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Belge Bilgin G, Burkett BJ, Bilgin C, Orme JJ, Childs DS, Rincon MM, Abdelrazek AS, Johnson DR, Johnson GB, Kwon ED, Sartor O, Kendi AT. Neurologic Symptoms After 177Lu-Prostate-Specific-Membrane Antigen-617 Therapy: A Single-Center Experience. J Nucl Med 2024; 65:1402-1408. [PMID: 39089816 DOI: 10.2967/jnumed.124.267643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
Treatment with 177Lu-prostate-specific membrane antigen (PSMA)-617 (177Lu-vipivotide tetraxetan [Pluvicto]) prolongs both progression-free and overall survival in advanced PSMA-positive metastatic castration-resistant prostate cancer. Data examining specifically neurologic symptoms after 177Lu-PSMA-617 treatment are scarce. In this study, we aimed to review the neurologic findings in a large cohort of metastatic castration-resistant prostate cancer patients undergoing 177Lu-PSMA-617 therapy. Methods: The clinical records and imaging data of patients who received their initial dose of 177Lu-PSMA-617 between March 2022 and November 2022 were retrospectively reviewed. All patients presenting for medical evaluation, regardless of specific specialty appointments, with new or worsening neurologic symptoms were included in the study. Results: A total of 185 patients underwent 177Lu-PSMA-617 therapy. The median age was 70 y (range, 58-90 y). The mean follow-up time was 12.04 ± 2.87 mo. Fifty-five new or worsening neurologic symptoms were observed in 50 patients (27%, 50/185). Of these, 27 (11.9%, 27/185) reported altered taste. Eleven patients (6%, 11/185) experienced dizziness with no other clear etiology; 2 of these patients were admitted to the emergency department (ED). Paresthesia symptoms were reported in 6 patients (3.2%, 6/185). Five patients (2.7%, 5/185) reported headaches, 3 of these patients were admitted to the ED because of the severity of the symptoms. Two patients (1.08%, 2/185) presented with extremity weakness. Two patients (1.08%, 2/185) had an ischemic stroke and were admitted to the ED. One patient (0.05%, 1/185) exhibited gait disturbances. In total, 7 patients (3.78%, 7/185) were admitted to the ED because of neurologic symptoms. None of the patients discontinued or failed to complete the 177Lu-PSMA-617 therapy because of neurologic symptoms. Conclusion: After 177Lu-PSMA-617 treatment, the most common neurologic symptoms were dysgeusia and dizziness. In this study, our follow-up period and population size might not have been sufficient to detect delayed or uncommon neurologic symptoms. In patients without neurologic symptoms or central nervous system metastases before treatment, we found the development of severe neurologic problems to be rare and unlikely to require discontinuation of treatment.
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Affiliation(s)
| | | | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Jacob J Orme
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | - Geoffrey B Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Immunology, Mayo Clinic, Rochester, Minnesota; and
| | - Eugene D Kwon
- Department of Immunology, Mayo Clinic, Rochester, Minnesota; and
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Oliver Sartor
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Dai X, Ren X, Zhang J, Zheng Y, Wang Z, Cheng G. Advances in the selection and timing of postoperative radioiodine treatment in patients with differentiated thyroid carcinoma. Ann Nucl Med 2024; 38:688-699. [PMID: 39044048 DOI: 10.1007/s12149-024-01963-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. Patients who receive systematic care typically have a better prognosis. RAI treatment plays a key role in eradicating any remaining thyroid lesions in DTC patients, hence decreasing the risk of distant metastases and cancer recurrence. As research continues to advance, RAI treatment is becoming more and more individualized. Because of the excellent prognosis for DTC patients, there is a relatively broad window for RAI treatment, making it easy to overlook when to receive RAI treatment. However, research on this issue can help patients with varying recurrence risk stratification make better decisions about when to begin RAI treatment following surgery, and physicians can schedule patients based on the severity of their disease. This will improve patient prognosis and lessen needless anxiety in addition to helping solve the problems of unjust healthcare resource distribution. In this review, we will mainly discuss the target population of RAI treatment as well as studies that examine the impact of RAI treatment timing on patient outcomes. In an effort to discourage DTC patients and physicians from selecting RAI therapy at random, we also review the possible negative effects of this treatment.
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Affiliation(s)
- Xin Dai
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xinyi Ren
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jinyu Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yuxin Zheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Gang Cheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Yang Z, Zhang M, Yan L, Xiao J, Li Y, Li X, Luo Y. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine 2024; 85:1066-1074. [PMID: 38801598 DOI: 10.1007/s12020-023-03660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. METHODS PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. CONCLUSIONS Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
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Affiliation(s)
- Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Kang F, Wu J, Hong L, Zhang P, Song J. Iodine-125 seed inhibits proliferation and promotes apoptosis of cholangiocarcinoma cells by inducing the ROS/p53 axis. Funct Integr Genomics 2024; 24:114. [PMID: 38862667 PMCID: PMC11166828 DOI: 10.1007/s10142-024-01392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
With advances in radioactive particle implantation in clinical practice, Iodine-125 (125I) seed brachytherapy has emerged as a promising treatment for cholangiocarcinoma (CCA), showing good prognosis; however, the underlying molecular mechanism of the therapeutic effect of 125I seed is unclear. To study the effects of 125I seed on the proliferation and apoptosis of CCA cells. CCA cell lines, RBE and HCCC-9810, were treated with reactive oxygen species (ROS) scavenger acetylcysteine (NAC) or the p53 functional inhibitor, pifithrin-α hydrobromide (PFTα). Cell counting kit-8 (CCK-8) assay, 5-bromo-2-deoxy-uridine (BrdU) staining, and terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) assay and flow cytometry assay were performed to test the radiation-sensitivity of 125I seed toward CCA cells at different radiation doses (0.4 mCi and 0.8 mCi). 2,7-dichlorofluorescein diacetate (DCF-DA) assay, real-time quantitative polymerase chain reaction (RT-qPCR), and western blot analysis were performed to assess the effect of 125I seed on the ROS/p53 axis. A dose-dependent inhibitory effect of 125I seeds on the proliferation of CCA cells was observed. The 125I seed promoted apoptosis of CCA cells and induced the activation of the ROS/p53 pathway in a dose-dependent manner. NAC or PFTα treatment effectively reversed the stimulatory effect of 125I seed on the proliferation of CCA cells. NAC or PFTα suppressed apoptosis and p53 protein expression induced by the 125I seed. 125I seed can inhibit cell growth mainly through the apoptotic pathway. The mechanism may involve the activation of p53 and its downstream apoptotic pathway by up-regulating the level of ROS in cells.
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Affiliation(s)
- Fuping Kang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, 804 Shengli South Street, Yinchuan City, Ningxia Hui Autonomous Region, 750004, China
| | - Jing Wu
- Medical Experiment Center, General Hospital of Ningxia Medical University, 804 Shengli South Street, Yinchuan City, Ningxia Hui Autonomous Region, 750004, China
| | - Li Hong
- Department of Pediatrics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan City, Ningxia Hui Autonomous Region, China
| | - Peng Zhang
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, 804 Shengli South Street, Yinchuan City, Ningxia Hui Autonomous Region, 750004, China
| | - Jianjun Song
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, 804 Shengli South Street, Yinchuan City, Ningxia Hui Autonomous Region, 750004, China.
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Volpe F, Nappi C, Ponsiglione A, Klain M. Radiofrequency ablation versus radioactive iodine: the race for the best cure. Eur J Nucl Med Mol Imaging 2024; 51:2047-2049. [PMID: 38489055 DOI: 10.1007/s00259-024-06679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Fabio Volpe
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Koch M, Fauck V, Sievert M, Mantsopoulos K, Iro H, Mueller S. Ultrasound Changes in Salivary Glands after Radioactive Iodine Treatment in Benign Diseases and Differentiated Cancer of Thyroid Glands in Consideration of Dose and Time Dependency. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38171382 DOI: 10.1055/a-2190-6751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE To assess ultrasound (US) features observed in salivary glands after radioactive iodine treatment (RAIT) in relation to the dose and time interval after RAIT. MATERIALS AND METHODS A retrospective analysis of US findings regarding the salivary glands of patients presenting after RAIT due to thyroid cancer (Group 1, n=99) or benign thyroid diseases (Group 2, n=25). The control group consisted of randomly selected patients (no RAIT, Group 3, n=100). Groups were compared regarding RAIT dose, symptoms, and US findings (duct dilation, hypoechoic/heterogeneous parenchyma, parenchymal loss). The association of the presence of US parameters after RAIT with various dose levels (2000-15000MBq) and time intervals (24, 60, 120 months) and the differences between the groups was evaluated. RESULTS Significant differences between US parameters were noted when comparing Group 1 with Group 2 or 3. Nothing of relevant significance was noted when Groups 2 and 3 were compared. US features indicating a slight or moderate sialadenitis showed the most significant associations with doses <4000MBq and time intervals <24 months after RAIT. US changes indicating a serious sialadenitis or even gland atrophy showed the most significant association at doses between >7000-9000MBq and when US was performed >60 months after RAIT. CONCLUSION Our results point to a dose and time dependency of pathologic US findings in RAIT-induced effects on the major salivary glands. Based on the US findings, a better estimation of the current impact of RAIT on the salivary glands and the further prognosis appears possible.
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Affiliation(s)
- Michael Koch
- Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Vanessa Fauck
- ENT, Head and Neck Surgery, Nuremberg Hospital Campus North, Nurnberg, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Sarina Mueller
- Department of Otorhinolaryngology, Head & Neck Surgery, Erlangen University Hospital, Erlangen, Germany
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Baudin C, Bressand A, Buffet C, Menegaux F, Soret M, Lê AT, Cardon T, Broggio D, Bassinet C, Huet C, Armengol G, Richardson DB, Leenhardt L, Bernier MO, Lussey-Lepoutre C. Dysfunction of the Salivary and Lacrimal Glands After Radioiodine Therapy for Thyroid Cancer: Results of the START Study After 6-Months of Follow-Up. Thyroid 2023; 33:1100-1109. [PMID: 37300484 DOI: 10.1089/thy.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background: Understanding of changes in salivary and lacrimal gland functions after radioactive iodine therapy (131I-therapy) remains limited, and, to date, no studies have evaluated dose-response relationships between absorbed dose from 131I-therapy and dysfunctions of these glands. This study investigates salivary/lacrimal dysfunctions in differentiated thyroid cancer (DTC) patients six months after 131I-therapy, identifies 131I-therapy-related risk factors for salivary/lacrimal dysfunctions, and assesses the relationships between 131I-therapy radiation dose and these dysfunctions. Methods: A cohort study was conducted involving 136 DTC patients treated by 131I-therapy of whom 44 and 92 patients received 1.1 and 3.7 GBq, respectively. Absorbed dose to the salivary glands was estimated using a dosimetric reconstruction method based on thermoluminescent dosimeter measurements. Salivary and lacrimal functions were assessed at baseline (T0, i.e., immediately before 131I-therapy) and six months later (T6) using validated questionnaires and salivary samplings, with and without stimulation of the salivary glands. Statistical analyses included descriptive analyses and random-effects multivariate logistic and linear regressions. Results: There was no difference between T0 and T6 in the level of parotid gland pain, nor was there difference in the number of patients with hyposalivation, but there were significantly more patients with dry mouth sensation and dry eyes after therapy compared with baseline. Age, menopause, depression and anxiety symptoms, history of systemic disease, and not taking painkillers in the past three months were found to be significantly associated with salivary or lacrimal disorders. Significant associations were found between 131I-exposure and salivary disorders adjusted on the previous variables: for example, per 1-Gy increase in mean dose to the salivary glands, odds ratio = 1.43 [CI 1.02 to 2.04] for dry mouth sensation, ß = -0.08 [CI -0.12 to -0.02] mL/min for stimulated saliva flow, and ß = 1.07 [CI 0.42 to 1.71] mmol/L for salivary potassium concentration. Conclusions: This study brings new knowledge on the relationship between the absorbed dose to the salivary glands from 131I-therapy and salivary/lacrimal dysfunctions in DTC patients six months after 131I-therapy. Despite the findings of some dysfunctions, the results do not show any obvious clinical disorders after the 131I-therapy. Nevertheless, this study raises awareness of the risk factors for salivary disorders, and calls for longer follow-up. Clinical Trials Registration: Number NCT04876287 on the public website (ClinicalTrials.gov).
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Affiliation(s)
- Clémence Baudin
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | | | - Camille Buffet
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Fabrice Menegaux
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Department of General and Endocrine Surgery, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Marine Soret
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Biomedical Imaging Laboratory, CNRS, INSERM, Sorbonne University, Paris, France
| | - Anh Thu Lê
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Thomas Cardon
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - David Broggio
- Internal Dose Assessment Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Céline Bassinet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Christelle Huet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Gemma Armengol
- Department of Animal Biology, Plant Biology and Ecology, Faculty of Biosciences, Universitat Autònoma de Barcelona, Bellaterra, Catalonia, Spain
| | - David B Richardson
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laurence Leenhardt
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Marie-Odile Bernier
- Laboratory of Epidemiology, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Charlotte Lussey-Lepoutre
- Department of Thyroid Disease and Endocrine Tumor, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Unit of Radionuclide Treatment, Department of Nuclear Medicine, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, France
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Machine learning reveals salivary glycopatterns as potential biomarkers for the diagnosis and prognosis of papillary thyroid cancer. Int J Biol Macromol 2022; 215:280-289. [PMID: 35660041 DOI: 10.1016/j.ijbiomac.2022.05.194] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022]
Abstract
The diagnosis of thyroid cancer, especially papillary thyroid cancer (PTC), is increasing rapidly worldwide. In this study, we aimed to study the glycosylation of salivary proteins associated with PTC and assess the likelihood that salivary glycopatterns may be a potential biomarker of PTC diagnosis. Firstly, 22 benign thyroid nodule (BTN) samples, 27 PTC samples, and 30 healthy volunteers (HV) samples were collected to probe the difference of salivary glycopatterns associated with PTC using lectin microarrays. Then, five machine learning models including K-Nearest Neighbor (KNN), Multilayer Perceptron (MLP), Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM) were established to distinguish HV, BTN and PTC based on the changes of salivary glycopatterns. As a result, SVM had the best diagnostic effect with an accuracy rate of 92 % in testing set. Besides, lectin microarrays were used to explore the differences in salivary glycopatterns of 26 paired salivary samples of PTC patients before and after operation in order to probe into salivary glycopatterns as potential biomarkers for prognosis of PTC patients. The results showed that the levels of salivary glycopatterns recognized by 6 different lectins in patients after the operation almost convergenced with HVs. This study could help to screen and assess patients with PTC and their prognosis based on precise changes of salivary glycopatterns.
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Quantitative Scintigraphy Evaluated the Relationship between 131I Therapy and Salivary Glands Function in DTC Patients: A Retrospective Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7640405. [PMID: 35463665 PMCID: PMC9023193 DOI: 10.1155/2022/7640405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/18/2022] [Indexed: 11/18/2022]
Abstract
Purpose Quantitative scintigraphy to evaluate salivary gland function changes in patients with differentiated thyroid cancer (DTC) after iodine-131 (131I) treatment. Methods A total of 458 patients with DTC grouped by sex and age were included. Salivary gland scintigraphy was performed to evaluate salivary gland function before and after 131I treatment. The uptake fraction (UF), uptake index (UI), and excretion fraction (EF) of two pairs of parotid glands and submandibular glands were measured and compared. The Chi-square test was conducted according to function impairment count. Results Salivary gland function in different age groups and sexes were quite different, especially for women <55 years old, who had decreased UF, UI, and EF of all four glands without basal injury. The secretion or uptake function of some salivary glands with basic function impairment before 131I treatment was increased after iodine treatment. Only a small percentage of males showed reduced functional parameters after several treatments. The most significant difference in the count of impairment for the four salivary glands were the first and third examinations, which was more evident in women. The submandibular gland had the most significant reduction in uptake. Conclusion Changes in salivary gland function are more common in young females being treated for DTC. Impairment of salivary gland function is correlated with the number of treatments and the cumulative dose of 131I. Some salivary gland functions impaired before 131I treatment were enhanced in the early treatment.
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Borzouei S, Bawand R, Salimbahrami S, Sheikh V. Comparison of clinical efficacy of antithyroid drugs, radioactive iodine, and thyroidectomy for treatment of patients with graves' disease, toxic thyroid adenoma, and toxic multinodular goiter. BIOMEDICAL AND BIOTECHNOLOGY RESEARCH JOURNAL (BBRJ) 2022. [DOI: 10.4103/bbrj.bbrj_99_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lin B, Zhao F, Liu Y, Sun J, Feng J, Zhao L, Wang H, Chen H, Yan W, Guo X, Shi S, Li Z, Wang S, Lu Y, Zheng J, Wei Y. Alterations in Oral Microbiota of Differentiated Thyroid Carcinoma Patients With Xerostomia After Radioiodine Therapy. Front Endocrinol (Lausanne) 2022; 13:895970. [PMID: 36093087 PMCID: PMC9459331 DOI: 10.3389/fendo.2022.895970] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS Oral xerostomia remains one of the most common complications of differentiated thyroid carcinoma patients (DTC) after radioiodine therapy (RAI). Environmental factors in the etiology of xerostomia are largely unknown. We aimed to characterize the oral microbiota signatures and related biological functions associated with xerostomia and identify environmental factors affecting them. METHODS Saliva was collected from 30 DTC patients with xerostomia (XAs), 32 patients without xerostomia (indicated as non-XAs) following RAI after total thyroidectomy, and 40 healthy people (HCs) for 16S rRNA sequencing analysis. RESULTS The oral microbiota of XAs and non-XAs exhibited significant differences in α and β diversities and bacterial taxa. The abundance of porphyromonas, fusobacterium, and treponema_2 were significantly higher in XAs, while the abundance of the streptococcus was lower in the microbiota of non-XAs. Fusobacterium, and porphyromonas were negatively correlated with unstimulated/stimulated whole salivary secretion (USW)/(SWS), while fusobacterium, porphyromonas, and treponema_2 genera levels were positively associated with cumulative radioiodine dose. PICRUSt2 and BugBase suggested a significant difference in the expression of potentially_pathogenic, anaerobic, gram_negative, the arachidonic acid metabolism, and lipopolysaccharide (LPS) biosynthesis between XAs and non-XAs, possibly interdependent on radioiodine-induced inflammation. NetShift analysis revealed that porphyromonas genus might play as a key driver during the process of xerostomia. Five genera effectively distinguished XAs from non-XAs (AUC = 0.87). CONCLUSION Our study suggests for the first time that DTC patients with xerostomia after RAI display microbiota profiles and associated functional changes that may promote a pro-inflammatory environment. Dysbiosis of the oral microbiota may contribute to exacerbating the severity of xerostomia. Our results provide a research direction of the interaction mechanism between oral microbiota alteration and the progress of xerostomia.
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Affiliation(s)
- Baiqiang Lin
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fuya Zhao
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yang Liu
- Pancreatic and Gastrointestinal Surgery Division, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Clinical Research Center for Digestive System Tumors, Ningbo, China
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiayu Sun
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- General Surgery, Zhujiang Hospital, SouthernMedical University, Guangzhou, China
| | - Jing Feng
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhao
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haoran Wang
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongye Chen
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Yan
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao Guo
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shang Shi
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiyong Li
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuang Wang
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu Lu
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianjun Zheng
- Imaging Center, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Clinical Medical Research Center of Imaging Medicine, Ningbo, China
- *Correspondence: Yunwei Wei, ; Jianjun Zheng,
| | - Yunwei Wei
- Pancreatic and Gastrointestinal Surgery Division, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Clinical Research Center for Digestive System Tumors, Ningbo, China
- Oncology and Laparoscopy Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Yunwei Wei, ; Jianjun Zheng,
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12
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Campanhã D, PereiraLIMA EN, Alves FA, Jaguar GC. Bethanechol used to prevent salivary gland dysfunction in patients submitted to radioactive iodine therapy: A double blind, placebo-controlled, randomized study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e626-e630. [PMID: 34954424 DOI: 10.1016/j.jormas.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/05/2021] [Accepted: 12/21/2021] [Indexed: 02/02/2023]
Abstract
Symptoms related to salivary gland damage are one of the most frustrating complications after radioactive iodine (131I) therapy. To the best of our knowledge, this is the first study that aimed to evaluate the prophylactic effect of Bethanechol on the radioiodine content of salivary gland. Fifty patients who were referred to 131I therapy were randomized into Bethanechol and placebo groups. Patients received Bethanechol or Placebo (25 mg, 2 times daily), starting 2 h after 131I therapy to 1-month. Both groups were compared at baseline, 10, 30 and 90 days after 131I therapy based on the following: symptoms related to salivary gland damage; unstimulated whole saliva (UWS) and quality of life using University of Washington Quality of Life 4 questionnaire. Bethanechol group presented significantly lower complaints of dry mouth on 10 (p = 0.047) and 30 (p = 0.003) days compared with placebo. Salivary gland pain and swelling were more frequent among placebo patients at 10 days (p = 0.047). Comparison of the two groups by UWS, no statistical difference was found. Placebo group presented worse score related to activity (p = 0.034), saliva (p = 0.05) and humor (p = 0.05) at 10 days; palate (p = 0.05) and saliva (p = 0.05) at 1 month. Interestingly, Bethanechol patients who received 131I dose > 125mCi, showed better xerostomia indices when compared to the Placebo with same dose. Bethanechol during 131I therapy was found to be effective in decreasing the acute salivary gland damage with impact on patients' quality of life.
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Affiliation(s)
- Daniel Campanhã
- A.C. Camargo Cancer Center, Stomatology Department, 211 Bairro: Liberdade, São Paulo, SP 01509-900, Brazil
| | | | - Fábio Abreu Alves
- A.C. Camargo Cancer Center, Stomatology Department, 211 Bairro: Liberdade, São Paulo, SP 01509-900, Brazil.
| | - Graziella Chagas Jaguar
- A.C. Camargo Cancer Center, Stomatology Department, 211 Bairro: Liberdade, São Paulo, SP 01509-900, Brazil.
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Adramerinas M, Andreadis D, Vahtsevanos K, Poulopoulos A, Pazaitou-Panayiotou K. Sialadenitis as a complication of radioiodine therapy in patients with thyroid cancer: where do we stand? Hormones (Athens) 2021; 20:669-678. [PMID: 34143403 DOI: 10.1007/s42000-021-00304-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/31/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE This study aims to elaborate on the current knowledge concerning the mechanism, frequency, clinical manifestations, diagnostic procedures, prevention, and management of radioactive iodine (RAI)-induced sialadenitis in patients receiving treatment for differentiated thyroid cancer (DTC). METHODS A review of the literature was carried out through the " www.ncbi.nlm.nih.gov/pubmed " database focusing on the results of the past decade. RESULTS The high concentration of RAI in the salivary glands results in high beta radiation exposure of the striated duct cells and stem cells. This exposure leads to acute and/or chronic sialadenitis with obstructive symptoms and progressive loss of salivary gland function and xerostomia, with severe impact on patients' quality of life. No standard diagnostic method has been established. As far as prevention is concerned, many approaches have been proposed, such as sialogogues, local massage, vitamin E, and amifostine administration. Although there is no unanimity as to their effectiveness, the use of sialogogues is recommended. Treatment includes conservative drug therapy and sialendoscopy when necessary. CONCLUSION RAI-induced sialadenitis has a major impact on patients' quality of life. Due to the good prognosis of DTC, the reduction of sialadenitis and its prognosis, prevention, and treatment constitute a priority for the overall treatment of these patients. Further studies that will establish a coherent treatment protocol for this condition are necessary.
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Affiliation(s)
| | - Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Vahtsevanos
- Department of Oral/Maxillofacial Surgery, "G. Papanikolaou" Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Poulopoulos
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Buchholzer S, Thakachy Subha S, Tchérémissinoff L, Boselie F, Triponez F, Faure F, Lopez JM, Borner U, Kleinjung T, Seebach JD, Dulguerov P, Marchal F. The RAI-6 Questionnaire: A New Screening Questionnaire to Monitor Complications of Radioiodine Treatment. Front Surg 2021; 8:641945. [PMID: 34540883 PMCID: PMC8445110 DOI: 10.3389/fsurg.2021.641945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study is to develop a simple and efficient screening questionnaire to be able to routinely monitor potential radioiodine therapy-induced complications. Materials and Methods: A new radioiodine 6 (RAI-6) questionnaire containing six questions adressing salivary, ocular, and nasal symptoms as well as quality of life was developed. Validation of the RAI-6 questionnaire was assessed with a group of fifty-four patients diagnosed with differentiated thyroid carcinoma treated post-operatively with radioiodine therapy, and in a group of fifty healthy volunteers. The patient's group was subdivided into subgroups according to the radioiodine dose received: 23 patients received less or 30 mCi, 28 patients received 100 mCi, and three patients received between 200 and 300 mCi. We asked the patients to complete the RAI-6 questionnaire in a retrospective manner, regarding their situation before radioiodine therapy and regarding their actual symptoms after radioiodine therapy. The time needed to complete the RAI-6 was also assessed both in patients and in healthy volunteers. Results: The mean post radioiodine treatment RAI-6 score were significantly higher than the mean pre radioiodine RAI-6 scores (p < 0.001) and the scores of healthy participants (p < 0.001). The mean total RAI-6 scores increased significantly with increasing radioiodine dose. A total mean RAI-6 score of each question was also analysed and revealed that ocular and nasal discomfort as well as quality of life were the items which affected the patients most after radioiodine treatment. The mean time to fill the RAI-6 questionnaire was 2 min for patients and 49 s for healthy volunteers. Conclusion: The RAI-6 represents a new questionnaire which is easy and quick to complete. This simple screening tool can be recommended for general clinical practise and further epidemiological research.
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Affiliation(s)
- Samanta Buchholzer
- Department of Maxillofacial Surgery and Oral Medicine and Pathology, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Franciscus Boselie
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Triponez
- Department of Thoracic Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Faure
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Lyon, Lyon, France
| | - Jean-Michel Lopez
- Department of Otolaryngology-Head and Neck Surgery, Perpignan Hospital, Perpignan, France
| | - Urs Borner
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Bern, Bern, Switzerland
| | - Tobias Kleinjung
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Zürich, Zurich, Switzerland
| | - Jörg D Seebach
- Division of Allergy and Immunology, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Francis Marchal
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Christou A, Papastavrou E, Merkouris A, Charalambous A. A pretest-posttest pilot study for the development and preliminary validation of a tool for the clinical assessment of radioiodine induced sialadenitis. SAGE Open Med 2021; 9:20503121211042211. [PMID: 34484788 PMCID: PMC8414619 DOI: 10.1177/20503121211042211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: The clinical assessment of radioiodine-induced sialadenitis is relied on the
observer-defined toxicity grading model. However, this model has significant
limitations, the major one being the lack of systematic assessment based on
objective criteria. The main aim of this study was the development and
testing of an assessment tool which could examine the severity of
post-irradiation sialadenitis. Methods: The development of the Sialadenitis Assessment Tool proceeded through three
phases. The first and second phases included a literature review and the
development of the tool which derived from the review, respectively. The
third phase involved a pilot testing of the Assessment Tool to a sample of
34 patients undergoing I131 therapy. The assessment was carried
out by two independent healthcare professionals, pre- and post-radioiodine
therapy. The results of the assessment tool were compared with other scales,
including the DIRIX and EORTC H&N35. Results: According to the Cohen’s kappa test, the Sialadenitis Assessment Tool is a
reliable tool for the assessment of sialadenitis (Cohen’s κ = 1). The
concurrent and internal validity tests showed a tendency of association with
most variables (p < 0.001) in the DIRIX and EORTC QLQ-HN35 scales. Conclusion: Preliminary evidence show that Sialadenitis Assessment Tool is a valid and
reliable tool to assess radioiodine-induced sialadenitis in patients
undergoing I131 therapy post-thyroidectomy.
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Affiliation(s)
- Andri Christou
- Department of Nursing, School of Health Sciences, Cyprus University Technology, Limassol, Cyprus
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University Technology, Limassol, Cyprus
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University Technology, Limassol, Cyprus
| | - Andreas Charalambous
- Department of Nursing, School of Health Sciences, Cyprus University Technology, Limassol, Cyprus.,Department of Nursing, University of Turku, Turku, Finland
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Does the radioactive iodine dose affect smell, taste sensation and nose function? The Journal of Laryngology & Otology 2021; 135:50-56. [PMID: 33478598 DOI: 10.1017/s0022215120002571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To detect whether the adverse effects of post-operative radioactive iodine therapy following differentiated thyroid cancer on smell, taste and nasal functions were associated with radioactive iodine dose. METHODS Fifty-one patients who had undergone total thyroidectomy because of differentiated thyroid cancer were divided into two groups depending on the post-operative radioactive iodine therapy dose: low dose group (50 mCi; 21 patients) and high dose group (100-150 mCi; 30 patients). The Sniffin' Sticks smell test, the Taste Strips test and the 22-item Sino-Nasal Outcome Test were performed on all patients one week before therapy, and at two months and one year following therapy. RESULTS Statistically significant differences were detected in the Sniffin' Sticks test results, total odour scores, total taste scores and Sino-Nasal Outcome Test results between the assessment time points. There was no statistically significant difference between the low and high dose groups in terms of odour, taste or Sino-Nasal Outcome Test scores either before or after therapy. CONCLUSION Radioactive iodine therapy has some short- and long-term adverse effects on nasal functions and taste and odour sensations, which affect quality of life. These effects are not dose-dependent.
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6,8-Diprenylorobol Induces Apoptosis in Human Hepatocellular Carcinoma Cells via Activation of FOXO3 and Inhibition of CYP2J2. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8887251. [PMID: 33312341 PMCID: PMC7721496 DOI: 10.1155/2020/8887251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/24/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
6,8-Diprenylorobol is a phytochemical derived from the roots of Glycyrrhiza uralensis Fisch. 6,8-Diprenylorobol exhibits several biological activities, but the effects of 6,8-diprenylorobol on cancers have been hardly investigated. This study is aimed at elucidating the anticancer effect and working mechanism of 6,8-diprenylorobol in HepG2 and Huh-7, two kinds of human hepatocellular carcinoma (HCC) cell lines. WST-1, cell counting, and colony formation assays and morphological change analysis showed that 6,8-diprenylorobol treatment decreased the cell viability and proliferation rate. Cell cycle analysis indicated that 6,8-diprenylorobol treatment increased the population of the G1/0 stage. Annexin V/PI double staining and TUNEL analysis showed that 6,8-diprenylorobol treatment increased the apoptotic cell population and DNA fragmentation. Western blot analysis showed that 6,8-diprenylorobol treatment increased the expression of cleaved PARP1, cleaved caspase-3, FOXO3, Bax, Bim, p21, and p27 but decreased the expression of Bcl2 and BclXL. Interestingly, 6,8-diprenylorobol inhibited CYP2J2-mediated astemizole O-demethylation and ebastine hydroxylase activities with Ki values of 9.46 and 2.61 μM, respectively. CYP2J2 siRNA transfection enhanced the anticancer effect of 6,8-diprenylorobol in HepG2 and Huh-7 cells through the downregulation of CYP2J2 protein expression and upregulation of FOXO3. Taken together, this study proposes that 6,8-diprenylorobol treatment may be a useful therapeutic option against HCC by targeting CYP2J2 and FOXO3.
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Thorpe RK, Foggia MJ, Marcus KS, Policeni B, Maley JE, Hoffman HT. Sialographic Analysis of Radioiodine-Associated Chronic Sialadenitis. Laryngoscope 2020; 131:E1450-E1456. [PMID: 33200832 PMCID: PMC10049839 DOI: 10.1002/lary.29279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/30/2020] [Accepted: 11/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To apply a novel sialography classification system to identify parotid and submandibular ductal findings following I-131 therapy and to assess correlates to dose and duration of symptoms. STUDY DESIGN Retrospective single-center case series. METHODS Patients who underwent sialography between February 2008 and February 2019 after previously receiving I-131 treatment were identified via a retrospective chart review. Their sialograms were systematically evaluated and scored by applying the Iowa parotid sialogram scale to also include submandibular gland analysis. RESULTS From 337 sialograms, 30 (five submandibular, 25 parotid) underwent analysis. Ductal stenosis was identified in all sialograms and was graded as moderate (>50%-75%) in 7/30 cases and severe (>75%) in 15/30 cases. The distal (main) duct was narrowed in 23/30 cases. No association was identified between degree of ductal stenosis and I-131 dose (P = .39), age (P = .81), or time from I-131 therapy to sialogram (P = .97). CONCLUSIONS The Iowa parotid sialogram scale was successfully applied to report abnormalities of the parotid and submandibular ductal system. The most common manifestation of I-131-associated sialadenitis was a severe stenosis within the distal salivary duct. No statistically significant association was found between degree of ductal stenosis and dose of I-131, age, or duration of symptoms. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1450-E1456, 2021.
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Affiliation(s)
- Ryan K Thorpe
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Megan J Foggia
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Kathryn S Marcus
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Bruno Policeni
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Joan E Maley
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Sánchez Barrueco A, González Galán F, Alcalá Rueda I, Santillán Coello JM, Barrio Dorado MP, Villacampa Aubá JM, Escanciano Escanciano M, Llanos Jiménez L, Mahillo Fernández I, Cenjor Español C. Incidence and risk factors for radioactive iodine-induced sialadenitis. Acta Otolaryngol 2020; 140:959-962. [PMID: 32815758 DOI: 10.1080/00016489.2020.1802507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radioactive iodine (131I) is one of the treatments of hyperthyroidism and differentiated thyroid carcinoma (DTC). Swelling of salivary glands are one of the possible side effects of this treatment, known as radioactive iodine-induced sialadenitis (RAIS). The prevalence of RAIS varies widely and no specific risk ratio has been established. OBJECTIVES To determine the incidence of RAIS, analysing the epidemiological data and tumour- and treatment-related factors that may influence the development of the disease. MATERIAL AND METHODS 197 patients who received radioiodine treatment between 2015 and 2017 were studied (76.6% women). The variables studied were age, gender, weight, height, and body mass index; presence of high blood pressure, dyslipidemia, diabetes, and thyroid diseases; cumulative radioiodine dose, presence of sialadenitis, affected salivary gland, and the time of onset. RESULTS 14 patients developed sialadenitis (78.6% women), all with DTC. The incidence of sialadenitis was 3.4% overall and 6.3% among DTC patients. Furthermore, we found that higher cumulative radioiodine doses confer a greater risk of developing sialadenitis, with a hazard ratio of 1.009 (p = .001). No association was found between the epidemiologic data studied and sialadenitis. CONCLUSIONS In this series, a dose-dependent relationship was found between radioiodine treatment and sialadenitis.
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Affiliation(s)
- Alvaro Sánchez Barrueco
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Fernando González Galán
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Ignacio Alcalá Rueda
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | | | | | | | | | - Lucía Llanos Jiménez
- Instituto de Investigación Sanitaria, Research Unit, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Ignacio Mahillo Fernández
- Instituto de Investigación Sanitaria, Research Unit, Fundación Jiménez Diaz University Hospital, Madrid, Spain
| | - Carlos Cenjor Español
- ENT and Cervicofacial Surgery Department, Fundación Jiménez Diaz University Hospital, Madrid, Spain
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20
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Jayarajah U, Wijekoon M, Seneviratne SA. Prophylactic prednisolone for the prevention of early and intermediate adverse effects of radioactive iodine therapy in patients with thyroid cancer: study protocol for a single-centre, phase II/III, randomized, double-blinded, placebo-controlled clinical trial. Trials 2020; 21:812. [PMID: 32993815 PMCID: PMC7526358 DOI: 10.1186/s13063-020-04744-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022] Open
Abstract
Background Radioactive iodine (RAI) therapy is the standard adjuvant treatment for differentiated thyroid cancer (i.e. papillary and follicular). RAI is associated with troublesome early, intermediate and late adverse effects. Although glucocorticoids are used for the management of these adverse effects, there is little evidence regarding the effectiveness of prophylactic glucocorticoids to prevent these complications. This trial will evaluate the efficacy of a short course of prophylactic glucocorticoids in the prevention of adverse effects of RAI treatment in patients with differentiated thyroid cancer. Methods A phase II/III, single-centre, randomized, double-blinded, placebo-controlled, parallel-arm clinical trial will be conducted. Patients with differentiated thyroid cancer who are referred to RAI therapy at the National Cancer Institute, Sri Lanka, will be randomized into two arms consisting of 200 patients each. The experimental group will receive prophylactic oral prednisolone 0.5 mg/kg and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral prednisolone 0.5 mg/kg and omeprazole 20 mg daily for 3 days. The control group will receive oral placebo and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral placebo and omeprazole 20 mg daily for 3 days. Clinically significant adverse effects assessed as related to RAI as well as prednisolone therapy and the quality of life parameters will be compared between the two groups. Discussion If proven beneficial, this intervention can be incorporated into the standard practice to reduce early and intermediate adverse effects of RAI for thyroid cancer with a potential improvement of quality of life. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2020/009. Registered prospectively on 23 February 2020. Items of the WHO Trial Registration Data Set are provided in the supplementary file.
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Affiliation(s)
- Umesh Jayarajah
- Department of Surgery, National Hospital of Sri Lanka, Colombo, Sri Lanka. .,Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka.
| | - Mahilal Wijekoon
- Apeksha Hospital, National Cancer Institute, Maharagama, Sri Lanka
| | - Sanjeewa A Seneviratne
- Department of Surgery, Faculty of Medicine, University of Colombo, P.O. Box 271, Kynsey Road, Colombo 8, Western Province, Sri Lanka.
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21
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Andersson CK, Elvborn M, Spetz JKE, Langen B, Forssell-Aronsson EB. Biodistribution of 131I in mice is influenced by circadian variations. Sci Rep 2020; 10:15541. [PMID: 32968085 PMCID: PMC7511401 DOI: 10.1038/s41598-020-72180-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/25/2020] [Indexed: 12/28/2022] Open
Abstract
Effects of radiation and biodistribution of radionuclides are often studied in animal models. Circadian rhythm affects many biological functions and may influence the biokinetics of radionuclides and observed responses. The aim of this study was to investigate if the time during the day of 131I injection affects the biodistribution and absorbed dose to tissues in mice. Biodistribution studies were conducted on male C57BL/6 N mice for three diurnal time-series: the animals were i.v. injected with 160 kBq 131I at 8 am, 12 pm or 4 pm. The activity concentration in organs and tissues was measured at 1 h to 7 days after administration and absorbed dose at day 7 was determined. Comparison between the three time-series showed statistically significant differences in activity concentration in all investigated tissues and organs. Administration performed at 12 pm resulted in general in higher absorbed dose to the organs than injection performed at 8 am and 4 pm. Time of day of administration affects the biodistribution of 131I in mice and consequently the absorbed dose to individual organs. These findings advocate that subsequent biodistribution studies and dosimetry calculations should consider time-point of administration as a variable that could influence the results.
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Affiliation(s)
- Charlotte K Andersson
- Department of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden.
| | - Mikael Elvborn
- Department of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden
| | - Johan K E Spetz
- Department of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden
| | - Britta Langen
- Department of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden
| | - Eva B Forssell-Aronsson
- Department of Radiation Physics, Inst of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE 413 45, Gothenburg, Sweden
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22
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Simões Lima GA, López RVM, de Freitas RMC, Willegaignon J, Sapienza MT, Chammas MC, Coura-Filho GB. Evaluation of Parotid Salivary Gland Echo Texture by Ultrasound Examinations and Correlation With Whole-Body Scintigraphy After Radioiodine Therapy in Patients With Differentiated Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1811-1818. [PMID: 32309884 DOI: 10.1002/jum.15289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 03/19/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This study aimed to evaluate the echo texture of the parotid salivary glands before and after radioiodine therapy (RIT) using ultrasound (US) images in patients with differentiated thyroid cancer and to evaluate the correlations between post-RIT whole-body scintigraphy (WBS) images and US image patterns in salivary and cervical areas. METHODS A retrospective study was performed with data on demographic and clinical information, US examinations, and WBS images collected through medical recordings. RESULTS Comparing the US features before and after RIT, significant echo texture heterogeneity was found in 31.3% of all patients evaluated. When evaluated according to the level of iodine 131 (I-131) radioactivity (<5.6, 5.6-<9.3, and ≥9.3 GBq), echo texture heterogeneity was significantly associated with the 5.6-GBq I-131 radioactivity group (P < .001). No association was found for any level of I-131 post-RIT WBS uptake intensity and changes in US feature patterns. CONCLUSIONS Ultrasound may be a useful tool for evaluating chronic sialadenitis after RIT, and the I-131 uptake intensity using a routine post-RIT WBS is not associated with US echo texture changes.
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Affiliation(s)
- Graziele Aparecida Simões Lima
- Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rossana Verónica Mendoza López
- Centro de Investigaçao Translacional em Oncologia, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Miguel Costa de Freitas
- Serviço de Radiologia, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Willegaignon
- Serviço de Medicina Nuclear, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Tatit Sapienza
- Centro de Medicina Nuclear, Instituto de Radiologia, Hospital das Clínicas HCFMSUP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Christina Chammas
- Instituto de Radiologia, Hospital das Clínicas HCFMSUP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - George Barberio Coura-Filho
- Serviço de Medicina Nuclear, Instituto do Cancer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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23
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Singer MC, Marchal F, Angelos P, Bernet V, Boucai L, Buchholzer S, Burkey B, Eisele D, Erkul E, Faure F, Freitag SK, Gillespie MB, Harrell RM, Hartl D, Haymart M, Leffert J, Mandel S, Miller BS, Morris J, Pearce EN, Rahmati R, Ryan WR, Schaitkin B, Schlumberger M, Stack BC, Van Nostrand D, Wong KK, Randolph G. Salivary and lacrimal dysfunction after radioactive iodine for differentiated thyroid cancer: American Head and Neck Society Endocrine Surgery Section and Salivary Gland Section joint multidisciplinary clinical consensus statement of otolaryngology, ophthalmology, nuclear medicine and endocrinology. Head Neck 2020; 42:3446-3459. [PMID: 32812307 DOI: 10.1002/hed.26417] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/03/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement. METHODS A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations. RESULTS Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management. CONCLUSION Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.
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Affiliation(s)
- Michael C Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Francis Marchal
- Department of Otolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Peter Angelos
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Vic Bernet
- Department of Endocrinology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Laura Boucai
- Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samanta Buchholzer
- Maxillofacial Surgery and Oral Medicine and Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Brian Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Eisele
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evren Erkul
- Department of Otorhinolaryngology, Gulhane Medical School, University of Health Sciences, Istanbul, Turkey
| | - Frederic Faure
- Department of Otolaryngology - Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Suzanne K Freitag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Marion Boyd Gillespie
- Department of Otolaryngology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Richard Mack Harrell
- Memorial Center for Integrative Endocrine Surgery, Memorial Healthcare System, Hollywood, Florida, USA
| | - Dana Hartl
- Department of Head and Neck Oncology, Institut de Cancerologie Gustave Roussy, Villejuif, France
| | - Megan Haymart
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Susan Mandel
- Department of Endocrinology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Barbra S Miller
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth N Pearce
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rahmatullah Rahmati
- Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - William R Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Barry Schaitkin
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Doug Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ka Kit Wong
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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24
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Nylén C, Eriksson FB, Yang A, Aniss A, Turchini J, Learoyd D, Robinson BG, Gill AJ, Clifton-Bligh RJ, Sywak MS, Glover AR, Sidhu SB. Prophylactic central lymph node dissection informs the decision of radioactive iodine ablation in papillary thyroid cancer. Am J Surg 2020; 221:886-892. [PMID: 32878695 DOI: 10.1016/j.amjsurg.2020.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/02/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prophylactic central lymph node dissection (CLND) in papillary thyroid cancer (PTC) is controversial. We aimed to investigate if prophylactic CLND aids risk stratification and contributes to the decision for postoperative RAI ablation. METHODS Patients undergoing thyroidectomy for PTC and prophylactic CLND were identified from an endocrine surgical unit database. Pathology reports where reviewed for number and size of lymph nodes and patients stratified by risk according to the ATA guidelines. RESULTS 426 patients were identified with PTC ≤4 cm and prophylactic CLND. 96 patients (23%) had central lymph node metastasis (CLNM) that qualified them for the intermediate risk group. In 17 patients (4%), the CLNM data led to upgrading independently of other histopathological characteristics. Correcting for multiple variables, CLNM was an independent factor contributing to RAI treatment. CONCLUSION Prophylactic CLND provides information to aid the selection of RAI ablation independent of primary cancer histology for risk stratification in 4% of patients. This benefit should be carefully balanced with the risk of CLND and patient treatment choice when deciding on management of PTC ≤4 cm.
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Affiliation(s)
- Carolina Nylén
- Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Endocrine Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Frida Bragvad Eriksson
- Department of Endocrine Surgery, Uppsala University, Akademiska Hospital, 751 85 Uppsala, Sweden
| | - Anna Yang
- Department of Endocrine Surgery, Uppsala University, Akademiska Hospital, 751 85 Uppsala, Sweden
| | - Ahmad Aniss
- Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - John Turchini
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Histopathology, Douglass Hanly Moir Pathology, Macquarie Park, NSW, 2113, Australia; Discipline of Pathology, MQ Health, Macquarie University, NSW, 2109, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Diana Learoyd
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Bruce G Robinson
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Anthony J Gill
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Roderick J Clifton-Bligh
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Department of Endocrinology and Diabetes, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Mark S Sywak
- Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anthony R Glover
- Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Endocrine Cancer Program, Cancer Theme, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School. Faculty of Medicine, University of New South Wales Sydney, NSW, 2010, Australia
| | - Stan B Sidhu
- Department of Endocrine Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia; Cancer Genetics Unit, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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25
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Le Roux MK, Graillon N, Guyot L, Taieb D, Galli P, Godio-Raboutet Y, Chossegros C, Foletti JM. Salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma: Long-term study. Head Neck 2020; 42:3133-3140. [PMID: 32652742 DOI: 10.1002/hed.26359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/05/2020] [Accepted: 06/15/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although many studies focus on short-term side effects of radioiodine therapy, almost none studied long-term side effects. We assessed radioiodine long-term salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma and compared it to short-term morbidity within the same population. METHODS A standardized self-administrated questionnaire was submitted in 2019 by patients treated with radioiodine between January 2011 and December 2012. These patients had already answered the same questionnaire 6 years before. RESULTS Our study showed a significant reduction for salivary side effects: discomfort in submandibular or parotid area, swelling, pain, a bad or salty taste in the mouth, allowing to get back to a "normal" diet. CONCLUSIONS Our study suggests that a significant rate of patients will recover from I131 therapy salivary side effects. As almost 30% of these remissions happened during our late stage follow-up, we highlight the necessity of a long-term follow-up in these patients.
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Affiliation(s)
- Marc-Kevin Le Roux
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France.,Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
| | - Nicolas Graillon
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - Laurent Guyot
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - David Taieb
- Aix Marseille Univ, IFSTTAR, Marseille, France.,Department of Nuclear Medecine, APHM, CHU Timone, Marseille, France
| | - Philippe Galli
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | | | - Cyrille Chossegros
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - Jean-Marc Foletti
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France.,Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
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26
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Nixon IJ, Shah JP, Zafereo M, Simo RS, Hay ID, Suárez C, Zbären P, Rinaldo A, Sanabria A, Silver C, Mäkitie A, Vander Poorten V, Kowalski LP, Shaha AR, Randolph GW, Ferlito A. The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective. Eur J Surg Oncol 2020; 46:754-762. [PMID: 31952928 DOI: 10.1016/j.ejso.2020.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/16/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.
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Affiliation(s)
- I J Nixon
- Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, University of Edinburgh, UK.
| | - J P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - M Zafereo
- Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - R S Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - I D Hay
- Division of Endocrinology and Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - C Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - P Zbären
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - A Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - C Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden
| | - V Vander Poorten
- Department of Oncology, section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - L P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, and Head and Neck Surgery Department, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil
| | - A R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - G W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - A Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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27
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Krcalova E, Horacek J, Gabalec F, Zak P, Dolezal J. Salivary gland function in thyroid cancer patients with radioiodine administration history. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:277-283. [PMID: 31223135 DOI: 10.5507/bp.2019.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022] Open
Abstract
AIM Radioiodine (RAI) improves survival in patients with locally advanced or metastatic differentiated thyroid carcinoma (DTC). Although there has been an ongoing debate on RAI-induced salivary gland damage, published data have been inconsistent. Therefore, the purpose of our study was to compare salivary gland function in intermediate and high risk DTC patients after single or repeated RAI treatment with their age- and sex-matched RAI-naive counterparts. METHODS Uptake and excretion of parotid and submandibular glands were quantitatively evaluated using 99mTc-pertechnetate salivary gland scintigraphy in 23 patients previously treated with RAI. Patients (median 9.25 GBq 131I-NaI; Q1-Q3: 5.55-16.65; range: 5.55-27.5) were divided into subgroups according to previously administered 131I-NaI activity using cut-off values 5.55 GBq and 9.25 GBq. Their salivary gland scintigraphy results were compared with RAI-naive patients using Mann-Whitney test. RESULTS Compared to RAI-naive patients, parotid glands pertechnetate uptake was significantly lower in those treated with > 9.25 GBq (P=0.034) and parotid glands excretion fraction was already decreased with RAI activities > 5.55 GBq (P=0.031). In submandibular glands, no statistically significant difference in either function was observed even with RAI activity > 9.25 GBq. CONCLUSION Our data suggest that RAI therapy using activities ≤ 5.55 GBq does not substantially decrease saliva production. Activities > 5.55 GBq may lead to significant decrease in parotid excretion, and activities > 9.25 GBq also diminish parotid uptake. Surprisingly, submandibular glands, providing majority of seromucinous saliva under basal condition, seem to be unaffected even by RAI activities above 9.25 GBq.
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Affiliation(s)
- Eva Krcalova
- Department of Nuclear Medicine, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.,Academic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Jiri Horacek
- Academic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.,4
| | - Filip Gabalec
- Academic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.,4
| | - Pavel Zak
- Academic Department of Internal Medicine, Charles University, Faculty of Medicine in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.,4
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28
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Wong KS, Higgins SE, Marqusee E, Nehs MA, Angell T, Barletta JA. Tall Cell Variant of Papillary Thyroid Carcinoma: Impact of Change in WHO Definition and Molecular Analysis. Endocr Pathol 2019; 30:43-48. [PMID: 30565013 DOI: 10.1007/s12022-018-9561-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The morphologic criteria for tall cell variant (TCV) of papillary thyroid carcinoma (PTC) were modified in the 2017 WHO Classification of Tumors of Endocrine Organs, with a decrease in the requirements for both the height of cells and in the percentage of tumor demonstrating a tall cell morphology. The aim of this study was to determine if the change in criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. In addition, we evaluated the correlation between morphology, molecular alterations, and clinical behavior of TCV. We studied three cohorts to evaluate the above stated questions. The first cohort was comprised of 97 PTC consecutively resected over a 12-month period that were originally diagnosed as classic PTC, PTC with tall cell features, or TCV. Tumor slides of each case were reviewed to determine the percentage of the tall cell component (< 30%, 30-49%, and > 50%) and the height of the cells in this component. This cohort was evaluated to determine if the change in WHO criteria would result in a significant increase in the percentage of tumors that meet criteria for TCV. Our second cohort consisted of nine consecutively resected PTC with a tall cell component > 30% (with tall cells defined as at least 2-3× as tall as wide) that had molecular characterization through a targeted, next-generation sequencing (NGS) assay. The molecular characteristics were correlated with the percentage of the tall cell component. Finally, a third cohort comprised of seven clinically aggressive TCV (defined as those with T4 disease, disease recurrence, or subsequent tumor dedifferentiation) was evaluated to determine histologic and molecular characteristics. In cohort 1, the number of cases classified as TCV increased significantly with the change in definition of TCV: 8 (8%) cases met the previous criteria for TCV (cells 3× as tall as wide in > 50% of the tumor), whereas 24 (25%) cases met the new 2017 WHO criteria (cells 2-3× as tall as wide in > 30% of the tumor) (p = 0.0020). Molecular analysis of cohort 2 revealed that all 9 cases harbored a BRAF V600E mutation. Pathogenic secondary mutations were absent in cases with < 50% tall cells, but they were detected in 2 (33%) of 6 cases with > 50% tall cells (2 cases with TERT promoter mutations, including 1 that also had an AKT2 mutation). Histologic and molecular analysis of the clinically aggressive cohort (cohort 3), revealed that all cases had > 50% tall cells and 3 (43%) had secondary oncogenic mutations (all TERT promoter mutations). We found that the modified morphologic criteria put forth in the 2017 WHO tripled the number of cases that would be classified as TCV. Moreover, clinically aggressive tumors and those harboring secondary oncogenic mutations all had a tall cell component > 50%. Additional large multi-institutional studies incorporating clinical outcome and molecular data would be valuable to determine the best histologic definition of TCV.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Sara E Higgins
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Ellen Marqusee
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Trevor Angell
- Division of Endocrinology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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29
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Rahatli FK, Turnaoglu H, Iyidir OT, Kirnap NG, Haberal KM, Aydın E, Uslu N. Assessment of Parotid and Submandibular Glands With Shear Wave Elastography Following Radioactive Iodine Therapy for Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:357-362. [PMID: 30027680 DOI: 10.1002/jum.14695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Radioactive iodine (RAI) therapy is used for remnant ablation following thyroidectomy. Side effects such as dysphagia, xerostomia, and sialoadenitis may occur. We aimed to determine the differences in the parotid and submandibulary glands between healthy patients and patients with PTC who had undergone RAI therapy and have dry mouth symptoms using both shear wave elastography and ultrasonography. METHODS We enrolled 30 patients with PTC who had undergone RAI therapy following surgery and 30 healthy controls. Ultrasonography and shear wave elastography of submandibular and parotid glands were performed. The volume of the submandibular glands and the thickness of parotid glands were determined. Ten independent measurements were obtained from each gland, with the region of interest placed at different points on the glands. The mean shear wave velocities (SWVs) were calculated and compared between the patients and controls. RESULTS In the PTC group, there was a significant reduction in the volume of the submandibular glands (P < .05) and in the thickness of the parotid glands (P < .05) compared with the control group. The mean SWVs of the parotid glands and submandibular glands were significantly higher in the PTC group compared with the control group (P < .0001). The SWVs of the parotid glands were higher than the SWVs of the submandibular glands (P < .0001). CONCLUSIONS Shear wave elastography could be a noninvasive and easy assessment method of parotid and submandibular glands in patients who had undergone RAI therapy and experience dry mouth.
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Affiliation(s)
- Feride Kural Rahatli
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hale Turnaoglu
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ozlem Turhan Iyidir
- Department of Endocrinology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nazli Gulsoy Kirnap
- Department of Endocrinology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Kemal Murat Haberal
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Erdinç Aydın
- Department of Ear, Nose, and Throat, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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Selvakumar T, Nies M, Klein Hesselink MS, Brouwers AH, van der Horst-Schrivers ANA, Klein Hesselink EN, Tissing WJE, Vissink A, Links TP, Bocca G, Burgerhof JGM, van Dam EWCM, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Smit JWA, Plukker JTM, Ronckers CM, van Santen HM. Long-term effects of radioiodine treatment on salivary gland function in adult survivors of pediatric differentiated thyroid carcinoma. J Nucl Med 2018; 60:jnumed.118.212449. [PMID: 30504138 DOI: 10.2967/jnumed.118.212449] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/18/2018] [Indexed: 01/17/2023] Open
Abstract
Pediatric differentiated thyroid cancer (DTC) is a rare disease. Initial treatment of DTC consists of a (near) total thyroidectomy and radioactive iodine (131I) therapy. Previous studies in adults showed that 131I treatment may result in a reduced salivary gland function. Studies regarding salivary gland function in children treated for DTC are sparse. Our aim was to assess long-term effects of 131I treatment on salivary gland function in survivors of pediatric DTC. Methods: In a nationwide cross-sectional study, salivary gland function of patients treated for pediatric DTC between 1970 and 2013 (>5 years after diagnosis, ≥18 years old at time of evaluation) was studied. Salivary gland function was assessed by sialometry, sialochemistry and a xerostomia inventory. Salivary gland dysfunction was defined as unstimulated whole saliva flow ≤0.2mL/min and/or a stimulated whole saliva flow ≤0.7 mL/min. Results: Sixty-five patients (median age at evaluation 33 [IQR, 25-40] years, 86.2% female, median follow-up period 11 [IQR, 6-22] years) underwent 131I treatment. Median cumulative 131I activity was 5.88 [IQR, 2.92-12.95] GBq, 47.7% underwent multiple 131I administrations. Salivary gland dysfunction was present in 30 (47.6%) patients. Levels of amylase and total protein in saliva were reduced. Moderate to severe xerostomia was present in 22 (35.5%) patients. Stimulated salivary secretion was lower and severity of xerostomia complaints higher in patients treated with higher cumulative 131I activity. Conclusion: In survivors of pediatric DTC, clinically significant salivary gland dysfunction was found in 35.5% and was related to the cumulative 131I activity of the treatment.
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Affiliation(s)
- Tharsana Selvakumar
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Marloes Nies
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Adrienne H Brouwers
- Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Netherlands
| | | | - Esther N Klein Hesselink
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, University of Groningen, University Medical Center Groningen, Netherlands
| | - Arjan Vissink
- Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Netherlands
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Pilocarpine effect on dose rate of salivary gland in differentiated thyroid carcinoma patients treated with radioiodine. Nucl Med Commun 2018. [PMID: 29517578 DOI: 10.1097/mnm.0000000000000820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although different methods have been suggested on reducing salivary gland radiation after radioiodine administration, an effective preventive or therapeutic measure is still up for debate. The aim of this study was to evaluate the effect of pilocarpine, as a sialagogue drug on the radioiodine content of the salivary gland, and radioiodine-induced symptoms of salivary gland dysfunction. PATIENTS AND METHODS Patients who were referred for radioiodine therapy were randomized into pilocarpine and placebo groups. The patients as well as the nurse who administered the tablets, and the specialist who analyzed the images, were all unaware of the patients' group. Anterior and posterior planar images including that of both the head and neck were obtained 2, 6, 12, 24, and 48 h after the administration of radioiodine in all patients, and round regions of interest were drawn for both left and right parotid glands, with a rectangular region of interest in the region of the cerebrum as background. All patients were interrogated once, 6 months after radioiodine administration, by a phone call for subjective evaluation of symptoms related to salivary gland damage. RESULTS There was no significant difference between the two groups with regard to the mean age, sex, and initial iodine activity. The geometric mean of background-corrected count per administered dose and acquisition time was calculated for the bilateral parotid glands. This normalized parotid count showed a significant reduction in net parotid count in both groups during the first 48 h after radioiodine administration. However, no significant difference was found between the groups according to the amount and pattern of dose reduction in this time period. CONCLUSION This study revealed that pilocarpine had no significant effect on the radioiodine content of parotid glands during the first 48 h after radioiodine administration. No significant difference was found in the incidence of symptoms between the two groups treated with placebo and pilocarpine.
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Expression of ADAMTS2 and ADAMTS5 in the salivary gland of rats after radioiodine therapy. Nucl Med Commun 2018; 39:110-117. [PMID: 29194287 DOI: 10.1097/mnm.0000000000000781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the presence of ADAMTS2 and ADAMTS5 in the salivary gland (SG) of rats after high-dose radioiodine therapy. METHODS A total of 36 male Wistar albino rats were used for this study. Thirty-six male rats were divided randomly into six groups: control and five radioactive iodine (RAI) treatment groups of six rats each. All animals were killed. The evaluation of biodistribution and histopathological studies were carried out on the SGs removed. Real-time PCR and immunohistochemical analysis were carried out to determine mRNA and protein expression levels of ADAMTS genes. Differences between the groups were evaluated statistically. RESULTS In RAI-treated groups, ADAMTS2 and ADAMTS5 gene expression was observed to increase, whereas there was no mRNA or protein expression in the control group. There were statistically significant increases in the mRNA expression of ADAMTS2 (all RAI-administered groups in parathyroid gland and at 4, 24, and 48 h in submandibular gland) and ADAMTS5 (all RAI-administered groups, except on the 30th day in the parathyroid gland and all RAI groups in submandibular gland). Through immunohistochemical analysis, the staining pattern in the extracellular source was also observed in the overexpressed ADAMTS2 and ADAMTS5 groups. Nuclear coarsening and partial focal subnuclei vacuolization were determined in all RAI-administered groups with histopathological examinations. CONCLUSION An increase in the mRNA expression levels of ADAMTS2 and ADAMTS5 genes was detected in the RAI-administered groups. These results suggested that ADAMTS2 and ADAMTS5 genes might play a role in radiation exposure and radioiodine-induced SG changes.
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McHenry CR. Is Prophylactic Central Compartment Neck Dissection Indicated for Clinically Node-Negative Papillary Thyroid Cancer: The Answer is Dependent on How the Data are Interpreted and the Weight Given to the Risks and Benefits. Ann Surg Oncol 2018; 25:3123-3124. [PMID: 30014453 DOI: 10.1245/s10434-018-6649-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher R McHenry
- Department of Surgery, MetroHealth Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Park J, Blackburn BE, Ganz PA, Rowe K, Snyder J, Wan Y, Deshmukh V, Newman M, Fraser A, Smith K, Herget K, Kirchhoff AC, Abraham D, Kim J, Monroe M, Hashibe M. Risk Factors for Cardiovascular Disease Among Thyroid Cancer Survivors: Findings From the Utah Cancer Survivors Study. J Clin Endocrinol Metab 2018; 103:2468-2477. [PMID: 29850817 PMCID: PMC6915829 DOI: 10.1210/jc.2017-02629] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/25/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT Thyroid cancer survivors are at high risk of developing multiple cardiac and vascular conditions as consequence of cancer diagnosis and treatment. However, it is still unclear how the baseline and prognostic factors, as well as cancer treatments, play a role in increasing cardiac and vascular disease risk among thyroid cancer survivors. OBJECTIVE To investigate the association between potential risk factors, treatment effects, and cardiovascular disease (CVD) outcomes in thyroid cancer survivors. DESIGN, SETTING, PATIENTS Primary thyroid cancer survivors, diagnosed from 1997 to 2012 (n = 3822), were identified using the statewide Utah Population Database. The medical records were used to ascertain information on risk factors and CVD outcomes. Cox proportional hazards models were used to assess the risk of CVD with baseline demographic data and clinical factors. RESULTS Among thyroid cancer survivors, age and year at cancer diagnosis, cancer stage, sex, baseline body mass index, baseline comorbidities, and TSH suppression therapy were significantly associated with CVD risk 1 to 5 years after cancer diagnosis. Patients who were male, overweight or obese, older at cancer diagnosis, and diagnosed with cancer since 2005 had an increased risk of CVD compared with patients who were female, had a normal body mass index, were younger at cancer diagnosis, and diagnosed with cancer from 1997 to 1999. Administration of TSH suppression therapy, distant metastases at cancer diagnosis, and a higher Charlson comorbidity index score were associated with an increased CVD risk among thyroid cancer survivors. CONCLUSIONS Our findings suggest that examining the effect of thyroid cancer diagnosis, cancer treatment, and demographic characteristics on the risk of CVD is critical.
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Affiliation(s)
- Jihye Park
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brenna E Blackburn
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Patricia A Ganz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Kerry Rowe
- Intermountain Healthcare, Salt Lake City, Utah
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, Utah
| | - Yuan Wan
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Michael Newman
- Huntsman Cancer Institute, Salt Lake City, Utah
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Alison Fraser
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Ken Smith
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Kim Herget
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Dev Abraham
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Endocrinology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jaewhan Kim
- College of Health, University of Utah, Salt Lake City, Utah
| | - Marcus Monroe
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Otolaryngology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
- Correspondence and Reprint Requests: Mia Hashibe, PhD, Division of Public Health, Department of Family and Preventive Medicine, Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, Utah 84112. E-mail:
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Radioprotective effect of vitamin E on salivary glands after radioiodine therapy for differentiated thyroid cancer: a randomized-controlled trial. Nucl Med Commun 2018; 38:891-903. [PMID: 28806348 DOI: 10.1097/mnm.0000000000000727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to examine the radioprotective effect of vitamin E on salivary glands after radioactive iodine (I) therapy in patients with differentiated thyroid cancer. PATIENTS AND METHODS Eighty-two patients with differentiated thyroid cancer were enrolled in this study. They were divided randomly into four groups (control group: 22 cases, group A: 23 cases, group B: 22 cases, and group C: 15 cases) before postsurgical ablation therapy with 100 mCi I. The patients in groups A, B, and C received vitamin E 100, 200, and 300 mg/day orally, respectively, for a duration of 1 week before to 4 weeks after I therapy. Salivary gland function was assessed using salivary gland scintigraphy immediately before and 6 months after I therapy. Uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) of each salivary gland were measured and compared. RESULTS On comparison between before and after I therapy in the control group, there was a significant decrease in UF of both right and left parotid glands (all P<0.01). In group A, a significant increase in EF of the right parotid gland (P<0.01) and UI of the right submandibular gland (P<0.05) was found. In group B, there was a significant increase in UI of the right parotid gland and both submandibular glands (all P<0.01). In group C, there was a significant increase in UF of the left parotid gland (P<0.05) and the right submandibular gland (P<0.01). Also, there was a statistical increase in UI in both submandibular glands (all P<0.01). However, on comparing the changes in the post-I therapy salivary scintigraphy parameters among the four groups, there was a significant difference in ΔUI of the right parotid gland (P<0.05) and both submandibular glands (all P<0.01), as well as ΔER of the left parotid gland (P<0.05) and ΔUF of the left submandibular gland (P<0.05). CONCLUSION Vitamin E exerts significant protective effects on the parotid and submandibular glands after I therapy.
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Daniel FI, Lima LD, Grando LJ, Castro R, Cordeiro EAK, Dos Santos CR. Salivary evaluation in radioactive I 131 treated patients with thyroid carcinoma. Acta Odontol Scand 2018; 76:148-152. [PMID: 29125000 DOI: 10.1080/00016357.2017.1399214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE radioiodine treatment (I131) used to treat thyroid carcinomas produces side effects (sialadenitis, xerostomia, dysphagia and caries susceptibility) reflecting in a poor patient quality of life. This study aimed to evaluate the effect of I131 on salivary function and possible oral impairment. MATERIAL AND METHODS Thirty-seven patients undergoing I131 were submitted to oral examination, answer questions regarding xerostomia/hyposalivation and collect saliva at three moments (M1: 30-45 days before I131, M2: 1-2 days after I131 and M3: 7-10 days after treatment). Saliva was assayed for flow rate and calcium/phosphate concentrations. RESULTS AND CONCLUSIONS significant difference in calcium/phosphate concentration was shown between M1 and M2, with evident decrease at M2. Flow rate reduced right after treatment with 41% of patients returning to previous rate at M3 (no statistical difference). A higher number of patients related xerostomia and difficulty in swallowing food at M2. The results showed that xerostomia/hyposalivation, dysphagia and calcium/phosphate concentration decrease may be considered early radioiodine side effects.
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Affiliation(s)
- Filipe Ivan Daniel
- Department of Pathology, Health Science Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Luiza Dutra Lima
- Health Science Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Liliane Janete Grando
- Department of Pathology, Health Science Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Renata Castro
- Department of Dentistry, Health Science Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | | | - Claudia Regina Dos Santos
- Department of Pathology, Health Science Center, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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Mandel L, Greene LW. Differentiating 131 I Radiation Sialadenitis From Autoimmune (Sjögren Syndrome) Sialadenitis: Case Report. J Oral Maxillofac Surg 2017; 75:2379-2382. [DOI: 10.1016/j.joms.2017.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/06/2017] [Indexed: 12/13/2022]
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Moreddu E, Baumstarck-Barrau K, Gabriel S, Fakhry N, Sebag F, Mundler O, Chossegros C, Taïeb D. Incidence of salivary side effects after radioiodine treatment using a new specifically-designed questionnaire. Br J Oral Maxillofac Surg 2017; 55:609-612. [DOI: 10.1016/j.bjoms.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/28/2017] [Indexed: 11/16/2022]
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Hamed RH. Is postoperative radioactive iodine associated with a survival advantage among…. FORUM OF CLINICAL ONCOLOGY 2017. [DOI: 10.1515/fco-2015-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Aim
This trial aimed to determine wether postoperative radioactive iodine(RAI) associated with a survival benefit among intermediate-risk Papillary Thyroid Cancer patients or not.
Methods
this study is a retrospective study of intermediate-risk papillary thyroid cancer patients that were treated with or without post operative RAI from 1st January 2002 till 1st January 2012. Overall survival (OS) and multivariate regression analyses were measured for all patients.
Results
100 patients were included in this trial : 70 patients received postoperative RAI and 30 patients did not. The mean follow-up time was 7.1 (4.8 -15.1 years), and a median survival time could not be estimated. Overall survival at 10 years was 96% in the RAI vs 93% in the group without RAI (P < .001). RAI reduced risk of death by a 27% [hazard risk (HR) 0.73, confidence interval (CI) 0.64 - 0.84, P < .001]. Older patient age, male gende, larger tumor size, multifocal tumors, lymph node metastases, aggressive histology, vascular invasion, positive surgical margin, minimal extrathyroidal extension and absence of postoperative RAI were accompanied by compromised OS (all P ≤ .001).
Conclusion
This representative study addresses the survival advantage of RAI for with intermediate risk PTC patients but conducting of large prospective randomized controlled trial is still warranted.
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Affiliation(s)
- Rasha Hamdy Hamed
- Clinical Oncology and Nuclear Medicine, Faculty of Medicine , Mansoura University , Mansoura , Egypt
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Validation of a Liquid Chromatography-Tandem Mass Spectrometric Assay for Quantitative Analysis of Lenvatinib in Human Plasma. Int J Anal Chem 2017; 2017:2341876. [PMID: 28680445 PMCID: PMC5478828 DOI: 10.1155/2017/2341876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/16/2017] [Indexed: 11/24/2022] Open
Abstract
Toward conducting clinical pharmacokinetic studies of an antineoplastic agent, lenvatinib, we developed a liquid chromatography-tandem mass spectrometric assay for its quantitative analysis in human plasma. Analyte (lenvatinib) and internal standard (IS, propranolol) in the plasma were extracted by using acetonitrile and chromatographically separated by using a XTerra MS C18 column with 0.2 mL/min flow and mobile phase starting with 0.1% formic acid in water, followed by increasing percentage of acetonitrile. Detection was performed by using combined reversed-phase liquid chromatography-tandem mass spectrometry (LC/MS-MS) with positive ion electrospray ionization. MS-MS ion transitions used were 427.602>371.000 for lenvatinib and 260.064>116.005 for IS. This study was validated for accuracy, precision, linearity, range, selectivity, lower limit of quantification, recovery, and matrix effect according to the Guideline on Bioanalytical Method Validation in Pharmaceutical Development in Japan. Calibration curve was plotted by using lenvatinib concentrations ranging within 9.6–200 ng/mL, and correlation coefficients (r2) were in excess of 0.997. Intra- and interday accuracy ranged within 95.8–108.3% with mean recoveries of 66.8% for lenvatinib, and precision was <6.7% at all quality control concentration levels. Matrix effect analysis showed extraction efficiency of 15.7% for lenvatinib. Collectively, these findings demonstrate the feasibility of this method to evaluate kinetic disposition of lenvatinib.
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Upadhyaya A, Meng Z, Wang P, Zhang G, Jia Q, Tan J, Li X, Hu T, Liu N, Zhou P, Wang S, Liu X, Wang H, Zhang C, Zhao F, Yan Z. Effects of first radioiodine ablation on functions of salivary glands in patients with differentiated thyroid cancer. Medicine (Baltimore) 2017. [PMID: 28640094 PMCID: PMC5484202 DOI: 10.1097/md.0000000000007164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to evaluate the effects of the first radioactive iodine (I) therapy on functions of salivary glands in patients with differentiated thyroid carcinoma (DTC).There were 36 consented patients with DTC enrolled in this study, who received 3.7 GBq (100mCi) I for ablation after total thyroidectomy. Salivary gland function was assessed using salivary gland scintigraphy in two phases, one 4 hours before and the other 6 months after I therapy (both under thyrotropin stimulation condition). Quantitative parameters including uptake fraction (UF), uptake index (UI), excretion fraction (EF), and excretion ratio (ER) were measured and compared. Blood parameters were also compared. Associations between sex and outcome of the first I therapy as well as individual salivary gland function were measured. Wilcoxon Signed Rank Sum test and χ test were used for statistical analysis.When compared between pre-ablation and post-ablation, UF of bilateral parotid and submandibular glands were significantly increased (all P < .01). UI of both submandibular glands were significantly increased (P < .05). This seemingly increased uptake function after the first I therapy was actually compensatory mechanism of salivary gland, which indicated a possible intermediate state after radiation. But salivary glands' secretory function had not changed significantly except for left submandibular gland; we demonstrated that only left submandibular gland showed significantly decreased ER (P < .05). Thyroglobulin and thyroglobulin antibody significantly decreased after I therapy (P < .05). There were no sex differences on therapeutic outcome and salivary gland dysfunctions after the first I therapy. Salivary gland of both males and females could be affected by I therapy.The first I ablative therapy may impair the salivary uptake and secretory function of patients with DTC. There was no association between sex and salivary gland dysfunction.
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A Randomized Controlled Trial for the Effectiveness of Aromatherapy in Decreasing Salivary Gland Damage following Radioactive Iodine Therapy for Differentiated Thyroid Cancer. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9509810. [PMID: 28042578 PMCID: PMC5155074 DOI: 10.1155/2016/9509810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/31/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022]
Abstract
Objective. The aim of this study was to investigate effects of aromatherapy in decreasing salivary gland damage for patients undergoing radioactive iodine (RAI) therapy with differentiated thyroid cancer (DTC). Materials and Methods. The subjects were 71 patients with DTC. They were divided into aromatherapy group (group A, n = 35) and a control group (group B, n = 36). We blended 1.0 mL of lemon and 0.5 mL of ginger essential oils. The patients in the inhalation aromatherapy group inhaled this blend oil and those in the control group inhaled distilled water as placebo for 10 min during admission. We statistically compared salivary gland function before and after treatment between groups A and B. Results. In comparison with group B, the rate of change of the accumulation rate was significantly higher in the parotid glands and submandibular glands of group A (P < 0.05). In comparison with group B, a significant increase in rate of secretion change before and after treatment was noted in the bilateral parotid glands in group A (P < 0.05). Conclusion. Because an amelioration of salivary gland function was observed in the present study, our results suggest the efficacy of aromatherapy in the prevention of treatment-related salivary gland disorder. This trial is registered with UMIN Clinical Trial Registry: UMIN000013968.
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Erkul E, Gillespie MB. Sialendoscopy for non-stone disorders: The current evidence. Laryngoscope Investig Otolaryngol 2016; 1:140-145. [PMID: 28894810 PMCID: PMC5510257 DOI: 10.1002/lio2.33] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/31/2016] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Review the current literature on the use of sialendoscopy in the treatment of non-stone disorders of the major salivary glands. DATA SOURCES Eligible articles that reported on the use of sialendoscopy in the treatment of non-stone disorders were identified using MEDLINE, Embase, and Google Scholar through May 2016. The search used key words sialendoscopy, salivary endoscopy, salivary scope, salivary duct stenosis, salivary duct stricture, Sjogren's disease, radioiodine sialadenitis, salivary duct obstruction, sialadenitis, chronic sialadenitis, juvenile recurrent parotitis, parotitis, and radiation sialadenitis. REVIEW METHODS Full-length prospective and retrospective original articles; systemic reviews; and meta-analysis, including adults and children with adequate data for evaluating the sialendoscopy for non-stone disorders, were included. Individual case reports were excluded. RESULTS There is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non-stone disorders worldwide. The studies of sialendoscopy for non-stone disorders are often retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjögren syndrome, respectively. CONCLUSION Although the initial evidence for the use of sialendoscopy for non-stone disorders is not as established as that for stones, it remains a promising gland-preserving tool in the management of non-stone disorders of major salivary glands.
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Affiliation(s)
- Evren Erkul
- Department of Otorhinolaryngology Gulhane Military Medical Academy, Haydarpasa Training Hospital Istanbul Turkey
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery Medical University of South Carolina Charleston South Carolina U.S.A
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Clinical Studies of Nonpharmacological Methods to Minimize Salivary Gland Damage after Radioiodine Therapy of Differentiated Thyroid Carcinoma: Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6795076. [PMID: 27446226 PMCID: PMC4944032 DOI: 10.1155/2016/6795076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/23/2016] [Accepted: 06/05/2016] [Indexed: 11/24/2022]
Abstract
Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000–10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly (p < 0.0001, p < 0.05, p < 0.10, and p < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly (p < 0.001). Additionally, vitamin C had some limited effect (p = 0.37), whereas no effect was present in the case of chewing gum (p = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions.
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Klein Hesselink EN, Brouwers AH, de Jong JR, van der Horst-Schrivers AN, Coppes RP, Lefrandt JD, Jager PL, Vissink A, Links TP. Effects of Radioiodine Treatment on Salivary Gland Function in Patients with Differentiated Thyroid Carcinoma: A Prospective Study. J Nucl Med 2016; 57:1685-1691. [DOI: 10.2967/jnumed.115.169888] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/17/2016] [Indexed: 01/04/2023] Open
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Wang LY, Ganly I. Nodal metastases in thyroid cancer: prognostic implications and management. Future Oncol 2016; 12:981-94. [PMID: 26948758 PMCID: PMC4992997 DOI: 10.2217/fon.16.10] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
The significance of cervical lymph node metastases in differentiated thyroid cancer has been controversial and continues to evolve. Current staging systems consider nodal metastases to confer a poorer prognosis, particularly in older patients. Increasingly, the literature suggests that characteristics of the metastatic lymph nodes such as size and number are also prognostic. There is a growing trend toward less aggressive treatment of low-volume nodal disease. The aim of this review is to summarize the current literature and discuss prognostic and management implications of lymph node metastases in differentiated thyroid cancer.
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Affiliation(s)
- Laura Y Wang
- Department of Surgery, Head & Neck Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Ian Ganly
- Department of Surgery, Head & Neck Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Janovsky CC, Maciel RM, Camacho CP, Padovani RP, Nakabashi CC, Yang JH, Malouf EZ, Ikejiri ES, Mamone MCO, Wagner J, Andreoni DM, Biscolla RPM. A Prospective Study Showing an Excellent Response of Patients with Low-Risk Differentiated Thyroid Cancer Who Did Not Undergo Radioiodine Remnant Ablation after Total Thyroidectomy. Eur Thyroid J 2016; 5:44-9. [PMID: 27099838 PMCID: PMC4836168 DOI: 10.1159/000442048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/29/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To prospectively evaluate the outcome of patients with low-risk papillary thyroid carcinoma treated with total thyroidectomy (TT) who did not undergo radioiodine remnant ablation (RRA). STUDY DESIGN We prospectively followed up 57 patients; 3 months after TT, thyroglobulin (Tg) assessment and neck ultrasonography (US) were performed while patients were taking l-T4, presenting suppressed TSH. Six months after TT, patients underwent stimulated Tg testing and whole-body scan (WBS) after recombinant TSH (rhTSH). Then, 18 months after TT, the patients were evaluated by neck US and Tg under TSH between 0.5 and 2.0 mIU/ml. Two years after TT, we performed another rhTSH assessment, measuring Tg and making a WBS. The patients were then annually monitored with neck US and Tg measurement under TSH between 0.5 and 2.0 mIU/l for 36-84 months. RESULTS Neck US of all patients, 3 months after TT, presented no evidence of abnormal residual tissues or metastatic lymph nodes (negative neck US); at this time, the mean Tg level was 0.42 ng/ml. Six months after surgery, after rhTSH, the mean thyroid bed uptake was 1.82%, and Tg levels ranged from 0.10 to 22.30 ng/ml (mean, 2.89 ng/ml). The patients were followed up without any sign of recurrence (negative neck US and stable or decreasing Tg levels). During the ongoing follow-up, the Tg trend was stable or decreasing, independently of the initial suppressed or stimulated Tg level, or WBS uptake. CONCLUSIONS In patients with low-risk differentiated thyroid cancer, who were operated by TT and who did not undergo RRA, an excellent response to treatment may be confirmed by annual neck US and Tg trend.
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Affiliation(s)
- Carolina C.P.S. Janovsky
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Rui M.B. Maciel
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
- *Rui M.B. Maciel, MD, PhD, Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11th Floor, São Paulo, SP 04039-032 (Brazil), E-Mail
| | - Cleber P. Camacho
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Rosalia P. Padovani
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Claudia C. Nakabashi
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Ji H. Yang
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Eduardo Z. Malouf
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Elza S. Ikejiri
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - M. Conceição O.C. Mamone
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Jairo Wagner
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Danielle M. Andreoni
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
| | - Rosa Paula M. Biscolla
- Thyroid Diseases Center and Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
- Thyroid Diseases Center, Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo, Brazil
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Short-Term Side Effects after Radioiodine Treatment in Patients with Differentiated Thyroid Cancer. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4376720. [PMID: 26989683 PMCID: PMC4773544 DOI: 10.1155/2016/4376720] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES I-131 therapy for differentiated thyroid cancer (DTC) could induce adverse effects. The purpose of this study was to report and analyze symptoms after I-131 treatment within the hospitalization and present relevant medical intervention. METHODS I-131 doses ranging from 3.7 to 9.25 GBq (100-250 mCi) were administrated for thyroid remnant ablation or treating DTC metastases. 117 patients with DTC for I-131 therapy were monitored through the video and intercommunicating with standardized questionnaire at different time points after I-131 oral administration. Adverse effects were recorded and relevant clinical factors were analyzed. RESULTS Among all the 117 patients, 55 cases complained of neck's pain or swelling and 79 cases presented with gastrointestinal symptoms. Pain or swelling of salivary gland occurred in 15 patients, headache and vertigo in 10, insomnia in 9, vocal cord paralysis in 6, fatigue or general malaise in 6, and foreign body sensation in 5. Body numbness and urinary symptoms were observed in only 1 case, respectively. Those side effects were related with sex, pre-I-131 treatment TSH levels, frequency of I-131 therapy, and lymph node metastases. CONCLUSIONS Short-term side effects after I-131 therapy for DTC patients varied individually; severe symptoms were not uncommon but generally did not need emergent medical intervention.
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Wang LY, Palmer FL, Migliacci JC, Nixon IJ, Shaha AR, Shah JP, Tuttle RM, Patel SG, Ganly I. Role of RAI in the management of incidental N1a disease in papillary thyroid cancer. Clin Endocrinol (Oxf) 2016; 84:292-295. [PMID: 26041503 PMCID: PMC4959964 DOI: 10.1111/cen.12828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/03/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Following total thyroidectomy (TT) for papillary thyroid cancer (PTC), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes (LNs) with occult metastases. These cN0pN1a patients often receive radioactive iodine (RAI) therapy for this indication alone. The aim of this study was to determine the central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment. METHODS An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. A total of 232 pT1-3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LNs on pathology. Patients with other indications for RAI, such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan-Meier method was used to determine central neck LN recurrence-free survival (RFS). RESULTS The median age of the cohort was 40 years (range 17-83). The median follow-up was 53 months (range 1-211). The median number of positive LNs removed and maximum LN diameter were 1 (range 1-8) and 5 mm (range 1-16 mm), respectively. A total of 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion (P = 0·01), LNs >2 mm (P = 0·07) and >2 positive nodes (P = 0·06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5-year central neck LN RFS compared to those treated with RAI: 96·2% vs 94·6%, respectively (P = 0·92). CONCLUSION There is no difference in the 5-year central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.
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Affiliation(s)
- Laura Y. Wang
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Frank L. Palmer
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jocelyn C. Migliacci
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Iain J. Nixon
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ashok R. Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - R. Michael Tuttle
- Department of Medicine, Endocrine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Snehal G. Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8701] [Impact Index Per Article: 1087.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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