RESUMEN
INTRODUCTION: The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF-). METHOD: A prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48h after and 6months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. RESULTS: 41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stagesiii and iv, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P=.01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P=.03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P=.02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P=.02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P=.02) and at 7days (0.006%/gr vs 0.034%/gr, P=.04) CONCLUSIONS: The mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease.
Asunto(s)
Radioisótopos de Yodo/uso terapéutico , Mutación , Proteínas Proto-Oncogénicas B-raf/genética , Cáncer Papilar Tiroideo/genética , Cáncer Papilar Tiroideo/terapia , Estudios de Cohortes , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Estudios ProspectivosRESUMEN
PURPOSE: The correct determination and delineation of tumor/organ size is crucial in 2-D imaging in 131I therapy. These images are usually obtained using a system composed of a Gamma camera and high-energy collimator, although the system can produce artifacts in the image. This article analyses these artifacts and describes a correction filter that can eliminate those collimator artifacts. METHODS: Using free software, ImageJ, a central profile in the image is obtained and analyzed. Two components can be seen in the fluctuation of the profile: one associated with the stochastic nature of the radiation, plus electronic noise and the other periodically across the position in space due to the collimator. These frequencies are analytically obtained and compared with the frequencies in the Fourier transform of the profile. A specially developed filter removes the artifacts in the 2D Fourier transform of the DICOM image. This filter is tested using a 15-cm-diameter Petri dish with 131I radioactive water (big object size) image, a 131I clinical pill (small object size) image, and an image of the remainder of the lesion of two patients treated with 3.7GBq (100mCi), and 4.44GBq (120mCi) of 131I, respectively, after thyroidectomy. RESULTS: The artifact is due to the hexagonal periodic structure of the collimator. The use of the filter on large-sized images reduces the fluctuation by 5.8-3.5%. In small-sized images, the FWHM can be determined in the filtered image, while this is impossible in the unfiltered image. The definition of tumor boundary and the visualization of the activity distribution inside patient lesions improve drastically when the filter is applied to the corresponding images obtained with HE gamma camera. CONCLUSION: The HURRA filter removes the artifact of high-energy collimator artifacts in planar images obtained with a Gamma camera without reducing the image resolution. It can be applied in any study of patient quantification because the number of counts remains invariant. The filter makes possible the definition and delimitation of small uptakes, such as those presented in treatments with 131I.