0131labilecek gibiyse cerrahi genellikle ilk tercihtir. Radyoaktif iyot tedavisi, tek ba\u015f\u0131na veya ameliyatla birlikte kullan\u0131labilir. Kanser oda\u011f\u0131 radyoaktif iyot taramas\u0131nda kayda de\u011fer tutulum g\u00f6stermezken, MR veya 18F-FDG-PET taramas\u0131 gibi di\u011fer g\u00f6r\u00fcnt\u00fclemelerde saptan\u0131yorsa, radyoaktif iyota refrakter diferansiye tiroid kanseri varl\u0131\u011f\u0131ndan \u015f\u00fcphelenilmelidir.<\/span><\/p>\n

Radyoaktif \u0130yota Refrakter Diferansiye Tiroid Kanseri Tedavisi<\/b><\/span><\/p>\n

Tan\u0131m:<\/i><\/b><\/span><\/p>\n