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Domínguez Ayala M, Expósito Rodríguez A, Bilbao González A, Mínguez Gabiña P, Gutiérrez Rodríguez T, Rodeño Ortiz de Zarate E, García Carrillo M, Barrios Treviño B. BRAF V600E mutation in papillary thyroid cancer and its effect on postoperative radioiodine ( 131I) therapy: Should we modify our therapeutic strategy? Cir Esp 2018; 96:276-282. [PMID: 29567362 DOI: 10.1016/j.ciresp.2018.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Maite Domínguez Ayala
- Departamento de Cirugía General y Digestiva, Hospital Universitario Basurto, Bilbao, España.
| | | | | | - Pablo Mínguez Gabiña
- Departamento de Medicina Física, Hospital Universitario Gurutzeta-Cruces, Barakaldo, Bizkaia, España
| | | | | | | | - Borja Barrios Treviño
- Departamento de Cirugía General y Digestiva, Hospital Universitario Basurto, Bilbao, España
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202
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Ballinger JR. Theranostic radiopharmaceuticals: established agents in current use. Br J Radiol 2018; 91:20170969. [PMID: 29474096 DOI: 10.1259/bjr.20170969] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although use of the term "theranostic" is relatively recent, the concept goes back to the earliest days of nuclear medicine, with the use of radioiodine for diagnosis and therapy of benign and malignant thyroid disease being arguably the most successful molecular radiotherapy in history. A diagnostic scan with 123I-, 124I-, or a low activity of 131I-iodide is followed by therapy with high activity 131I-iodide. Similarly, adrenergic tumours such as phaeochromocytoma and neuroblastoma can be imaged with 123I-metaiodobenzylguanidine and treated with 131I-metaiodobenzylguanidine. Bone scintigraphy can be used to select patients with painful bone metastases from prostate cancer who may benefit from treatment with beta- or alpha-particle emitting bone seeking agents, the most recent and successful of which is 223Ra radium chloride. Anti-CD20 monoclonal antibodies can be used to image and treat non-Hodgkins lymphoma, though this has not been as commercially successful as initially predicted. More recently established theranostics include somatostatin receptor targeting peptides for diagnosis and treatment of neuroendocrine tumours with agents such as 68Ga-DOTATATE and 177Lu-DOTATATE, respectively. Finally, agents which target prostate-specific membrane antigen are becoming increasingly widely available, despite the current lack of a commercial product. With the recent licensing of the somatostatin peptides and the rapid adoption of 68Ga- and 177Lu-labelled prostate-specific membrane antigen targeting agents, we have built upon the experience of radioiodine and are already seeing a great expansion in the availability of widely accepted theranostic radiopharmaceuticals.
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Affiliation(s)
- James R Ballinger
- 1 Department of Imaging Chemistry and Biology, School of Biomedical Engineering and Imaging Sciences, King's College London , London , UK
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203
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Han YH, Jeong HJ, Sohn MH, Lee SY, Lim ST. Radioiodine ablation in thyroid cancer patients: renal function and external radiation dose rate at discharge according to patient preparation. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018. [PMID: 29521481 DOI: 10.23736/s1824-4785.18.03029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An elevated thyroid stimulating hormone (TSH) level is essential for the uptake of radioiodine into thyroid remnants and residual thyroid cancer in patients undergoing high-dose radioiodine therapy (HD-RIT). Recently, the use of recombinant human thyroid stimulating hormone (rh-TSH) has increased in preference over the conventional method of thyroid hormone withdrawal (THW). However, the clinical influences of the two methods, aside from the therapeutic effects, have not been widely evaluated. The aim of this work was to investigate the influences of the two methods, particularly on the renal function and external radiation dose rate (EDR) from patients undergoing HD-RIT. METHODS From February 2012 to November 2016, 667 patients (M:F=138:529, mean age: 47.7±11.8 years), who underwent first HD-RIT (120, 150, or 180 mCi, 1 mCi=37 MBq) for ablation of remnant thyroid tissue or residual thyroid cancer, were enrolled. Patients who were proven to have distant metastasis to lung or bone were excluded. Low- to high-risk patients based on 2015 American thyroid association management guidelines who underwent first HD-RIT in our department were included. The period from total thyroidectomy to HD-RIT was limited within 12 months. The following parameters were collected and evaluated: age, gender, histology type and TNM stage of thyroid cancer, glomerular filtration rate on the admission day for total thyroidectomy (baseline GFR), GFR on the day of HD-RIT (follow-up GFR), thyroglobulin (Tg) and TSH levels on the day of HD-RIT, and EDR on the discharge day after HD-RIT. RESULTS There were 386 patients using the THW method and 281 patients choosing the rh-TSH method. The baseline GFR of the THW group (106±16 mL/min/1.73 m2) and that of the rh-TSH group (104±17 mL/min/1.73 m2) were within normal limits and there was no significant difference. However, follow-up GFR of the THW group (84±17 mL/min/1.73 m2) was much lower than that of the rh-TSH group (104±16 mL/min/1.73 m2) (P=0.000). In the THW group, the follow-up GFR decreased significantly (P=0.000), yet the follow-up GFR of the rh-TSH group was not statistically different when compared with its baseline GFR (P=0.142). EDRs were lower in all rh-TSH subgroups compared to those of THW subgroups with statistical significance. Tg and TSH levels were not different between the two groups, excluding a few small-sized subgroups analyses. CONCLUSIONS In this retrospective analysis of renal function and EDR, the use of rh-TSH appears to help maintain renal function and finally decrease EDR in contrast to the THW method when undergoing HD-RIT.
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Affiliation(s)
- Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Myung-Hee Sohn
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Sun Y Lee
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea.,Department of Radiation Oncology, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea
| | - Seok T Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea - .,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea
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204
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Piccardo A, Puntoni M, Ferrarazzo G, Foppiani L, Bottoni G, Altrinetti V, Treglia G, Naseri M, Dib B, Cabria M, Trimboli P, Massollo M, Giovanella L. Could short thyroid hormone withdrawal be an effective strategy for radioiodine remnant ablation in differentiated thyroid cancer patients? Eur J Nucl Med Mol Imaging 2018; 45:1218-1223. [PMID: 29460027 DOI: 10.1007/s00259-018-3955-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/18/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Current guidelines recommend thyroid hormone withdrawal (THW) of 3-4 weeks before radioiodine remnant ablation (RRA) of differentiated thyroid carcinoma (DTC). We aimed to evaluate (1) the reliability of a shorter THW (i.e., 14 days) to achieve adequate TSH levels (i.e., 30 mU/l), (2) the association between length of THW and response to therapy, and (3) the potential association between pre-ablation TSH levels and patients' outcome. METHODS After thyroidectomy, all patients started LT4 therapy, which was subsequently discontinued in order to perform RRA. Patients were broken down into two groups according to the length of THW: group A, 2 weeks of THW, and group B, 3-4 weeks of THW. We used clinical, biochemical, and imaging data to evaluate patients' outcome. By means of univariate and multivariate analysis, including main DTC prognostic factors, we assessed the impact of THW length and TSH levels on patients' outcome. RESULTS We evaluated 222 patients, 85 of whom were treated with RRA after a THW period of 2 weeks (group A). All other 137 patients underwent RRA after 3-4 weeks THW (group B). At the time of RRA all patients presented TSH levels ≥30 mU/l. After a median follow-up time of 3.4 years, we found 183 patients (82%) with excellent response to treatment and 39 patients (18%) showing incomplete response. Kaplan-Meier response to therapy curves showed that ablation-Tg, tumor size, and lymph node status were significantly associated with prognosis; no associations were found between THW length, TSH levels, and prognosis. Multivariate Cox model showed that only ablation-Tg was significantly associated with treatment response. CONCLUSIONS Prior to RRA, a short 2-week THW is an effective method to stimulate TSH levels. No difference in terms of incomplete response to treatment was observed between DTC patients prepared for RRA with a short THW and those with the long THW.
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Affiliation(s)
| | - Matteo Puntoni
- Clinical Trial Unit, Office of the Scientific Director, Galliera Hospital, Genoa, Italy
| | | | | | | | | | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mehrdad Naseri
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Bassam Dib
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Manlio Cabria
- Nuclear Medicine Department, Galliera Hospital, Genoa, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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205
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Trimboli P, Imperiali M, Piccardo A, CampennÌ A, Giordani I, Ruggeri RM, Baldari S, Orlandi F, Giovanella L. Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2018; 88:295-302. [PMID: 28960391 DOI: 10.1111/cen.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 μg/L and 1.82 μg/L for Elecsys® and 0.36 μg/L and 1.62 μg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M Imperiali
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genova, Italy
| | - A CampennÌ
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - I Giordani
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Orlandi
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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206
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Raue F, Frank-Raue K. Thyroid Cancer: Risk-Stratified Management and Individualized Therapy. Clin Cancer Res 2018; 22:5012-5021. [PMID: 27742787 DOI: 10.1158/1078-0432.ccr-16-0484] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
Thyroid cancer is the most common endocrine malignancy. Differentiated thyroid cancer (DTC) with the two subtypes, papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC), is the most frequent subtype of thyroid cancer; more rare subtypes are medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC). The incidence of DTC has increased rapidly in recent years due to the more frequent use of imaging methods such as ultrasound of the neck and fine-needle aspiration (FNA) of thyroid nodules. After total thyroidectomy and radioiodine treatment, DTC remains an indolent and curable disease in most patients, whereas the cure rate in MTC is lower and depends on early diagnosis. Most ATCs are incurable. In recent years, there has been great progress in identifying genetic changes in thyroid cancer, and genetic testing of FNA samples or blood samples provides useful information for clinical decision making. Tumor staging, either postoperatively or by imaging, and measuring the tumor markers thyroglobulin for DTC and calcitonin for MTC, allow for dynamic risk-adapted stratification for follow-up procedures. In advanced metastatic thyroid cancer, molecular targeted therapy using tyrosine kinase receptor inhibitors, including sorafenib, lenvantinib, vandetanib, and cabozantinib, helps control tumor progression and prolongs progression-free survival. Using a dynamic risk-stratified approach to manage thyroid cancer, the outcomes for most thyroid cancer patients are excellent compared with those for other cancers. The major challenge in the future is to identify high-risk patients and to treat and monitor them appropriately. Clin Cancer Res; 22(20); 5012-21. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "ENDOCRINE CANCERS REVISING PARADIGMS".
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Affiliation(s)
- Friedhelm Raue
- Molecular Laboratory, Endocrine Practice, Heidelberg, Germany.
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207
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Clinical Value of 99mTc-3PRGD2 SPECT/CT in Differentiated Thyroid Carcinoma with Negative 131I Whole-Body Scan and Elevated Thyroglobulin Level. Sci Rep 2018; 8:473. [PMID: 29323252 PMCID: PMC5765165 DOI: 10.1038/s41598-017-19036-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to assess the usefulness of integrin imaging with 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) single photon emission computed tomography (SPECT)/computed tomography (CT) in detecting recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg). Thirty-seven patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels were included. 99mTc-3PRGD2 SPECT/CT was performed 1 week after the negative diagnostic 131I WBS. Diagnostic performance indicators, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), for 99mTc-3PRGD2 SPECT/CT was calculated. The correlations between SPECT/CT results and clinic-pathological characteristics were examined. In 30 (81.1%) of the 37 patients, 99mTc-3PRGD2 SPECT/CT showed positive uptake. The sensitivity, specificity, PPV, and NPV of SPECT/CT to detect recurrent disease at follow-up were 96.6%, 75%, 93.3% and 85.7%, respectively. The sensitivity and PPV of SPECT/CT increased with increasing serum Tg levels. 99mTc-3PRGD2 SPECT/CT showed high sensitivity and PPV in the detection of recurrence among DTC patients with higher Tg levels and negative WBS, and the probability of obtaining a positive SPECT/CT result was related with the level of Tg.
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208
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Giovanella L, Imperiali M, Verburg FA, Trimboli P. Early post-treatment risk stratification of differentiated thyroid cancer: comparison of three high-sensitive Tg assays. Eur J Endocrinol 2018; 178:75-82. [PMID: 29142052 DOI: 10.1530/eje-17-0663] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/28/2017] [Accepted: 10/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of three high-sensitive assays in a cohort of TgAb-negative and TgAb-positive differentiated thyroid cancer (DTC) patients. DESIGN Retrospective study on prospectively selected DTC patients. METHODS Serum samples from 154 DTC patients were obtained 6-12 months after radioiodine ablation and tested by Beckman, Roche, BRAHMS Tg and TgAb assays, respectively. Receiver operating characteristics curves for Tg were plotted using outcome over time as benchmark and assay-specific Tg thresholds were obtained for TgAb-negative and TgAb-positive patients. RESULTS The frequency of positive TgAb was 21, 20 and 20% for Beckman, Roche and BRAHMS, respectively. In TgAb-negative patients, clinical sensitivities and specificities of 100% and 85-95%, respectively, were observed across all assays. In TgAb-positive patients, clinical sensitivities and specificities of 80-100% and 92-96%, respectively, were observed using lower thresholds than in patients without TgAb. CONCLUSIONS Adopting appropriate thresholds, lower than those for TgAb-negative patients, is possible to reliably follow TgAb-positive patients using highly sensitive Tg assays.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mauro Imperiali
- Department of Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Frederik A Verburg
- Department of Nuclear Medicine, Marburg University Hospital, Marburg, Germany
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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209
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Dießl S, Verburg F, Biko J, Schryen B, Reiners C, Buck A, Hänscheid H. Improved follow-up of patients with differentiated thyroid carcinoma. Nuklearmedizin 2017; 52:81-7. [DOI: 10.3413/nukmed-0525-12-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 02/04/2013] [Indexed: 11/20/2022]
Abstract
SummaryAim: Physicians typically are unaware of the radioiodine uptake (RIU) detection limit (LoD) on scintigrams of differentiated thyroid carcinoma (DTC) patients. We evaluated a novel method to determine LoD as a quantitative upper limit for RIU in negative scans and as a value to contextualize faint visible uptake. Patients, methods: To test whether LoD is related to physicians’ ratings, RIU and LoD were calculated from scintigraphic count statistics for 120 static planar neck scans and were compared with the ratings of five nuclear medicine specialists blinded to patient/ scan characteristics regarding visible cervical uptake. Scans were acquired on days 1 (d1) and 2 (d2) post-administration of 298 ± 30 MBq iodine-131 in 60 consecutive DTC patients after recombinant human thyrotropin (rhTSH) or thyroid hormone withdrawal (THW) (n = 30 each). Results: Indicating good inter-observer agreement, ≥ 4 readers concurred regarding 56 (93.3%) [54 (90.0%)] d1[d2] scans. Seventeen scans from 12 patients received ≥ 3 positive votes; in 15 (88.2%), RIU exceeded LoD. RIU assessed from regions-of-interest over former thyroid beds in scans with ≤ 2 positive votes was typically below the LoD (99/103 scans, 96.1%). In 48 patients with ≤ 2 positive votes in both scans, LoD was a median 0.0094% (0.0050%) in d1(d2) images and was significantly lower (p < 0.01) on early or late scans in 22 euthyroid rhTSH patients versus 26 hypo thyroid THW patients. Conclusion: LoD data obtained by the proposed method closely reflect nuclear medicine specialists’ scan ratings and provide comparators in serial scintigrams, improving diagnostic 131I imaging accuracy in differentiated thyroid carcinoma.
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210
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Gerss J, Maier T, Schober O, Vrachimis A, Riemann B. Peace of mind for patients with differentiated thyroid cancer? Nuklearmedizin 2017; 52:115-20. [DOI: 10.3413/nukmed-0563-13-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
SummaryDifferentiated thyroid carcinomas (DTC) have an excellent prognosis, with 10-year overall survival rates over 90%. In addition, DTC patients benefit from their lifelong medical surveillance. The aim of the study was to compare the patients’ overall survival with that of a matched general population. Patients and methods: We have analyzed 1497 consecutive patients with DTC, who underwent radioiodine therapy in Münster, Germany, according to international standards. We classified our patients according to the current 7th edition of the UICC (Union Internationale Contre le Cancer) classification and we compared the overall survival of the patients with the expected survival based on age and sex of the general population as provided by the Federal Statistical Office, Germany. Results: There were no significant differences in overall survival rates between DTC patients of the cohort in stages I to IVa compared to the expected survival based on age and sex of the general population. However, patients in stage IVc showed a significantly worse overall survival rate using the log-rank test (p < 0.0001). Conclusion: Patients with DTC showed excellent overall survival rates in stages I, II, III and IVa. All patients, except for those in stage IVc (M1 ≥ 45 years), had overall survival rates similar to the general population.
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211
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Lemb J, Hüfner M, Meller B, Homayounfar K, Sahlmann C, Meller J. How reliable is secondary risk stratification with stimulated thyroglobulin in patients with differentiated thyroid carcinoma? Nuklearmedizin 2017; 52:88-96. [DOI: 10.3413/nukmed-0517-12-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/21/2013] [Indexed: 11/20/2022]
Abstract
SummaryObjective: Primary risk factors in patients with differentiated thyroid carcinoma (DTC) are well established. In our institution, secondary risk stratification has been performed with stimulated Thyroglobulin (sTg; TSH > 30 mIU/l) within six months after primary therapy since 2001. In this study, we evaluated the predictive value of sTg for long-term disease- free survival (DFS). Patients, methods: Data of 202 consecutive patients with DTC were analyzed retrospectively. Median follow-up time was 6.4 years (12 months to 16.2 years). Patients were staged according to Union International Contre le Cancer (UICC) criteria. Primary risk stratification was carried out according to European Thyroid Association criteria. Initially, 134 patients (66%) were classified as low-risk and 68 patients (34%) as high-risk. The influence of established risk factors and sTg on DFS was analyzed at three different time points, up to 36 months after initial therapy. Results: In total, 169 (84%) of all patients remained in complete remission after surgery followed by radioiodine-therapy. Six patients (3%) developed tumour recurrence after initial complete remission. Primary risk factors for persistent disease were male sex, follicular or oncocytic tumour, primary tumour > 4 cm in diameter, initial lymph node involvement, initial metastatic disease and microscopic or macroscopic residual tumor. sTg ≤ 0.3 ng/ml measured within six months after initial therapy was a highly significant predictor (p ≤ 0.001) for lasting DFS, 99% of patients with sTg ≤ 0.3 ng/ml were in complete remission 36 months after initial therapy. Conclusions: A stimulated Tg ≤ 0.3 ng/ml within six months after initial therapy is a reliable predictor for long-term disease- free survival independent of primary risk stratification.
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212
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Meixner M, Hellmich M, Dietlein M, Kobe C, Schicha H, Schmidt M. Disease-free survival in papillary and follicular thyroid carcinoma. Nuklearmedizin 2017; 52:71-80. [DOI: 10.3413/nukmed-0530-12-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
Abstract
SummaryT stage was redefined for patients with differentiated thyroid carcinoma (DTC) between the 5th and 7th versions of the UICC tumour classification system. Patients, methods: 636 patients (486 women, 150 men; mean age 49.1 ± 15.6 years, mean follow-up 4.6 years) who had been treated with ablative radioiodine therapy after thyroidectomy for papillary (PTC) or follicular thyroid carcinomas (FTC) were retrospectively assessed on occurrence of locoregional recurrent disease, or cervical lymph node or distant metastases. Disease-free survival was calculated from initial T stage, classified according to both versions of the UICC staging system and compared with the prognostic value of primary tumour size. Kaplan-Meier method and two measures of explained variation, (1) R2 based on the (partial) likelihood ratio statistic of the Cox proportional hazards model and (2) a model-free variant of a distance measure proposed by Schemper had the aim to detect the most advantageous classification. Results: Of the 508 patients with PTC, 11 (2.2%) developed a local recurrence, 37 (7.3%) cervical lymph node and 23 (4.5%) distant metastases, 3 (2.3%), 8 (6.3%), and 18 (14.1%) were the numbers for the 128 FTC patients respectively. The two classification systems yielded an equal count of statistically significant differences regarding disease-free survival in patients with PTC while UICC 7th classification appeared slightly advantageous in patients with FTC. Regarding explained variation the UICC 7th classification tended to be superior to the UICC 5th classification, both in PTC and FTC, however statistical significance was not reached. Conclusion: The primary tumour size significantly added to the prognosis regarding local cervical and distant metastases.
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213
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Rosenbaum-Krumme S, Nagarajah J, Ruhlmann M, Bockisch A, Jentzen W. 124I-PET/CT images of differentiated thyroid cancer patients. Nuklearmedizin 2017; 51:213-6. [DOI: 10.3413/nukmed-0481-12-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/06/2012] [Indexed: 11/20/2022]
Abstract
SummaryFor an adequate therapy planning and staging of patients with differentiated thyroid cancer (DTC), the correct assignment of thyroid remnants (TRs) and lymph node metastases (LMs) is important. Patients, method: We retrospectively analyzed whether kinetic quantities can help improving LM assignment using serial 124I-PET/CT data. 127 patients with a total of 317 lesions (TR: n = 265; LM: n = 52) received pre-therapy 124I-PET/CT lesion dosimetry using images 24 h and > 96 h after 124I administration. For each lesion, maximum activity concentration (MAC) at 24 h and effective half-life (EHL) were determined. Moreover, the product of MAC and EHL was also investigated as a quantity and is referred to CAQ (cumulated activity proportional quantity). In addition, differences between endogenous and exogenous thyroid-stimulating hormone (TSH) stimulation and between papillary (PTC) and follicular thyroid cancer (FTC) were investigated. Results, conclusion: The median MAC, EHL, and CAQ values in TR were significantly higher than in LM but a clinically relevant cut-off value could not be determined because of high overlapping regions. No significant differences for the three quantities were found for the mode of TSH stimulations, but a significant difference for MAC and CAQ between PTC and FTC.
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214
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Schober O, Riemann B, Vrachimis A. Radioiodine remnant ablation in differentiated thyroid cancer after combined endogenous and exogenous TSH stimulation. Nuklearmedizin 2017; 51:67-72. [DOI: 10.3413/nukmed-0432-11-10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/19/2012] [Indexed: 11/20/2022]
Abstract
SummaryAim: Radioiodine remnant ablation (RRA) after (near-)total thyroidectomy (TE) is a key element in patients with differentiated thyroid cancer (DTC). The use of exogenous TSH stimulation (rhTSH) prior to RRA has shown promising results as compared to conventional thyroid hormone withdrawal (THW). As yet, the efficacy of RRA after brief THW and single rhTSH administration has not been assessed. Patients, methods: The study sample comprised 147 patients with DTC referred to our center between May 2008 and September 2010. All patients received TE with subsequent RRA. None of these 147 patients had evidence of distant metastasis. 93 patients had endogenous TSH stimulation 4–5 weeks after surgery (group I) and twenty-six received two rhTSH injections (group II). 28 patients were treated with a single rhTSH injection after a brief THW (group III). RRA-Efficacy was assessed three months after therapy by diagnostic whole-body scan and measurement of the tumour marker thyroglobulin (Tg) under TSH stimulation. Results: Three categories of success were defined for remnant ablation. Based on the definition of successful remnant ablation no visible uptake and a Tg ≤ 2.0 ng/ ml (category 1) was seen in 62/93 patients in group I, in 17/26 patients in group II (p = n.s.) and in 12/28 patients in group III (p < 0.05). Visible radioiodine uptake and a Tg ≤ 2.0 ng/ml (category 2) was seen in 16/28 patients of group III and thus significantly more frequent than in group I (28/93 patients) (p < 0.01). However, patients in group III (16/28 patients) and group II (8/26 patients) showed no significant difference in this category (p = n.s.). Visible radioiodine uptake and a Tg > 2.0 ng/ml (category 3) was found in 3/93 patients in group I and 1/26 patients in group II but in no patient in group III. Conclusion: The third strategy of remnant ablation using a single injection of rhTSH after a brief THW period resulted in a significant higher rate of patients with residual uptake in the thyroid bed and a Tg level below 2 ng/ml three months after remnant ablation in comparison to THW. However, the overall efficacy of the third protocol was not significantly different as compared to two rhTSH injections. Under the aspect of the supply shortage of rhTSH the combined endogenous and exogenous TSH stimulation may be an attractive alternative for remnant ablation in differentiated thyroid cancer.
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215
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Moldovan AS, Ruhlmann M, Görges R, Bockisch A, Rosenbaum-Krumme S, Jentzen W. Lowest effective 131I activity for thyroid remnant ablation of differentiated thyroid cancer patients. Nuklearmedizin 2017; 54:137-43. [DOI: 10.3413/nukmed-0711-14-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/17/2015] [Indexed: 12/13/2022]
Abstract
SummaryAim: A theoretical dosimetry-based model was applied to estimate the lowest effective radioiodine activity for thyroid remnant ablation of low-risk differentiated thyroid cancer patients. Patients, methods: The model is based on the distribution of the absorbed (radiation) dose per administered radioiodine activity and the absorbed dose threshold of 300 Gy for thyroid remnants, the level believed to destroy most thyroid remnants. For this purpose, 124I PET/CT images of 49 thyroid-ectomised patients were retrospectively analysed to measure the distribution of the (average) absorbed doses to thyroid remnant per administered 131I activity. The fraction of thyroid remnants that received at least 300 Gy was determined for standard activities between 0.37 and 5.55 GBq. The lower activity was considered to be equally effective to that obtained with higher activity if the (absolute) fraction difference was below 5%. Results: A total of 62 thyroid remnants were included. The medians and ranges (in parentheses) for the absorbed dose per unit 131I activity were 359 Gy/GBq (34 to 1825 Gy/ GBq). The fractions of thyroid remnants receiving more than 300 Gy at different therapy activities (within parentheses) were 60% (1.11 GBq), 76% (1.85 GBq), 79% (2.22 GBq), and 81–82% for activities between 2.59 and 3.70 GBq. The therapy activity of 1.11 GBq is considerably less effective than that of 1.85 or 2.22 GBq; therapy activities were equally effective in the range between 2.22 to 3.70 GBq. Conclusion: On the basis of the model and the patients' data included, the lowest effective therapy activity appears to be approximately 2.2 GBq to ablate thyroid remnants. The results of this study may help to guide the design of prospective clinical studies.
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216
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Zhang L, Chen J, Xu C, Qi L, Ren Y. Effects of iodine-131 radiotherapy on Th17/Tc17 and Treg/Th17 cells of patients with differentiated thyroid carcinoma. Exp Ther Med 2017; 15:2661-2666. [PMID: 29467858 DOI: 10.3892/etm.2017.5663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
Abstract
T helper 17 (Th17), T cytotoxic 17 (Tc17) and regulatory T (Treg) cells serve important roles in a number of inflammatory and autoimmune diseases. The aim of the present study was to examine the distribution of Th17, Tc17 and Treg cells in patients with differentiated thyroid cancer (DTC) prior to as well as 7, 30 and 90 days following radioactive iodine-131 (131I) therapy, and to elucidate the probable effects of 131I therapy on Th17/Tc17 and Treg/Th17 cells in patients with DTC. A total of 40 patients with DTC (26 female; 14 male) between the ages of 24 and 72 years, as well as 13 age- and sex-matched healthy subjects were included in this study. The number of Th17, Tc17 and Treg cells in the peripheral blood of patients with DTC and of healthy Controls were assessed by flow cytometry. Th17 and Tc17 cells were counted as percentages of the number of CD3+ T cells; Treg cells were counted as a percentage of the number of CD4+T cells. In addition, the serum levels of interleukin (IL)-17, IL-23, IL-10 and transforming growth factor (TGF)-β1 were examined by ELISA. The frequencies of Th17, Tc17 and Treg cells, as well as the serum levels of IL-17, IL-23, IL-10 and TGF-β1 were significantly elevated in patients with DTC compared with healthy Controls, whereas 131I therapy significantly decreased them. In addition, elevated Th17/Tc17 ratio and reduced Treg/Th17 ratio were observed in patients with DTC at day 0, however, these ratios returned to normal levels following 131I therapy for 90 days as compared with healthy Controls. Notably, Th17/Tc17 and Treg/Th17 ratios varied following 131I therapy for 7 and 30 days. In addition, a strong positive correlation between Th17 and Tc17 cells was observed in the healthy Controls and patients with DTC that received 131I treatment for 90 days, whereas a weak positive correlation between Th17 and Treg cell levels was identified in the healthy Controls and no obvious correlation between Th17 and Treg cells was observed in all patients with DTC pre- and post-131I therapy during the entire treatment period. These data suggested a significant involvement of Th17, Tc17 and Treg cells in the pathology of DTC. Restoring the balance of these cells may contribute to the recovery of patients with DTC following 131I therapy.
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Affiliation(s)
- Lixia Zhang
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Jinyan Chen
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Caiyun Xu
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Lili Qi
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yan Ren
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
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217
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Andersson M, Eckerman K, Mattsson S. Lifetime attributable risk as an alternative to effective dose to describe the risk of cancer for patients in diagnostic and therapeutic nuclear medicine. Phys Med Biol 2017; 62:9177-9188. [PMID: 29064376 DOI: 10.1088/1361-6560/aa959c] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study is to implement lifetime attributable risk (LAR) predictions of cancer for patients of various age and gender, undergoing diagnostic investigations or treatments in nuclear medicine and to compare the outcome with a population risk estimate using effective dose and the International Commission on Radiological Protection risk coefficients. The radiation induced risk of cancer occurrence (incidence) or death from four nuclear medicine procedures are estimated for both male and female between 0 and 120 years. Estimations of cancer risk are performed using recommended administered activities for two diagnostic (18F-FDG and 99mTc-phosphonate complex) and two therapeutic (131I-iodide and 223Ra-dichloride) radiopharmaceuticals to illustrate the use of cancer risk estimations in nuclear medicine. For 18F-FDG, the cancer incidence for a male of 5, 25, 50 and 75 years at exposure is 0.0021, 0.0010, 0.0008 and 0.0003, respectively. For 99mTc phosphonates complex the corresponding values are 0.000 59, 0.000 34, 0.000 27 and 0.000 13, respectively. For an 131I-iodide treatment with 3.7 GBq and 1% uptake 24 h after administration, the cancer incidence for a male of 25, 50 and 75 years at exposure is 0.041, 0.029 and 0.012, respectively. For 223Ra-dichloride with an administration of 21.9 MBq the cancer incidence for a male of 25, 50 and 75 years is 0.31, 0.21 and 0.09, respectively. The LAR estimations are more suitable in health care situations involving individual patients or specific groups of patients than the health detriment based on effective dose, which represents a population average. The detriment consideration in effective dose adjusts the cancer incidence for suffering of non-lethal cancers while LAR predicts morbidity (incidence) or mortality (cancer). The advantages of these LARs are that they are gender and age specific, allowing risk estimations for specific patients or subgroups thus better representing individuals in health care than effective dose.
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Affiliation(s)
- Martin Andersson
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Malmö, Sweden
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218
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Zerdoud S, Leboulleux S, Clerc J, Leenhardt L, Bournaud C, Al Ghuzlan A, Keller I, Bardet S, Giraudet AL, Groussin L, Sebag F, Garrel R, Lamy PJ, Toubert ME, Mirallié É, Hindié E, Taïeb D. Traitement par iode 131 des cancers thyroïdiens différenciés : recommandations 2017 des sociétés françaises SFMN/SFE/SFP/SFBC/AFCE/SFORL. MEDECINE NUCLEAIRE-IMAGERIE FONCTIONNELLE ET METABOLIQUE 2017. [DOI: 10.1016/j.mednuc.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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219
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Vassaux G, Zwarthoed C, Signetti L, Guglielmi J, Compin C, Guigonis JM, Juhel T, Humbert O, Benisvy D, Pourcher T, Cambien B. Iodinated Contrast Agents Perturb Iodide Uptake by the Thyroid Independently of Free Iodide. J Nucl Med 2017; 59:121-126. [DOI: 10.2967/jnumed.117.195685] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022] Open
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220
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Okuyama C, Kimura M, Oda M, Kodani N, Aibe N, Yamazaki H. A Case of Thyroid Papillary Carcinoma: Remarkable Decrease in Multiple Lung Metastases within 40 Years after a Single Administration of Radioiodine without Thyroidectomy and with Later Anaplastic Transformation. Case Rep Oncol 2017; 10:928-937. [PMID: 29279694 PMCID: PMC5731137 DOI: 10.1159/000481500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022] Open
Abstract
Differentiated thyroid carcinoma is an uncommon malignancy of childhood and adolescence that is unique because it has an overall favorable prognosis despite its relatively high rate of nodal and distant metastases. Total thyroidectomy and positive 131I therapy are recommended for cases with pulmonary metastases. In contrast, anaplastic thyroid cancer is one of the most aggressive malignancies that have an unfavorable and miserable prognosis. We report a case with an impressively long history. The patient had multiple pulmonary metastases that had been diagnosed by 131I administration when he was 14 years old, about 45 years before he underwent thyroidectomy. He had been kept unaware of his disease by his family and received no treatment for most of his life. Pulmonary nodules were noted at several medical checkups and showed a remarkable decrease in size during the untreated 44-year period after the 131I administration. At age 58, his thyroid cancer was first detected and total thyroidectomy was performed, with subsequent radioiodine therapy for pulmonary metastases. Unfortunately, anaplastic carcinoma developed and he died of disseminated tumors later.
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Affiliation(s)
- Chio Okuyama
- Shiga Medical Center, Research Institute, Moriyama, Japan.,Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuhiro Kimura
- Department of Otorhinolaryngology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Minori Oda
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan.,Image Communication Corporation, Kyoto, Japan
| | - Naohiro Kodani
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
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221
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Li T, Ao ECI, Lambert B, Brans B, Vandenberghe S, Mok GSP. Quantitative Imaging for Targeted Radionuclide Therapy Dosimetry - Technical Review. Theranostics 2017; 7:4551-4565. [PMID: 29158844 PMCID: PMC5695148 DOI: 10.7150/thno.19782] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 01/06/2023] Open
Abstract
Targeted radionuclide therapy (TRT) is a promising technique for cancer therapy. However, in order to deliver the required dose to the tumor, minimize potential toxicity in normal organs, as well as monitor therapeutic effects, it is important to assess the individualized internal dosimetry based on patient-specific data. Advanced imaging techniques, especially radionuclide imaging, can be used to determine the spatial distribution of administered tracers for calculating the organ-absorbed dose. While planar scintigraphy is still the mainstream imaging method, SPECT, PET and bremsstrahlung imaging have promising properties to improve accuracy in quantification. This article reviews the basic principles of TRT and discusses the latest development in radionuclide imaging techniques for different theranostic agents, with emphasis on their potential to improve personalized TRT dosimetry.
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Affiliation(s)
- Tiantian Li
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
| | - Edwin C. I. Ao
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
| | - Bieke Lambert
- Dept of Radiology and Nuclear medicine, Ghent University, De Pintelaan 185 9000 Gent, Belgium
- AZ Maria Middelares, Buiten-Ring-Sint-Denijs 30, 9000 Gent, Belgium
| | - Boudewijn Brans
- Dept of Nuclear Medicine, UZ Ghent-Ghent University, St-Pietersnieuwstraat 41, 9000 Gent, Belgium
| | - Stefaan Vandenberghe
- MEDISIP-ELIS-IBITECH-IMEC, Ghent University, St-Pietersnieuwstraat 41, 9000 Gent, Belgium
| | - Greta S. P. Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
- Faculty of Health Sciences, University of Macau, Macau SAR, China
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222
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Yordanova A, Eppard E, Kürpig S, Bundschuh RA, Schönberger S, Gonzalez-Carmona M, Feldmann G, Ahmadzadehfar H, Essler M. Theranostics in nuclear medicine practice. Onco Targets Ther 2017; 10:4821-4828. [PMID: 29042793 PMCID: PMC5633297 DOI: 10.2147/ott.s140671] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The importance of personalized medicine has been growing, mainly due to a more urgent need to avoid unnecessary and expensive treatments. In nuclear medicine, the theranostic approach is an established tool for specific molecular targeting, both for diagnostics and therapy. The visualization of potential targets can help predict if a patient will benefit from a particular treatment. Thanks to the quick development of radiopharmaceuticals and diagnostic techniques, the use of theranostic agents has been continually increasing. In this article, important milestones of nuclear therapies and diagnostics in the context of theranostics are highlighted. It begins with a well-known radioiodine therapy in patients with thyroid cancer and then progresses through various approaches for the treatment of advanced cancer with targeted therapies. The aim of this review was to provide a summary of background knowledge and current applications, and to identify the advantages of targeted therapies and imaging in nuclear medicine practices.
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Affiliation(s)
- Anna Yordanova
- Department of Nuclear Medicine (Clinical Nuclear Medicine)
| | | | | | | | | | | | - Georg Feldmann
- Department of Medicine 3, University Hospital Bonn, Bonn, Germany
| | | | - Markus Essler
- Department of Nuclear Medicine (Clinical Nuclear Medicine)
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223
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Ruhlmann M, Ruhlmann J, Görges R, Herrmann K, Antoch G, Keller HW, Ruhlmann V. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography May Exclude Malignancy in Sonographically Suspicious and Scintigraphically Hypofunctional Thyroid Nodules and Reduce Unnecessary Thyroid Surgeries. Thyroid 2017; 27:1300-1306. [PMID: 28793848 DOI: 10.1089/thy.2017.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful in the further characterization of sonographically suspicious and scintigraphically hypofunctional thyroid nodules. METHODS Sixty-five patients with sonographically suspicious thyroid nodules that were hypofunctional on 99m-Tc-pertechnetate scintigraphy (diameter >1 cm) were retrospectively analyzed. All patients underwent evaluation with FDG-PET/CT. Thyroid nodules were sonographically categorized by Thyroid Image Reporting and Data System (TIRADS) criteria. FDG uptake in the thyroid nodules was visually compared to the remainder of the thyroid tissue and categorized as pathological or non-pathological. In cases of pathologically increased uptake, maximum standardized uptake values (SUVmax) of the suspicious nodule and the perinodular thyroid tissue were determined. Depending on the results of the FDG-PET/CT, patients underwent thyroid surgery (pathological FDG uptake) or follow-up examinations (non-pathological FDG uptake). The endpoints for comparison with the FDG uptake were either histological results or sonographic follow-up examinations of at least five years. RESULTS In 18/65 (28%) patients, PET/CT showed visually pathological FDG uptake in the suspicious thyroid nodules (SUVmax 7.1 ± 4.6). Of these nodules, 3/18 (17%) were sonographically categorized as TIRADS 4a, 11/18 (61%) nodules as TIRADS 4b, 3/18 (17%) nodules as TIRADS 4c, and 1/18 (6%) nodule as TIRADS 5. The other nodules without pathological FDG uptake were categorized as TIRADS 4a in 24/47 (51%) patients, as TIRADS 4b in 18/47 (38%), and as TIRADS 4c in 5/47 (11%) patients. Twenty-three patients (18 FDG positive, 5 FDG negative) underwent surgery. The other patients underwent follow-up examinations with stability on observation over at least five years as a surrogate endpoint. Taking into consideration that FDG-PET/CT was rated as true negative in 42/47 patients with stability on sonographic follow-up, sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET/CT in detecting malignancy in the suspicious thyroid nodules were 100%, 87%, 61%, and 100%, respectively. CONCLUSION FDG-PET/CT allows stratification of patients with sonographically suspicious and scintigraphically hypofunctional thyroid nodules with a positive predictive value of 61% and negative predictive value of 100%. The absence of visually pathological FDG uptake in suspicious thyroid nodules may be useful for avoiding unnecessary thyroid surgery.
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Affiliation(s)
- Marcus Ruhlmann
- 1 Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen , Essen, Germany
- 2 Department of Diagnostic and Interventional Radiology, Medical Faculty, University Duesseldorf , Duesseldorf, Germany
| | - Jürgen Ruhlmann
- 3 Department of Nuclear Medicine and Radiology, Medizin Center Bonn , Bonn, Germany
| | - Rainer Görges
- 1 Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen , Essen, Germany
| | - Ken Herrmann
- 1 Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen , Essen, Germany
| | - Gerald Antoch
- 2 Department of Diagnostic and Interventional Radiology, Medical Faculty, University Duesseldorf , Duesseldorf, Germany
| | - Hans-Wilhelm Keller
- 4 Department of Surgery, Malteser Krankenhaus Bonn/Rein-Sieg , Bonn, Germany
| | - Verena Ruhlmann
- 1 Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen , Essen, Germany
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224
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Charalambous A. Seeking Optimal Management for Radioactive Iodine Therapy-induced Adverse Effects. Asia Pac J Oncol Nurs 2017; 4:319-322. [PMID: 28966960 PMCID: PMC5559942 DOI: 10.4103/apjon.apjon_23_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/08/2017] [Indexed: 12/02/2022] Open
Abstract
Radioactive iodine therapy (RAIT) is one of the important treatment modalities in the management of differentiated thyroid cancer (DTC). RAIT with iodine-131 has long been used in the management of DTC for the ablation of residual thyroid or treatment of its metastases. Despite being reasonably safe, radioiodine therapy is not always without side effects. Even relatively low administered activities of RAIT used for remnant ablation have been associated with the more clinically significant side effects of sialadenitis, xerostomia, salivary gland pain and swelling, dry eyes, excessive tearing, or alterations in taste in as many as 25% of patients. Given that there is a lack of comprehensive management of these RAIT-induced adverse effects, this paper explores the use of other nonpharmacological measures and their effectiveness as interventions to minimize salivary gland damage.
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Affiliation(s)
- Andreas Charalambous
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
- Department of Nursing, University of Turku, Turku, Finland
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225
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Eberlein U, Cremonesi M, Lassmann M. Individualized Dosimetry for Theranostics: Necessary, Nice to Have, or Counterproductive? J Nucl Med 2017; 58:97S-103S. [PMID: 28864620 DOI: 10.2967/jnumed.116.186841] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022] Open
Abstract
In 2005, the term theragnostics (theranostics) was introduced for describing the use of imaging for therapy planning in radiation oncology. In nuclear medicine, this expression describes the use of tracers for predicting the absorbed doses in molecular radiotherapy and, thus, the safety and efficacy of a treatment. At present, the most successful groups of isotopes for this purpose are 123I/124I/131I, 68Ga/177Lu, and 111In/86Y/90Y. The purpose of this review is to summarize available data on the dosimetry and dose-response relationships of several theranostic compounds, with a special focus on radioiodine therapy for differentiated thyroid cancer and peptide receptor radionuclide therapy. These are treatment modalities for which dose-response relationships for healthy tissues and tumors have been demonstrated. In addition, available data demonstrate that posttherapeutic dosimetry after a first treatment cycle predicts the absorbed doses in further cycles. Both examples show the applicability of the concept of theranostics in molecular radiotherapies. Nevertheless, unanswered questions need to be addressed in clinical trials incorporating dosimetry-related concepts for determining the amount of therapeutic activity to be administered.
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Affiliation(s)
- Uta Eberlein
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany; and
| | - Marta Cremonesi
- Radiation Research Unit, Istituto Europeo di Oncologia, Milano, Italy
| | - Michael Lassmann
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Würzburg, Germany; and
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Design and implementation of a mobile gamma spectrometry system to in vivo measure the accumulated activity of 131I in patients with thyroid diseases. Appl Radiat Isot 2017; 129:87-95. [PMID: 28830021 DOI: 10.1016/j.apradiso.2017.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/02/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
Abstract
The design and implementation of a mobile gamma spectrometry system to in vivo measure the accumulated activity of 131I in whole body and thyroid of patients with thyroid diseases are presented in this work. This system may be used for both pre-therapeutic and post-therapeutic dosimetry calculations. It consists of a detector and a movable support that allows its movement from one place to another.
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227
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Khvostunov IK, Saenko VA, Krylov V, Rodichev A, Yamashita S. Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2017; 56:213-226. [PMID: 28526978 DOI: 10.1007/s00411-017-0696-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving 131I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4 days after administration of 2-4 GBq of 131I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62 Gy (95% CI: 0.44-0.77 Gy) in the subgroup of patients treated one time and 0.67 Gy (95% CI: 0.03-1.00 Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments.
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Affiliation(s)
- Igor K Khvostunov
- A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Russian Ministry of Health Care, Koroliova str. 4, Obninsk, Kaluga Region, Russia, 249036.
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan.
| | - Vladimir A Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
| | - Valeri Krylov
- A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Russian Ministry of Health Care, Koroliova str. 4, Obninsk, Kaluga Region, Russia, 249036
| | - Andrei Rodichev
- A.F. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Centre, Russian Ministry of Health Care, Koroliova str. 4, Obninsk, Kaluga Region, Russia, 249036
| | - Shunichi Yamashita
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan
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228
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Abstract
PURPOSE OF REVIEW The purpose is to review recent advances concerning the role of nuclear medicine in endocrine oncology. RECENT FINDINGS For I therapy of thyroid cancer a thyrotropin (TSH) more than 30 mU/l has for many years been deemed a condition sine qua non. However, new data show that patients with lower TSH levels at the time of ablation have the same rate of successful ablation as those with TSH more than 30 mU/l.I-124 combined integrated positron emission tomography and computed X-ray tomography was shown to be highly accurate in predicting findings on posttherapy radioiodine scanning and was shown to have a high prognostic power.In neuroendocrine tumors, long-term complication rates of peptide receptor radionuclide therapy were reported. Furthermore first preclinical and clinical results of peptide receptor radionuclide therapy with somatostatin receptor antagonists were published.In nuclear medicine, prostate-specific membrane antigen (PSMA)-targeted radionuclide imaging and therapy is of interest. PSMA was shown to also be expressed in neoplasms of the thyroid, the adrenal glands and neuroendocrine tumors. SUMMARY Further individualization of thyroid cancer patient care by means of I-124-positron emission tomography and computed X-ray tomography-based selection of the therapeutic strategy is possible. I therapy might not require as intensive TSH stimulation as thought previously. For endocrine-related malignancies PSMA targeting deserves further investigation.
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229
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Li X, Semkow TM, Bradt CJ, Syed UF, Bari A, Torres MA, Nishikawa K, Khan AJ, Menia TA. Radiochemical analysis of a wide range of 131I activities in water and milk using well-type germanium detector. J Radioanal Nucl Chem 2017. [DOI: 10.1007/s10967-017-5292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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230
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Abstract
Differentiated thyroid cancer (DTC) is a rare malignant disease, although its incidence has increased over the last few decades. It derives from follicular thyroid cells. Generally speaking, the prognosis is excellent. If treatment according to the current guidelines is given, cases of recurrence or persistence are rare. DTC requires special expertise by the treating physician. In recent years, new therapeutic options for these patients have become available. For this article we performed a systematic literature review with special focus on the guidelines of the American Thyroid Association, the European Association of Nuclear Medicine, and the German Society of Nuclear Medicine. For DTC, surgery and radioiodine therapy followed by levothyroxine substitution remain the established therapeutic procedures. Even metastasized tumors can be cured this way. However, in rare cases of radioiodine-refractory tumors, additional options are to be discussed. These include strict suppression of thyroid-stimulating hormone (also known as thyrotropin, TSH) and external local radiotherapy. Systemic cytostatic chemotherapy does not play a significant role. Recently, multikinase or tyrosine kinase inhibitors have been approved for the treatment of radioiodine-refractory DTC. Although a benefit for overall survival has not been shown yet, these new drugs can slow down tumor progression. However, they are frequently associated with severe side effects and should be reserved for patients with threatening symptoms only.
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231
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Verburg FA, Luster M, Giovanella L, Lassmann M, Chiesa C, Chouin N, Flux G. The "reset button" revisited: why high activity 131I therapy of advanced differentiated thyroid cancer after dosimetry is advantageous for patients. Eur J Nucl Med Mol Imaging 2017; 44:915-917. [PMID: 28210770 DOI: 10.1007/s00259-017-3649-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany.
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Luca Giovanella
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Carlo Chiesa
- Department of Nuclear Medicine, Istituto Nazionale Tumori IRCCS Foundation, Milan, Italy
| | | | - Glenn Flux
- The Royal Marsden Hospital & Institute of Cancer Research, London, England
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232
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Zerdoud S, Giraudet AL, Leboulleux S, Leenhardt L, Bardet S, Clerc J, Toubert ME, Al Ghuzlan A, Lamy PJ, Bournaud C, Keller I, Sebag F, Garrel R, Mirallié E, Groussin L, Hindié E, Taïeb D. Radioactive iodine therapy, molecular imaging and serum biomarkers for differentiated thyroid cancer: 2017 guidelines of the French Societies of Nuclear Medicine, Endocrinology, Pathology, Biology, Endocrine Surgery and Head and Neck Surgery. ANNALES D'ENDOCRINOLOGIE 2017; 78:162-175. [PMID: 28578852 DOI: 10.1016/j.ando.2017.04.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Slimane Zerdoud
- Service de médecine nucléaire, institut universitaire du cancer Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Anne-Laure Giraudet
- Médecine nucleaire, centre LUMEN, curiethérapie, thyroïde, tumeurs endocrines, centre de lutte contre le cancer Léon-Berard, 28, rue Laennec, 69008 Lyon, France
| | - Sophie Leboulleux
- Service de médecine nucléaire et cancérologie endocrinienne Gustave-Roussy, université Paris Saclay, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Laurence Leenhardt
- Unité thyroïde tumeurs endocrines, institut E3M, hôpital La Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphane Bardet
- Service de médecine nucléaire et UCP thyroïde, centre François-Baclesse, 3, avenue Général-Harris, 14076 Caen cedex 05, France
| | - Jérôme Clerc
- Service de médecine nucléaire, groupe hospitalier Paris Centre, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France
| | - Marie-Elisabeth Toubert
- Service de médecine nucléaire, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - Abir Al Ghuzlan
- Département de biologie et de pathologie médicales Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France
| | - Pierre-Jean Lamy
- Laboratoire d'oncologie moléculaire, institut médical d'analyse génomique, Labosud, 141, avenue Paul-Bringuier, 34080 Montpellier, France; Unité de recherche clinique, clinique Beau-Soleil, 119, avenue de Lodeve, 34070 Montpellier, France
| | - Claire Bournaud
- Service de médecine nucléaire, hospices civils de Lyon, groupement hospitalier Est, 28, avenue Doyen-Lépine, 69677 Bron cedex, France
| | - Isabelle Keller
- Service de médecine nucléaire, hôpitaux universitaires Est Parisien, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Frédéric Sebag
- Service de chirurgie endocrinienne, université Aix-Marseille, CHU de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Renaud Garrel
- Département ORL et chirurgie cervico faciale, pole neuroscience tête et cou, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, rue Fliche, 34295 Montpellier, France
| | - Eric Mirallié
- Service de chirurgie endocrinienne et digestive, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - Lionel Groussin
- Service d'endocrinologie et maladies métaboliques, hôpital Cochin, AP-HP, 123, boulevard du Port-Royal, 75014 Paris, France
| | - Elif Hindié
- Service de médecine nucléaire, hôpital Haut-Lévêque, université de Bordeaux, CHU de Bordeaux, avenue Magellan, 33604 Pessac, France.
| | - David Taïeb
- Service central de biophysique et de médecine nucléaire, université Aix-Marseille, CHU de la Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 05, France.
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233
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Verburg FA, Hänscheid H, Luster M. Radioactive iodine (RAI) therapy for metastatic differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2017; 31:279-290. [PMID: 28911724 DOI: 10.1016/j.beem.2017.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. It usually has a comparatively benign course. If properly executed, radioiodine therapy can provide an effective treatment of even advanced, metastatic DTC. A major problem in determining the right RAI for a patient with metastatic disease is a comparative lack of evidence. There are no reports on randomized controlled trials in this patient group which can aid us in determining which way to treat which patient. Few non-randomized prospective observational studies have been performed. Most available evidence is based on retrospective analyses which, although often informative, still are hampered by the selection bias inherent to retrospective studies on a small, preselected sample of the total DTC population. The aim of the present review is to provide an overview of the relevant literature on the issues pertinent to the execution of RAI. Radioiodine therapy of metastatic DTC in patients can be an effective treatment modality which will contribute significantly to a patients' life expectancy. However, much is unclear in the management of this malignancy, including which activity to use, how to determine this activity (empiric vs. dosimetric approach) as well as the potential long-term complications. In pediatric patients, special considerations apply with regard to weight-adaptation of activities as well the risk of pulmonary fibrosis in patients with diffuse miliary metastases.
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Affiliation(s)
- Frederik A Verburg
- University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany.
| | - Heribert Hänscheid
- University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
| | - Markus Luster
- University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany
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234
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Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, Rodella C, Giubbini R. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine 2017; 56:551-559. [PMID: 27709475 DOI: 10.1007/s12020-016-1086-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022]
Abstract
The purpose of this prospective study was to determine the incremental diagnostic value of single photon emission computed tomography/computed tomography with iodine-131 over planar whole body scan in the staging of patients with differentiated thyroid carcinoma. A total of 365 patients (270 female, 95 male) with differentiated thyroid carcinoma were treated with radioiodine therapy for thyroid remnant ablation with radical intent after thyroidectomy between January 2013 and November 2014. In addition to planar whole body scan, single photon emission computed tomography/computed tomography of neck and chest were performed. Each radioactive focus at whole body scan was classified as positive or equivocal with respect of specific territories: thyroid bed, cervical lymph nodes and distant metastases.Whole-body scan detected focal uptake in 353 patients and no uptake in 12. The location was considered equivocal in 100. Single photon emission computed tomography/computed tomography detected focal uptake in 356 patients and no uptake in nine. In three patients with negative wholebody scan, single photon emission computed tomography/computed tomography provided information about residual activity in the thyroid bed. By single photon emission computed tomography/computed tomography the location was equivocal in 18 patients only. Single photon emission computed tomography/computed tomography was helpful in 82 out of 100 patients with equivocal findings by whole body scan allowing a correct identification of the uptake sites. In a great number of equivocal whole body scan, due to high remnant activity, single photon emission computed tomography/computed tomography was able to differentiate between thyroid remnant and lymph nodes uptake. In 22 out of 100 patients with doubtful whole body scan, single photon emission computed tomography/computed tomography correctly identified nodal or distant metastases, and in 2/100 patients, focal uptake classified as metastatic by whole body scan was reclassified as para-physiological by single photon emission computed tomography/computed tomography. The TNM classification changed in 13 out of 22 patients. Single photon emission computed tomography/computed tomography improves detection and localization of the iodine-131 uptake after thyroidectomy in patients with differentiated thyroid carcinoma and it is more accurate than whole body scan to evaluate lymph nodes and to identify and characterize distant metastases. Single photon emission computed tomography/computed tomography aids assessment of lower/upper stage in a significant number of patients with differentiated thyroid carcinoma and it can affect therapy decision-making and patient management.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Staging
- Radiotherapy Dosage
- Single Photon Emission Computed Tomography Computed Tomography/methods
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Whole Body Imaging/methods
- Young Adult
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Affiliation(s)
- Valentina Zilioli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessia Peli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Maria Beatrice Panarotto
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giancarlo Magri
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ahmed Alkraisheh
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Christiane Wiefels
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Carlo Rodella
- Medical Physics Department, Spedali Civili di Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy.
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil.
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235
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Mikalsen LTG, Arnesen MR, Bogsrud TV, Dale E, Stokke C. Combining radioiodine and external beam radiation therapy: the potential of integrated treatment planning for differentiated thyroid cancer. Acta Oncol 2017; 56:894-897. [PMID: 28464741 DOI: 10.1080/0284186x.2017.1286384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
- Department of Life Sciences and Health, Oslo and Akershus University College of Applied Science, Oslo, Norway
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236
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Trimboli P, Zilioli V, Imperiali M, Ceriani L, Giovanella L. High-sensitive basal serum thyroglobulin 6-12 months after thyroid ablation is strongly associated with early response to therapy and event-free survival in patients with low-to-intermediate risk differentiated thyroid carcinomas. Eur J Endocrinol 2017; 176:497-504. [PMID: 28137736 DOI: 10.1530/eje-16-1011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE High-sensitive thyroglobulin assays (hsTg) has decreased the need for stimulated Tg measurements in patients with differentiated thyroid carcinoma (DTC). However, multiple assays analyzing the same samples may report different values. Accordingly, appropriate assay-specific cut-off levels should be selected in representative patient series. Here, we evaluate the role of a new hsTg assay in low-to-intermediate risk DTC patients and select appropriate assay-specific clinical cut-off limits. DESIGN This was a retrospective study. The response to treatment was assessed according to ATA. METHODS Patients with low-to-intermediate risk DTC treated and regularly followed-up in our thyroid center. Tg was measured on the Kryptor Compact Plus Instrument (BRAHMS Thermo Fisher Scientific). RESULTS The study series comprised 201 DTC patients and excellent response (ER) was demonstrated in 184 (91.5%). Optimized threshold of basal Tg (onT4-Tg) measured 6-12 months after initial treatment was set by ROC curves analysis at 0.28 ng/mL. Having onT4-Tg <0.28 ng/mL at 6-12 months after treatment was associated with longer disease-free survival of Kaplan-Meier (P < 0.001), ER at early follow-up (odds ratio (OR): 165, P < 0.001) and absence of relapse during follow-up (OR: 328, P = 0.0001). CONCLUSIONS Patients with low- and intermediate-risk DTC could be considered cured when they have onT4-Tg levels <0.28 ng/mL coupled with negative imaging at their first post-ablation visit.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - V Zilioli
- Department of Nuclear MedicineBolzano Regional Hospital, Bolzano, Italy
| | - M Imperiali
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
| | - L Ceriani
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
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237
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Flux GD, Verburg FA, Chiesa C, Bardiès M, Gleisner KS, Hertz B, Konijnenberg M, Lassmann M, Ljungberg M, Luster M, Stabin M, Strigari L. Comparison of Empiric Versus Dosimetry-Guided Radioiodine Therapy: The Devil Is in the Details. J Nucl Med 2017; 58:862. [PMID: 28183989 DOI: 10.2967/jnumed.116.186643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Glenn D Flux
- Royal Marsden Hospital Downs Rd. Sutton, Su SM2 5PT, United Kingdom E-mail:
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238
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Samadi R, Ghanbari M, Shafiei B, Gheibi S, Azizi F, Ghasemi A. High dose of radioactive iodine per se has no effect on glucose metabolism in thyroidectomized rats. Endocrine 2017; 56:399-407. [PMID: 28283939 DOI: 10.1007/s12020-017-1274-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/23/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Thyroid concentrates radioactive iodine by sodium-iodide symporter; this is used for treating hyperthyroidism and thyroid cancer. Pancreas expresses NIS and radioactive iodine uptake may damage pancreatic beta-cells and predispose patients to type 2 diabetes. The aim of this study was to determine whether radioactive iodine is associated with glucose metabolism in thyroidectomized rats. METHODS Forty male Wistar rats were divided into four groups (n = 10/each); control, thyroidectomized, thyroidectomized-treated with 131-I (TX+I), and thyroidectomized-treated with 131-I and L-thyroxine (TX+I+T4). At the end of study, serum fasting glucose, insulin, thyroid-stimulating hormone, and free tetraiodothyronine were measured, intraperitoneal glucose tolerance test was performed, and homeostasis model assessment-insulin resistance was calculated. In in vitro experiments, glucose-stimulated insulin secretion from pancreatic islets and sodium-iodide symporter mRNA expression in thyroid and islets were determined. RESULTS Compared to control group, free tetraiodothyronine was lower by 41 and 77% and thyroid-stimulating hormone was higher by 36 and 126% in thyroidectomized and TX+I groups, respectively. Compared to controls, rats in TX+I group had glucose intolerance as assessed using the area under curve of intraperitoneal glucose tolerance test (12,376 ± 542 vs. 20,769 ± 1070, P < 0.001) and L-thyroxine replacement therapy restored the value (14,286 ± 328.24) to near normal. Fasting insulin and homeostasis model assessment-insulin resistance were comparable in all groups, however fasting glucose was higher in TX+I group. In in vitro experiments, glucose-stimulated insulin secretion from islets did not differ between groups. CONCLUSION Radioactive iodine therapy per se had no effect on glucose metabolism, just intensified thyroid hormone deficiency and the alterations on glucose metabolism in thyroidectomized rats. L-thyroxine therapy restored the glucose intolerance observed in radioactive iodine-treated thyroidectomized rats.
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Affiliation(s)
- Roghaieh Samadi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Ghanbari
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Shafiei
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sevda Gheibi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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239
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Nichols KJ, Robeson W, Yoshida-Hay M, Zanzonico PB, Leveque F, Bhargava KK, Tronco GG, Palestro CJ. Alternative Means of Estimating 131I Maximum Permissible Activity to Treat Thyroid Cancer. J Nucl Med 2017; 58:1588-1595. [PMID: 28408530 DOI: 10.2967/jnumed.117.192278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022] Open
Abstract
To protect bone marrow from overirradiation, the maximum permissible activity (MPA) of 131I to treat thyroid cancer is that which limits the absorbed dose to blood (as a surrogate of marrow) to less than 200 cGy. The conventional approach (method 1) requires repeated γ-camera whole-body measurements along with blood samples. We sought to determine whether reliable MPA values can be obtained by simplified procedures. Methods: Data acquired over multiple time points were examined retrospectively for 65 thyroid cancer patients, referred to determine 131I uptake and MPA for initial treatment after thyroidectomy (n = 39), including 17 patients with compromised renal function and 22 patients with known (n = 16) or suspected (n = 6) metastases. The total absorbed dose to blood (DTotal) was the sum of mean whole-body γ-ray dose component (Dγ) from uncollimated γ-camera measurements and dose due to β emissions (Dβ) from blood samples. Method 2 estimated DTotal from Dβ alone, method 3 estimated DTotal from Dγ alone, and method 4 estimated DTotal from a single 48-h γ-camera measurement. MPA was computed as 200 cGy/DTotal for each DTotal estimate. Results: Method 2 had the strongest correlation with conventional method 1 (r = 0.98) and values similar to method 1 (21.0 ± 13.7 cGy/GBq vs. 21.0 ± 14.1 cGy/GBq, P = 0.11), whereas method 3 had a weaker (P = 0.001) correlation (r = 0.94) and method 4 had the weakest (P < 0.0001) correlation (r = 0.69) and lower dose (16.3 ± 14.8 cGy/GBq, P < 0.0001). Consequently, correlation with method 1 MPA was strongest for method 2 MPA (r = 0.99) and weakest for method 4 (r = 0. 75). Method 2 and method 1 values agreed equally well regardless of whether patients had been treated with 131I previously or had abnormal renal function. Conclusion: Because MPA based on blood measurements alone is comparable to MPA obtained with combined body counting and blood sampling, blood measurements alone are sufficient for determining MPA.
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Affiliation(s)
- Kenneth J Nichols
- Hofstra Northwell School of Medicine of Hofstra University, Manhasset and New Hyde Park, New York .,Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - William Robeson
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - Miyuki Yoshida-Hay
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - Pat B Zanzonico
- Memorial Hospital Research Laboratories, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fritzgerald Leveque
- Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - Kuldeep K Bhargava
- Hofstra Northwell School of Medicine of Hofstra University, Manhasset and New Hyde Park, New York.,Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - Gene G Tronco
- Hofstra Northwell School of Medicine of Hofstra University, Manhasset and New Hyde Park, New York.,Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
| | - Christopher J Palestro
- Hofstra Northwell School of Medicine of Hofstra University, Manhasset and New Hyde Park, New York.,Division of Nuclear Medicine and Molecular Imaging, Northwell Health, Manhasset and New Hyde Park, New York; and
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240
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Calais PJ. Gaussian plume atmospheric modelling and radiation exposure calculations following the cremation of a deceased thyroid cancer patient treated with iodine-131. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2017; 37:247-265. [PMID: 28169221 DOI: 10.1088/1361-6498/aa51e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Shortly after treatment with 7200 MBq of 131I, a thyroid cancer patient died and was subsequently cremated. Calculations of the atmospheric emissions of 131I from the crematorium flue were performed using a standard atmospheric pollution Gaussian Plume Dispersal model. Estimates of whole-body and thyroid dose of those potentially exposed were made using OLINDA/EXM dosimetry software. Under the meteorological conditions prevalent at the time of the cremation, and depending on the actual release rate of the 131I, the Western Australian legal limit of 3.7 Bqm-3 for atmospheric emissions of 131I may have been exceeded for distances of up to 440 and 1610 m downwind of the crematorium chimney, with the maximum concentration being between 33 and 392 Bqm-3. Assuming 16% of the inhaled 131I was taken up in the thyroid with the balance in the remainder of the body, the radiation dose to maximally exposed individuals was calculated to be approximately 17.7 μSv to the thyroid and 0.04 μSv to the whole-body. Despite the maximum allowable atmospheric 131I concentration of 3.7 Bqm-3 being exceeded, as the number of people immediately downwind of the crematorium flue in the high concentration zones was very low, and considering the relatively high tolerable dose to the thyroid, the radiation dose to people was probably not a problem in this case. The local limit of 1000 MBq of 131I for the cremation of a deceased patient is reasonable, but with adequate precautions could be significantly increased without any harmful effects to people or the environment.
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Affiliation(s)
- Phillipe J Calais
- School of Physics, The University of Western Australia, Perth, 6009, Western Australia. Clinical Physics, Fiona Stanley Hospital, Murdoch, 6150, Western Australia
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241
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Higher preablative serum thyroid-stimulating hormone level predicts radioiodine ablation effectiveness in patients with differentiated thyroid carcinoma. Nucl Med Commun 2017; 38:222-227. [PMID: 28002173 DOI: 10.1097/mnm.0000000000000640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Radioiodine ablation of remnant thyroid tissue is an important adjuvant therapy of differentiated thyroid carcinoma (DTC) after thyroidectomy. Elevated serum thyroid-stimulating hormone (TSH) level is necessary for successful ablation. The optimum level of serum TSH level necessary for successful radioiodine ablation of well-DTC is, however, yet to be defined. We aimed to determine whether higher serum TSH level will result in a better rate of complete ablation of well-DTC using iodine-131 (I) following initial thyroidectomy. PATIENTS AND METHODS A total of 109 patients with differentiated thyroid cancer were divided into four treatment groups on the basis of serum TSH levels. They were followed up from 6 to 12 months after treatment with stimulated serum thyroglobulin level and a diagnostic whole-body scan with radioactive iodine I to determine early response. RESULTS Sixty-four patients had papillary thyroid carcinoma, whereas 45 patients had follicular carcinoma. An excellent response was observed in 66.7% of patients with TSH level more than 90 μIU/ml, 72.2% in the group with TSH level of 60-89 μIU/ml, 48.5% when TSH was 30-59 μIU/ml and 26.7% when TSH was less than 30 μIU/ml (P=0.002). CONCLUSION Higher preablative serum TSH predicts a better rate of ablation in patients with differentiated thyroid cancer treated with I after thyroidectomy.
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242
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McCready VR. Radioiodine - the success story of Nuclear Medicine : 75th Anniversary of the first use of Iodine-131 in humans. Eur J Nucl Med Mol Imaging 2017; 44:179-182. [PMID: 27761621 DOI: 10.1007/s00259-016-3548-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- V Ralph McCready
- Department Nuclear Medicine Royal Sussex County Hospital East Sussex UK, Brighton, UK.
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243
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Verburg FA, Luster M, Giovanella L. Adjuvant post-operative I-131 therapy in differentiated thyroid carcinoma: are the 2015 ATA guidelines an exact science or a dark art? Eur J Nucl Med Mol Imaging 2017; 44:183-184. [PMID: 27726016 DOI: 10.1007/s00259-016-3526-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Luca Giovanella
- Department of Nuclear Medicine & Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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245
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Radioiodine treatment after surgery for differentiated thyroid cancer: a reasonable option. Eur J Nucl Med Mol Imaging 2017; 44:918-925. [DOI: 10.1007/s00259-017-3654-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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246
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Less is more: reconsidering the need for regular use of diagnostic whole body radioiodine scintigraphy in the follow-up of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2017; 44:741-743. [DOI: 10.1007/s00259-017-3632-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/01/2017] [Indexed: 01/08/2023]
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247
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Goldsmith SJ. Radioactive Iodine Therapy of Differentiated Thyroid Carcinoma: Redesigning the Paradigm. Mol Imaging Radionucl Ther 2017; 26:74-79. [PMID: 28117291 PMCID: PMC5283712 DOI: 10.4274/2017.26.suppl.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Radioactive iodine therapy has evolved over the past 70 years from treatment of known metastatic thyroid carcinoma to include adjuvant use to decrease the incidence of recurrent disease and to ablation of normal remnant tissue following thyroidectomy, even for minimal tumor involvement. Advances in laboratory testing, development of drugs useful in radioiodine treatment, as well as advances in radiation detection and imaging instrumentation, have progressively improved the utility of radioiodine therapy of differentiated thyroid carcinoma. Guidelines have proliferated and they have become more detailed and complex. This trend is likely to continue as the science and technology involved increases in sophistication and efficacy.
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Affiliation(s)
- Stanley J Goldsmith
- Weill Cornell Medical College, Clinic of Radiology; New York-Presbyterian Hospital, Clinic of Radiology; Weill Medical College of Cornell University, Departments of Radiology and Medicine, New York, USA, E-mail:
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Kim J, Cho SG, Kang SR, Kwon SY, Cho DH, Cho JS, Song HC. Preparation for radioactive iodine therapy is not a risk factor for the development of hyponatremia in thyroid cancer patients. Medicine (Baltimore) 2017; 96:e6004. [PMID: 28151897 PMCID: PMC5293460 DOI: 10.1097/md.0000000000006004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to evaluate whether the preparation for radioactive iodine (RAI) therapy by thyroid hormone withdrawal (THW) or a low-iodine diet (LID) can be risk factors for the development of hyponatremia in patients with differentiated thyroid cancer after thyroidectomy.We retrospectively reviewed the medical records and laboratory findings of 326 patients who underwent preparation for RAI therapy after thyroidectomy from 2012 to 2014. Demographic and clinical variables including the method of thyrotropin stimulation and duration of LID were assessed. Serum sodium was measured twice, before operation and before RAI therapy.Hyponatremia was detected in only 3 patients (0.9%) before operation, but in 15 patients (4.6%) before RAI therapy. None of the patients had severe hyponatremia after preparation for RAI therapy. Pre-RAI therapy serum sodium was correlated with the method of thyrotropin stimulation (TWH vs recombinant human thyroid stimulating hormone, P = 0.014) and duration of LID (r = -0.131, P = 0.018); however, the preparation of RAI therapy, THW and LID, did not affect the development of hyponatremia in logistic regression analysis. Preoperative serum sodium was a significant risk factor for hyponatremia during preparation for RAI therapy.Preparation for RAI therapy by THW or LID is not a risk factor for the development of hyponatremia in patients with thyroid cancer. The development of hyponatremia was neither frequent nor severe during preparation for RAI therapy. Physicians should not be greatly concerned about rare life-threatening hyponatremia during preparation for RAI therapy.
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Affiliation(s)
- Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital
| | - Dong-Hyeok Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Hospital
| | - Jin-Seong Cho
- Department of Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital
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Trimboli P, Zilioli V, Imperiali M, Giovanella L. Thyroglobulin autoantibodies before radioiodine ablation predict differentiated thyroid cancer outcome. ACTA ACUST UNITED AC 2017; 55:1995-2001. [DOI: 10.1515/cclm-2017-0033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Serum thyroglobulin (Tg) is essential to manage differentiated thyroid carcinoma (DTC). However, Tg determination is affected by circulating Tg antibodies (TgAb), and a role of TgAb as surrogate biomarker has been proposed. Here we evaluated the role of TgAb measured before and after radioiodine ablation (RRA) as potential predictors of prognosis.Methods:Patients treated since 2006 were screened. Cancers with structural relapse were defined as recurrent. Both Tg and TgAb were measured by immunoassays on the fully automated KryptorResults:A series of 215 DTC patients was enrolled, of whom 28.8% had positive preablation TgAb. Overall, 2.8% patients died by DTC and 11% recurred. High-risk class (p=0.004) and cancer relapse (p=0.007) occurred more frequently in positive TgAb, whereas better disease-free survival was observed in negative group (hazard ratio 2.59, p=0.01). Having positive preablation TgAb was significantly associated with risk to develop recurrence (odds ratio 3.57, p=0.004). Among positive TgAb subgroup, higher levels were recorded in recurrent cases (p=0.0001), and the most accurate preablation TgAb threshold was 107.5 IU/mL. When TgAb were measured at first follow-up, recurrence rate was significantly (p<0.0001) higher in persistently TgAb-positive patients (75%) than normalized ones (2.4%). At that time, the highest negative predictive value could be obtained when considering TgAb normalization (<33 IU/mL) or reduction by ≥36.4%.Conclusions:Positive TgAb before RRA indicates higher risk of poor prognosis, but their significant drop 6–12 months later could be considered a favorable factor.
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250
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Haap M, Roth HJ, Huber T, Dittmann H, Wahl R. Urinary iodine: comparison of a simple method for its determination in microplates with measurement by inductively-coupled plasma mass spectrometry. Sci Rep 2017; 7:39835. [PMID: 28045077 PMCID: PMC5206638 DOI: 10.1038/srep39835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/25/2016] [Indexed: 12/02/2022] Open
Abstract
The aim of our study was to develop and validate an inexpensive, rapid, easy to use quantitative method to determine urinary iodine without major procurement costs for equipment. The rationale behind introducing this method is the increasing demand for urinary iodine assessments. Our study included 103 patients (76 female, 27 male), age (arithmetic mean) 52 ± 17.3 years. Urinary iodine was determined in microplates by a modification of the Sandell-Kolthoff reaction. The results were compared with inductively-coupled plasma mass spectrometry (ICP-MS) for iodine, considered as reference method. Geometric mean of urinary iodine determined by the Sandell-Kolthoff reaction method was 62.69 μg/l (95% confidence interval 53.16-73.92) whereas by the ICP-MS method it was 65.53 μg/l (95% confidence interval 54.77-78.41). Passing-Bablok regression equations for both methods gave y = 3.374 + 0.873x (y: Sandell-Kolthoff method, x: ICP-MS). Spearman´s correlation coefficient was 0.981, indicating a very high degree of agreement between the two methods. Bland-Altman plots showed no significant systematic difference between the two methods. The modified Sandell-Kolthoff method using microtiter plate technique presented here is a simple, inexpensive semi-automated method to determine urinary iodine with very little toxic waste. Comparison with the ICP-MS-technique yielded a good agreement between the two methods.
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Affiliation(s)
- Michael Haap
- Internal Medicine IV (Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry), Eberhard-Karls-University, Tübingen, Germany
| | - Heinz Jürgen Roth
- Labor Dr. Limbach & Kollegen, GbR, Medizinisches Versorgungszentrum, Im Breitspiel 15, 69126 Heidelberg, Germany
| | - Thomas Huber
- Labor Dr. Limbach & Kollegen, GbR, Medizinisches Versorgungszentrum, Im Breitspiel 15, 69126 Heidelberg, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine, Eberhard-Karls-University, Tübingen, Germany
| | - Richard Wahl
- Internal Medicine IV (Endocrinology, Diabetology, Angiology, Nephrology, and Clinical Chemistry), Eberhard-Karls-University, Tübingen, Germany
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