Special Issue Postoperative Adjuvant Therapy and Follow Up of Thyroid Carcinoma Ka Hee Yi, M.D. Department of Internal Medicine Korea Cancer Center Ho
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1 Special ssue Postoperative Adjuvant Therapy and Follow Up of Thyroid Carcinoma Ka Hee Yi, M.D. Department of nternal Medicine Korea Cancer Center Hospital khyi@kcch.re.kr Abstract Differentiated thyroid cancer is usually a curable disease, for which treatment modalities such as surgery, radioiodine, and thyroid hormone have been used for the last 50 years, yet little consensus has been established due to the lack of prospective randomized controlled therapeutic trials. After an initial surgery, the patients' outcome can be predicted by staging classification on the basis of several parameters such as the age of the patient, tumor size, tumor grade or differentiation, presence of local invasion, and regional or distant metastases. However, regardless of the pathologic stage, most patients(except those with micopapillary or minimally invasive follicular carcinomas who underwent only a lobectomies) are supposed to receive radioiodine therapy for ablation of any remnant thyroid tissue, which increases the sensitivity of serum Tg and 131 whole body scan used to detect recurrence or metastasis during a longterm followup. Until recently, a high dose of 131 has been preferred, however, low dose therapy(30mci) is a new trend nowadays, which decreases the incidence of both acute and late complications of radioiodine with the same ablation rate. All patients take thyroid hormone after surgery and radioremnant ablation to suppress the level of serum TSH, which is thought to stimulate tumor cell growth.the T 4 dose should be adjusted according to the age of the patient, other medical conditions and the risk of recurrence. During the followup, the serum Tg level with antitg antibody and the TSH level and 131 whole body scan should be checked regularly. Recently the serum Tg level stimulated by T 4 withdrawal or rhtsh injection is suggested to be the most sensitive marker for the detection of recurrence or metastasis. When the stimulated Tg is undetectable (< 2ng/mL), residual or metastatic cancer can be nearly excluded; when it is higher than 10ng/mL, a high dose 131 therapy and posttherapy 131 whole body scan are needed. n cases where the localization fails(tgpositive/ 131 scannegative cases), other imaging studies such as highresolution ultrasonography of the neck, spiral CT of chest, bone Xray or 99m Tc MDP bone scan and 18 FFDG PET scan can be useful. 18 FFDG PET is especially sensitive to detect poorly differentiated thyroid cancers that have lost the ability to uptake radioiodine. Keywords : Thyroid cancer; Staging; Radioiodine; Thyroid hormone; Follow up 1183
2 Special ssue (AJCC) Stage 4545 M0 T1 T1 M1 T2 T2~4 VA VB VC T3N0M0 T13N1aM0 T4a N1b T4b M1 N1 M1 1184
3 Staging or Scoring System EORTC AGES AMES U of C MACS OSU MSKCC (1979) (1987) (1988) (1990) (1993) (1994) (1995) :, :, : EORTC = European Organization for Research and Treatment of Cancer AGES ; Lahey clinic AMES, MACS ; Mayo clinic U of C = University of Chicago OSU = Ohio State University MSKCC = Memorial SloanKettering Cancer Center ü 1185
4 Special ssue National Thyroid Cancer Treatment Cooperation Study Registry (cm) < 1 1~4 > , V V 1186
5 1187
6 Special ssue 1188
7 1189
8 Special ssue 1190
9 1191
10 Special ssue 1192
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14 Special ssue differentiated thyroid cancer : a prospective study. J Nucl Med 1992 ; 33 : Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Pinchera A, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for lowrisk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 2003 ; 88 : Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Wiersinga WM, et al. Followup of lowrisk patients with differentiated thyroid carcinoma : a European perspective. Eur J Endocrinol 2004 ; 150 : Park HM, Perkins OW, Edmondson JW, Schnute RB, Manatunga A. nfluence of diagnostic radioiodines on the uptake of ablative dose of iodine131. Thyroid 1994 ; 4 : Schlumberger M, Mancusi F, Baudin E, Pacini F. 131 therapy for elevated thyroglobulin levels. Thyroid 1997 ; 7 : Cailleux AF, Baudin E, Travagli JP, Ricard M, Schlumberger M. s diagnostic iodine131 scanning useful after total thyroid ablation for differentiated thyroid cancer? J Clin Endocrinol Metab 2000 ; 85 : Antonelli A, Miccoli P, Ferdeghini M, Di Coscio G, Alberti B, Baschieri L, et al. Role of neck ultrasonography in the follow up of patients operated on for thyroid cancer. Thyroid 1995 ; 5 : Naidich DP. Helical computed tomography of the thorax : clinical applications. Radiol Clin North Am 1994 ; 32 : Feine U, Lietzenmayer R, Hanke JP, Held J, Wohrle H, Müller Schauenburg W. Fluorine18FDG and iodine131iodide uptake in thyroid cancer. J Nucl Med 1996 ; 37 : Grunwald F, Schomburg A, Bender H, Klemm E, Menzel C, Biersack HJ, et al. Fluorine18 fluorodeoxyglucose positron emission tomography in the followup of differentiated thyroid cancer. Eur J Nucl Med 1996 ; 23 : Chung JK, So Y, Lee JS, Choi CW, Lim SM, Cho BY, et al. Value of FDG PET in papillary thyroid carcinoma with negative 131 wholebody scan. J Nucl Med 1999 ; 40 : Petrich T, Borner AR, Otto D, Hofmann M, Knapp WH. nfluence of rhtsh on [(18)F]fluorodeoxyglucose uptake by differentiated thyroid carcinoma. Eur J Nucl Med Mol maging 2002 ; 29 : Wang W, Larson SM, Fazzari M, Tickoo SK, Kolbert K, Robbins RJ, et al. Prognostic value of [18F]fluorodeoxyglucose positron emission tomographic scanning in patients with thyroid cancer. J Clin Endocrinol Metab 2000 ; 85 :
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DOI: 10.3857/JKSTRO.2008.26.2.113 노령의 피부암에서 방사선치료 계명대학교 의과대학 동산의료원 방사선종양학교실 김 진 희 목 적: 노령의 피부암에서 방사선치료 후 국소 제어률, 생존율, 실패양상, 부작용을 알아보기 위해 이 연구를 시행 하였다. 대상 및 방법: 1990년 1월부터 2002년 10월까지 계명대학교 동산의료원 방사선종양학과에서
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RESEARCH ARTICLE Kor. J. Aesthet. Cosmetol., 20-40대 여성의 외모만족도가 미용관리태도에 미치는 영향 홍수남 1, 김효숙 2 * 1 건국대학교 뷰티사이언스디자인학과, 2 건국대학교 의상디자인과 Effects of Extrinsic Body Satisfaction on Beauty Management Behavior of
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서론
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