A Brief History of Radioactive Iodine Theranostics: Origins of Nuclear Ontology
John Dennis Ehrhardt1, Seza Gulec21Aventura Hospital and Medical Center and Kendall Regional Medical Center, Miami, FL, USA2Miami Cancer Research Center, Miami, FL, USA
The early history of radioactive iodine (RAI) use in thyroid disease is well-cultivated in the literature, yet largely oriented towards hyperthyroidism. Saul Hertz’s success with RAI in thyrotoxicosis fueled a seamless transition to Samuel Seidlin’s investigations with RAI in thyroid cancer. These landmark events embody nuclear ontology, a philosophical foundation for the creation and existence of radiotherapeutic principles that continue to influence clinical practice today. Saul Hertz of the Massachusetts General Hospital Thyroid Clinic created a framework for RAI theranostics with preclinical experiments and clinical cases from 1937-1942. Samuel Seidlin of Montefiore Hospital consulted Hertz on the feasibility of using RAI for thyroid cancer in 1942. Seidlin and colleagues assembled a sixteen-patient series showcasing a unique entity: functional thyroid metastases that respond to RAI. Other investigations at the time demonstrated that RAI had little efficacy as a therapeutic agent, mainly because most thyroid tumors do not form colloid, and therefore cannot concentrate RAI. These findings were soon overshadowed by a mainstream article in the October 1949 issue of Life that portrayed RAI as a lifesaving therapy for thyroid cancer. The paradigm was set, and later writings by William H. Beierwaltes and other prominent nuclear medicine physicians established the primary goals and principles of RAI therapy. This paper examines controversial topics in the advent of thyroid theranostics, and applies historical significance to current discussions on the role of RAI in thyroid cancer management. Another paradigm shift is on the horizon as thyroidology enters the age of genomics. The molecular theranostic profiles will soon be incorporated into a dynamic clinical decision-making and management algorithm for thyroid surgery and RAI therapy.
Keywords: Thyroid theranostics, radioactive iodine, Saul Hertz, Samuel Seidlin, history of medicineRadyoaktif IyotTeranostiginin Kisa Hikayesi: Nukleer Ontolojinin Kokenleri
John Dennis Ehrhardt1, Seza Gulec21Aventura Hospital and Medical Center and Kendall Regional Medical Center, Miami, FL, USA2Miami Cancer Research Center, Miami, FL, USA
Titoit hastaliklarinda radyoaktif iyot kullaniminin ilk yillarina ait calismalar hipertiroidi konusunda yogunlasmistir Saul Hertz’un basarili calismalari, hipertiroidi tedavisinde edinilen basarinin dogal olarak kanser tedavisine aktarilabilecegi inancini dogurmustur. Ilk calismalarin teranostik gostergeleri daha sonraki yillarda gidedrek guclenecek olan nukleer onkolojinin bilimsel ve felsefi temelini olusrturmasi itibariyle “ontolojik” bir oneme haizdir. Bu ontolojik temeli atan Dr. Saul Hertz Harvard Universitesi ile baglantili calisan Massachusetts General Hospital Tiroit klinigi kurucu direktorudur. Hertz bugunku bilgilerimize esas olmus tiroit teranostik caismalarini 1937-1942 yillari arasinda surdurmustur. Radyoaktif iyot ile Ilk tiroit kanseri tedavisi 1942 de Samuel Seidlin tarafindan uygulanmistir. Ilk uygulamanin sansayonel etkisi, ilginc olarak, bilimsel verileri golgeleyecek kadar guclu olmustur. Kavramin gelismasinde erken yillarda teorik fizik ve nukleer instrumantasyonlardaki gelismelerin ve bu gelismelere imza atan bilim adamlarinin buyuk katkilari olmustur. Nukleer tip alaninda ise William H. Beierwaltes en onemli katkilari olan bir klinik arastirmaci olarak tarihimize gecmistir. Onunla baslayan klasik paradigma bizleri bugunun molekuler teranostik gorus acisina kadar tasimistir. Bundan boyle molekuler patoloji ve yeni teranostik acilimlar ile nukleer onkoloji artik yeni bir ontolojik kimlige kavusacaktir.
Anahtar Kelimeler: .,.,.Corresponding Author: Seza Gulec, United States
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