Strahlenrisiken nach Radiojodtherapie

ZUSAMMENFASSUNG

Bei der Anwendung ionisierender Strahlung ist prinzipiell die Induktion von Zweitmalignomen möglich. Dies trifft auch auf die Radiojodtherapie beim differenzierten Schilddrüsenkarzinom bzw. bei benignen Erkrankungen der Schilddrüse zu. Bei der in der Regel höher dosierten Radiojodgabe zur Behandlung des differenzierten Schilddrüsenkarzinoms ist der Effekt in einigen groß angelegten retrospektiven Studien nachweisbar und muss dem therapeutischen und auch diagnostischen Nutzen gegenübergestellt werden. Das Strahlenrisiko bei der Behandlung von gutartigen Schilddrüsenerkrankungen ist als sehr gering einzuschätzen. Eine jüngst publizierte Studie mit sehr langem Follow-up beschreibt eine dosisabhängig steigende Sterblichkeit an Zweitmalignomen. Eine am gleichen Kollektiv durchgeführte weitere Analyse fand jedoch nur eine erhöhte Sterblichkeit im Vergleich zur Normalbevölkerung bei Langzeitthyreostase und nicht nach Radiojodgabe.

Insgesamt gilt es, im Kontext von Radiojod auch bei der Interpretation von Studiendaten, die Strahlenrisiken mit den weiteren Risiken, den Vorteilen und Vorzügen bzw. Nachteilen der alternativen Therapieoptionen in Bezug zu setzen.

When using ionizing radiation, in principle, the induction of secondary malignancies always has to be taken into account. This also applies to the use of radioiodine in differentiated thyroid cancer as well as in the treatment of benign thyroid disorders. After higher dose administration of radioiodine in differentiated thyroid cancer an effect has been documented only in some large cohorts of patients and needs to be balanced in the context of the therapeutic and diagnostic benefits. The radiation risk of radioiodine treatment of benign thyroid disorders is rather small. A recently published large scale cohort study describes a dose effect on cancer mortality. However, an analysis of data from the same data collective only found an increased cancer mortality compared to the normal population in patients treated long term with antithyroid drugs and not in patients treated with radioiodine. All in all, caution must be taken, when interpreting study data on radiation risks of radioiodine, since also other risks, the benefits as well as the advantages and disadvantages of alternative therapeutic approaches have to be considered.

Schlüsselwörter

Radiojod - Strahlenrisiko - Sekundärneoplasie - ¹³¹I - Schilddrüsenkarzinom

Keywords

Radioiodine - radiation risk - secondary neoplasm - thyroid cancer

Publication History

Article published online:
02 July 2021

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