Revisão Sistemática e Metanálise da Eficácia da Pesquisa de Corpo Inteiro pré-dose terapêutica com 131I em indivíduos com Carcinoma Diferenciado da Tireoide

• Ano de defesa: 2018
• Autor(a) principal: Petrocelli, Diego
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Estadual Paulista (Unesp)
• Palavras-chave em Português: câncer diferenciado de tireoide; pesquisa de corpo inteiro com 131I ou 123I; dose ablativa com 131I; Differentiated Thyroid Cancer; Whole Body Imaging with 131I or 123I; ablative dose with 131I
• Link de acesso: http://hdl.handle.net/11449/155881

Although being controversial, some services use Whole Body Imaging (WBI) with 131I prior to the ablative dose with this radiopharmaceutical in the treatment of differentiated thyroid cancers (DTC). Proponents of this approach argue for a better optimization of the ablative dose, and opponents argue that this WBI could lead to the "stunning effect" characterized by reduced tissue uptake of 131I in ablative dose treatment, thereby compromising treatment and prognosis of these individuals. Objective: To evaluate whether WBI with 131I, ablative pre-dose, interferes with the efficacy of the therapeutic dose of iodine as remission of the disease after total or near total thyroidectomy in individuals with DTC. Methodology: A systematic review of the literature was conducted in which randomized, non-randomized and observational studies were included in which the patients were in the late postoperative period of total or subtotal thyroidectomy due to one of the DCT and were assigned the diagnostic WBI with I131 before the ablative dose (intervention) or they performed WBI with 123I before the ablative dose, or non-performance of the diagnostic WBI (directly ablative dose with 131I) (control). The primary outcome was disease remission assessed by the ablative success rate at least six months after follow-up. Results: After performing the searches in the following electronic databases Embase (1980-25/04/2017), Pubmed (1966-25/04/2017), CENTRAL (Cochrane Controlled Trials Register) (04/25/2017) and Virtual Health Library (1982-25 /04/2017), we identified 3005 references. Two reviewers independently assessed the titles and abstracts identified by the literature search, and of these, 23 were potentially eligible, and they were selected for reading in full. Twelve studies were included: four are prospective and eight retrospective. In the four prospective studies, the ablative success rate at six months was 86% in the intervention group and 87% in the control, the meta-analysis showed no significant difference between the groups (RR 1.02, CI 0.92,1.13, p = 0.66, I2 = 0%). Among the observational studies, four studies did not present significant differences between the groups, and in three the control group had a significantly higher ablative success rate. Conclusion: With a low quality of evidence, among the prospective studies there was no significant difference in the ablative success rate in patients who underwent pre-dose PCI with 131I or performed it with 123I or did not have this diagnostic PCI. Among observational studies, in three studies, individuals who performed pre-dose PCI with 131I had a significant reduction in ablative success rate at six months of follow-up, whereas in four studies there was no significant difference between groups.