Dr.

Aisyah Elliyanti SpKN,Mkes

Instalasi Kedokteran Nuklir
 HISTORY-THERAPY

1936 Therapeutic use of Na-24 (leukemia) Hamilton et al

1936 Therapeutic use of P-32 (leukemia and Lawrence
polycythemia vera)
1941 Therapeutic use of iodine in hyperthyroidism Hertz et al
1942 Therapeutic use of iodine in treatment of
metastasis from thyroid cancer
1945 Therapeutic use of Au-198 in treatment of Muller
malignant effusion
1958 Treatment of bone metastasis with P-32 Maxfield
1963 Medical synovectomy using Au-198 Ansell
 CURRENT METHODS-THERAPY
Radiopharmaceutical For treatment of Route of Maximum
administration activity

I-131 iodide Thyrotoxicosis Oral 1 GBq

I-131 iodide Carcinoma of thyroid Oral 20 GBq
I-131 MIBG Malignancy IV 10 GBq
P-32 phosphate Polycythaemia vera IV or oral 200 MBq
Sr-89 chloride Bone metastases IV 150 MBq
Y-90 colloid Arthritic conditions Intra-articular 250 MBq
malignant effusions Intra-cavitary 5 GBq
Er-169 colloid Arthritic conditions Intra-articular 50 MBq
Re-186 colloid Arthritic conditions Intra-articular 150 MBq
Terapi Radiasi

Terapi radiasi eksterna

Sumber radiasi tertutup
Diberikan secara transmisi
Sifat : Definitif, adjuvan dan paliatif

Terapi radiasi interna

Sumber radiasi terbuka
Diberikan secara oral/parenteral
Sifat : adjuvan, paliatif
Jenis Radioisotop

Iodium radioaktif (I-131)

Strontium-89 Clorida (89SrCl)
Samarium-153 (153Sm)EDTMP
Rhenium-189 (189Re) HEDP
Phosporus-32
Contoh terapi radiasi interna
Iodine-131 (sodium iodide) untuk hipertiroidi,
karsinoma tiroid well differentaited
Phosphorus-32 (sodium phosphate)
Myeloproliferative disorders such as polycythemia vera and
thrombocytosis.
intracavitary therapy of malignant ascites, malignant pleural
effusion, malignant pericardial effusions, and malignant brain
cysts.
Strontium-89 (strontium chloride) and samarium-153
lexidronam ethylene diaminetetrame
thylenephosphonic acid (EDTMP)
Terapi adjuvant dan palliative nyeri tulang karena
metastase
Yttrium-90 ibritumomab tiuxetan and iodine-131
tositumomab.
treatment of patients with CD20 positive follicular B-cell non-
Hodgkin's lymphoma
Terapi definitif

Hipertiroidi
Radioisotop : Iodium 131
Diberikan per-oral
Waktu paruh 8 hari
Sifat : memancarkan radiasi beta dan gamma
Tujuan : eutiroid
Mengablasi sel-sel folikel tiroid sehingga produksi
hormon tiroid yang berlebihan dihentikan
Efek baru akan tampak setelah 8-12 minggu
Munculnya efek yang diharapkan dipengaruhi oleh
dosis
Dapat menimbulkan hipotiroidi setelah pengobatan
hormon tiroid
Kontra indikasi terapi I-131
Thyrotoxicosis factitia
Subacute thyroiditis
Silent thyroiditis (atypical ,subacute,
lymphocytic, transient, postpartum)
Struma ovarii
Thyroid hormone resistance
Secondary hyperthyroidism
Thyrotoxicosis associated with Hashimotos
disease (hashitoxicosis)
Jod-Basedow phenomenon (iodine-induced
hyperthyroidism)
 Terapi Adjuvan
Kanker tiroid berdifferensiasi baik
Radioisotop : Iodium 131
Diberikan per-oral
Kombinasi dengan terapi hormon tiroid
Pasca total tiroidektomi ( 5-6 minggu)
Bertujuan mengablasi jaringan tiroid yang tersisa
(mikro)
Terapi dapat diulang setelah 4-6 bulan ( tergantung
hasil kontrol kadar tiroglobulin,sidik seluruh tubuh)
Maksimal jumlah dosis 1 curie
Tiroglobulin tetap tinggi, jaringan sisa menentap di
lapang tiroid radioresisten
Radioresisten dilanjutkan dengan radiasi eksterna
Kanker Tiroid
Papillary Follicular Medullary Anaplastic

% of 76 % 16 % 4% 1%
thyroid
cancers
% die from 6% 24 % 33 % 98 %
thyroid Ca
Treatment Surgery Surgery Surgery Surgery
RAI RAI +/- XRT
LT4 LT4
 Prognostic Risk Classification for Patients with Well-
Differentiated Thyroid Cancer
(AMES or AGES)

Low Risk High Risk

Age <40 years >40 years
Sex Female Male
Extent No local extension, Capsular invasion, extra-
intrathyroid, no caps thyroidal extension
invasion
Metastasis None Regional/distant
Size <2 cm >4 cm
Grade Well diff Poorly diff
Radioiodine treatment

Not statistically significances of

leading the secondary cancer by
radioiodine therapy
Not reduce fertility
Congenital defects are not increased
in the child of treated patients
Terapi Paliatif

Terapi pada rasa nyeri akibat proses

metastase ke tulang
Penyakit keganasan dengan metastase
ketulang menimbulkan nyeri yang hebat
Timbul nyeri belum diketahui dengan pasti
Hipotesis :
infiltrasi tumor dan ekspansi membrana
periosteal yang kaya dengan nosiseptor
ketidak stabilan mekanik tulang yang terserang
Produksi mediator humoral oleh sel tumor
maupun oleh sel lainnya pada
microenviromental osteoklast
Radioisotop untuk terapi
paliatif nyeri
Posphorus-32 (32P)
Strontium-89 Clorida (89Sr-Cl)
Samarium-153 (153Sm)EDTMP
Rhenium-186(186Re)HEDP
Terapi Radiasi Interna

Terapi dapat diberikan pada pasien

bila jumlah trombosit >60.000/ml dan
leukosit >2.400/ml
Kontraindikasi
Hamil
Laktasi
Hasil pemeriksaan darah tepi abnormal
Efek samping
Mielosupresi bersifat sementara
Terapi dapat diulang dalam masa 3-
24 bulan pasca terapi sebelumnya