Factores asociados a remisión imagenológica funcional completa en pacientes con carcinoma diferenciado de tiroides tratados con yodo radiactivo para manejo de metástasis pulmonares

dc.contributorWandurraga Sánchez, Edwin Antonio
dc.contributorMorales Avellaneda, Tatiana
dc.contributorCamacho López, Paul Anthony
dc.contributorWandurraga Sánchez, Edwin Antonio [0001475567]
dc.contributorCamacho López, Paul Anthony [0000323578]
dc.contributorCamacho López, Paul Anthony [es&oi=ao]
dc.contributorWandurraga Sánchez, Edwin Antonio [0000-0002-0529-2343]
dc.contributorCamacho López, Paul Anthony [0000-0002-6233-9582]
dc.contributorCamacho López, Paul Anthony [16047325700]
dc.contributorWandurraga Sánchez, Edwin Antonio [Edwin-Antonio-Wandurraga-Sanchez-2168480303]
dc.creatorTorres Agredo, Liliana Patricia
dc.date.accessioned2021-09-10T19:22:29Z
dc.date.available2021-09-10T19:22:29Z
dc.date.created2021-09-10T19:22:29Z
dc.date.issued2021
dc.identifierhttp://hdl.handle.net/20.500.12749/14233
dc.identifierinstname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifierreponame:Repositorio Institucional UNAB
dc.identifierrepourl:https://repository.unab.edu.co
dc.description.abstractIntroducción: el carcinoma diferenciado de tiroides (CDT) es uno de los tipos de cáncer endocrino más comúnmente observados. En general, el pronóstico del CDT es favorable; sin embargo, los pacientes que presentan metástasis a distancia tienen peor pronóstico. La localización a distancia más frecuente de las metástasis del CDT es a nivel pulmonar y la terapia con yodo radiactivo [131I]NaI es las más adecuada para aquellas metástasis pulmonares de CDT ávidas de [131I]NaI pero que no se pueden resecar quirúrgicamente y puede aliviar la afección parcialmente o eliminar la lesión de manera efectiva. Actualmente se ha convertido en la piedra angular del tratamiento de las metástasis pulmonares del CDT y hasta la fecha, algunas investigaciones previas han discutido la eficacia del yodo radioactivo y sus factores influyentes para los pacientes con CDT con metástasis pulmonares. Objetivo: Evaluar la eficacia de la terapia con el [131I]NaI para los pacientes con CDT con metástasis pulmonares, buscando explorar los factores asociados con la remisión imagenológica funcional completa. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo, incluyendo a los pacientes atendidos en un centro de medicina nuclear entre el 1 enero de 2010 al 31 de diciembre de 2019 con diagnóstico de carcinoma diferenciado de tiroides. con metástasis pulmonares, a quienes se les realizó terapia ablativa con yodo radioactivo luego de la tiroidectomía total y posteriormente se analizó la remisión imagenológica completa, mediante los hallazgos del [131I]NaI -RCT posterior a los 24 meses de tratamiento con [131I]NaI. Se tomaron las variables sociodemográficas, histopatológicas, clínicas y quirúrgicas, para establecer los factores asociados con la remisión funcional pulmonar. Resultados: De los 10 años de seguimiento se identificaron 2640 pacientes con CDT el 3,18% presentaron metástasis a nivel pulmonar, y al aplicar los criterios de inclusión - exclusión se reclutaron 54 pacientes (2,05%). En el análisis bivariado, se encontró asociaciones entre la respuesta funcional pulmonar posterior a la terapia con yodo y el tamaño tumoral mayor a 3,5 cm RR 0.56, IC (95% 0.19-1.6) p = 0,28], la presencia de extensión extratiroidea (ETE) [RR 0.53, IC (95% 0.18-1.57) p = 0,24], y tener una dosis acumulada mayor a 370 mCi (13690 MBq) [RR 3.75, IC (95% 1.13-12.34) p = 0.16]. El 42 % de los pacientes presentaron remisión completa posterior a la tercera dosis de [131I] NaI; el tener mas sesiones de terapia con yodo-radioactivo presenta una probabilidad de 4,7 veces más de presentar remisión imagenológica que el realizar menos sesiones de terapia con [131I]NaI [RR 4.7, IC (95% 1.13-12.34) p = 0.03]. Al realizar el análisis multivariado, los factores asociados con la predicción de la eficacia en la terapia con [131I]Na para CDT con metástasis pulmonares fueron la presencia de ETE y la administración de yodo radiactivo en un número de dosis > de 3 veces. Conclusiones: Este estudio indicó que uno de cada cinco pacientes con CDT con metástasis pulmonares pueden obtener una remisión completa después de la terapia con [131I]NaI. La administración de yodo radiactivo en un número de dosis > de 3 veces, es un factor indicativo de buena respuesta.
dc.languagespa
dc.publisherUniversidad Autónoma de Bucaramanga UNAB
dc.publisherFacultad Ciencias de la Salud
dc.publisherEspecialización en Medicina Nuclear
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dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombia
dc.titleFactores asociados a remisión imagenológica funcional completa en pacientes con carcinoma diferenciado de tiroides tratados con yodo radiactivo para manejo de metástasis pulmonares


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