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

dc.contributor.advisorWandurraga Sánchez, Edwin Antonio
dc.contributor.advisorMorales Avellaneda, Tatiana
dc.contributor.advisorCamacho López, Paul Anthony
dc.contributor.authorTorres Agredo, Liliana Patricia
dc.coverage.spatialBucaramanga (Santander, Colombia)spa
dc.coverage.temporal2010-2019spa
dc.date.accessioned2021-09-10T19:22:29Z
dc.date.available2021-09-10T19:22:29Z
dc.date.issued2021
dc.identifier.urihttp://hdl.handle.net/20.500.12749/14233
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.spa
dc.description.tableofcontentsLISTA DE SIGLAS LISTADO DE TABLAS LISTA DE ILUSTRACIONES O FIGURAS LISTA DE ANEXOS RESUMEN ABSTRACT INTRODUCCIÓN JUSTIFICACIÓN MARCO TEÓRICO ESTADO DEL ARTE PREGUNTA DE INVESTIGACIÓN OBJETIVOS METODOLOGÍA PROCEDIMIENTO DISPOSICIONES VIGENTES RESULTADOS DISCUSIÓN CONCLUSIONES FORTALEZAS Y LIMITACIONES FINANCIACIÓN Y CONFLICTOS DE INTERÉS REFERENCIAS
dc.format.mimetypeapplication/pdfspa
dc.language.isospaspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/*
dc.titleFactores asociados a remisión imagenológica funcional completa en pacientes con carcinoma diferenciado de tiroides tratados con yodo radiactivo para manejo de metástasis pulmonaresspa
dc.title.translatedFactors associated with complete functional imaging remission in patients with differentiated thyroid carcinoma treated with radioactive iodine for the management of lung metastasesspa
dc.degree.nameEspecialista en Medicina Nuclearspa
dc.publisher.grantorUniversidad Autónoma de Bucaramanga UNABspa
dc.rights.localAbierto (Texto Completo)spa
dc.publisher.facultyFacultad Ciencias de la Saludspa
dc.publisher.programEspecialización en Medicina Nuclearspa
dc.description.degreelevelEspecializaciónspa
dc.type.driverinfo:eu-repo/semantics/masterThesis
dc.type.localTesisspa
dc.type.coarhttp://purl.org/coar/resource_type/c_bdcc
dc.subject.keywordsMedical sciencesspa
dc.subject.keywordsHealth sciencesspa
dc.subject.keywordsNuclear medicinespa
dc.subject.keywordsRadiationspa
dc.subject.keywordsPhysiological effectspa
dc.subject.keywordsThyroid cancerspa
dc.subject.keywordsLung metastasisspa
dc.subject.keywordsRadioactive iodine therapyspa
dc.subject.keywordsWhole body scanspa
dc.subject.keywordsEndocrine glandsspa
dc.subject.keywordsThyroid diseasesspa
dc.subject.keywordsCarcinomasspa
dc.identifier.instnameinstname:Universidad Autónoma de Bucaramanga - UNABspa
dc.identifier.reponamereponame:Repositorio Institucional UNABspa
dc.type.hasversioninfo:eu-repo/semantics/acceptedVersion
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.accessrightshttp://purl.org/coar/access_right/c_abf2spa
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dc.contributor.cvlacWandurraga Sánchez, Edwin Antonio [0001475567]spa
dc.contributor.cvlacCamacho López, Paul Anthony [0000323578]
dc.contributor.cvlacCamacho López, Paul Anthony [0000323578]
dc.contributor.googlescholarCamacho López, Paul Anthony [es&oi=ao]
dc.contributor.googlescholarCamacho López, Paul Anthony [OvqUoOAAAAAJ]
dc.contributor.orcidWandurraga Sánchez, Edwin Antonio [0000-0002-0529-2343]spa
dc.contributor.orcidCamacho López, Paul Anthony [0000-0002-6233-9582]
dc.contributor.orcidCamacho López, Paul Anthony [0000-0002-6233-9582]
dc.contributor.scopusCamacho López, Paul Anthony [16047325700]
dc.contributor.researchgateWandurraga Sánchez, Edwin Antonio [Edwin-Antonio-Wandurraga-Sanchez-2168480303]spa
dc.contributor.researchgateCamacho López, Paul Anthony [Paul_Camacho_Lopez]
dc.subject.lembCiencias médicasspa
dc.subject.lembMedicina nuclearspa
dc.subject.lembRadiaciónspa
dc.subject.lembEfectos fisiológicosspa
dc.subject.lembGlándulas endocrinasspa
dc.subject.lembEnfermedades de las tiroidesspa
dc.subject.lembCarcinomasspa
dc.identifier.repourlrepourl:https://repository.unab.edu.cospa
dc.description.abstractenglishIntroduction: differentiated thyroid carcinoma (DTC) is one of the most commonly observed types of endocrine cancer. In general, the prognosis for CDT is favorable; however, patients with distant metastases have a worse prognosis. The most frequent distant localization of CDT metastases is at the pulmonary level and radioactive iodine therapy [131I] NaI is the most appropriate for those pulmonary metastases of CDT avid for [131I] NaI but that cannot be surgically resected and can alleviate the condition partially or remove the injury effectively. It has now become the cornerstone of treatment for CDT lung metastases and to date, some previous research has discussed the efficacy of radioactive iodine and its influencing factors for CDT patients with lung metastases. Objective: To evaluate the efficacy of therapy with [131I] NaI for patients with DTC with pulmonary metastases, seeking to explore the factors associated with complete functional imaging remission Materials and methods: A retrospective cohort study was conducted, including patients treated at a nuclear medicine center between January 1, 2010 and December 31, 2019 with a diagnosis of differentiated thyroid carcinoma with pulmonary metastases, who underwent he performed ablative therapy with radioactive iodine after total thyroidectomy, and complete imaging remission was subsequently analyzed, using the [131I] NaI -RCT findings after 24 months of treatment with [131I] NaI. Sociodemographic, histopathological, clinical and surgical variables were taken to establish the factors associated with functional pulmonary remission. Results: Of the 10 years of follow-up, 2,640 patients with DTC were identified, 3.18% presented metastases at the lung level, and when applying the inclusion-exclusion criteria, 54 patients (2.05%) were recruited. In the bivariate analysis, associations were found between the pulmonary functional response after iodine therapy and tumor size greater than 3.5 cm RR 0.56, CI (95% 0.19-1.6) p = 0.28], the presence of extrathyroid extension (TEE) [RR 0.53, CI (95% 0.18-1.57) p = 0.24], and having a cumulative dose greater than 370 mCi (13690 MBq) [RR 3.75, CI (95% 1.13-12.34) p = 0.16]. 42% of the patients had complete remission after the third dose of [131I] NaI; having more sessions of therapy with radioactive iodine is 4.7 times more likely to present imaging remission than having fewer sessions of therapy with [131I] NaI [RR 4.7, CI (95% 1.13-12.34) p = 0.03 ]. When performing multivariate analysis, the factors associated with the prediction of efficacy in [131I] Na therapy for CDT with lung metastases were the presence of TEE and the administration of radioactive iodine in a number of doses> 3 times. Conclusions: This study indicated that one in five CDT patients with lung metastases can achieve complete remission after [131I] NaI therapy. The administration of radioactive iodine in a number of doses> 3 times is an indicative factor of a good response.spa
dc.subject.proposalCiencias de la saludspa
dc.subject.proposalCáncer de tiroidesspa
dc.subject.proposalMetástasis pulmonarspa
dc.subject.proposalTerapia yodo radioactivospa
dc.subject.proposalRastreo corporal totalspa
dc.type.redcolhttp://purl.org/redcol/resource_type/TM
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 2.5 Colombia*
dc.contributor.apolounabCamacho López, Paul Anthony [paul-anthony-camacho-lópez]
dc.coverage.campusUNAB Campus Bucaramangaspa
dc.description.learningmodalityModalidad Presencialspa
dc.contributor.linkedinCamacho López, Paul Anthony [paulcamachomdepi]


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