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Legrand A, Bernier MO, Bressand A, Buffet C, Mandin C, Menegaux F, Soret M, Broggio D, Bassinet C, Huet C, Leenhardt L, Lussey-Lepoutre C, Baudin C. Health-related quality of life and radioiodine therapy in thyroid cancer patients: a before-and-after study. Qual Life Res 2024:10.1007/s11136-024-03721-0. [PMID: 38907832 DOI: 10.1007/s11136-024-03721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Thyroid cancers are on the rise, but the associated vital prognosis and long-term survival rates are very good. Therefore, treated patients' quality of life and psychological well-being are important considerations. The treatment usually involves surgery and radioactive iodine (radioiodine) ablation. This study aims to investigate potential effects of radioiodine ablation therapy on health-related quality of life, anxiety and depression symptoms, and nutritional status at 6 months post-therapy. METHODS This study included 136 patients diagnosed with thyroid cancer. Absorbed doses to the salivary glands were estimated from dosimeters worn by patients. Patient health-related quality of life, psychological status and nutritional status were assessed before and 6 months after therapy using standardized questionnaires (including SF-36, Hospital Anxiety and Depression (HAD) scale). Statistical analyses included random-effects logistic and linear regressions adjusted for potential confounders. RESULTS While no significant association was found between radioiodine exposure and anxiety or depression symptoms, or nutritional status, a significant increase in the SF-36 role physical sub- score was observed in relation with the salivary gland dose (β= 6.54, 95%CI 2.71;10.36 for a 1-Gy increase). CONCLUSIONS The findings suggest an improved physical health-related quality of life, namely reduced pain and functional impairment, 6 months after radioiodine therapy in thyroid cancer patients. No significant association was found between radioiodine exposure and mental health-related quality of life, anxiety or depression scores nor nutritional status. This study does not provide any evidence that radioiodine therapy has a potentially adverse effect on patient health-related quality of life.
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Affiliation(s)
- Alix Legrand
- Faculty of Medicine, School of Public Health, Sorbonne University, Paris, F-75013, France
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Marie-Odile Bernier
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Alice Bressand
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Camille Buffet
- Thyroid disease and Endocrine Tumor Department, Sorbonne University, Pitié Salpêtrière Hospital AP-HP, Paris, F- 75013, France
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
- Biomedical Imaging Laboratory, Sorbonne University, CNRS UMR 7371, INSERM U1146, LIB, Paris, F-75006, France
| | - Corinne Mandin
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, France
| | - Marine Soret
- Biomedical Imaging Laboratory, Sorbonne University, CNRS UMR 7371, INSERM U1146, LIB, Paris, F-75006, France
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, 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 Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Christelle Huet
- Ionizing Radiation Dosimetry Laboratory, Institut de Radioprotection et Sûreté Nucléaire, Fontenay-aux-Roses, France
| | - Laurence Leenhardt
- Thyroid disease and Endocrine Tumor Department, Sorbonne University, Pitié Salpêtrière Hospital AP-HP, Paris, F- 75013, France
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
| | - Charlotte Lussey-Lepoutre
- Sorbonne University, Groupe de recherche Clinique Tumeurs Thyroïdiennes n°16, Paris, F-75013, France
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, F-75013, France
- PARCC, INSERM, Equipe Labellisée par la Ligue contre le Cancer, Paris, F-75015, France
| | - Clémence Baudin
- Ionizing Radiation Epidemiology Laboratory (LEPID), Institute for Radiological Protection and Nuclear Safety (IRSN), BP 17, Fontenay-aux-Roses, 92262, France.
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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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Nautiyal A, Mondal T, Mitra D, Goel A, Dey SK, Kaushik A. A SIMPLE AND NOVEL APPROACH TO STUDY KINETICS AND ESTIMATE RADIATION DOSES FROM INTERNALLY ADMINISTERED RADIOPHARMACEUTICALS USING AN EXTERNAL DOSE MEASUREMENT SYSTEM. RADIATION PROTECTION DOSIMETRY 2021; 196:141-152. [PMID: 34585244 DOI: 10.1093/rpd/ncab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Various methods have been reported to study radiotracer kinetics and make internal dosimetry feasible in the routine clinical nuclear medicine practice. The aim of the present study was to quantify cumulative activity and organ doses using an indigenously designed and fabricated external dose measurement system. The measurement was demonstrated on patients undergoing whole-body (WB) 18F-FDG (Fluorine-18-fluorodeoxyglucose) direct positron emission tomography/computed tomography investigations. An external dose measurement system comprising of an ionisation chamber-survey meter and the movable focussing collimator was used to quantify the uptake of 18F-FDG in liver and brain. Cumulative activity and normalised cumulative activity in these organs were calculated. The results were validated by performing measurements on a phantom uniformly filled with known activity of 18F-FDG.The difference in the absorbed dose estimated with and without collimator was statistically significant (p < 0.05). The external dose measurement technique is relatively novel, convenient and reliable for the assessment of internal absorbed dose of organs.
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Affiliation(s)
- Amit Nautiyal
- Institute of Nuclear Medicine & Molecular Imaging, AMRI Hospitals, Dhakuria, Kolkata, India
- Amity Institute of Nuclear Science & Technology, Amity University Uttar Pradesh, Noida, India
| | - Tanmoy Mondal
- Department of Biotechnology, Maulana Abul Kalam Azad University of Technology, Salt Lake, Kolkata, India
| | - Deepanjan Mitra
- Institute of Nuclear Medicine & Molecular Imaging, AMRI Hospitals, Dhakuria, Kolkata, India
| | - Alpana Goel
- Amity Institute of Nuclear Science & Technology, Amity University Uttar Pradesh, Noida, India
| | - Subrata Kumar Dey
- Department of Biotechnology, Maulana Abul Kalam Azad University of Technology, Salt Lake, Kolkata, India
| | - Aruna Kaushik
- Institute of Nuclear Medicine & Allied Sciences, Brig. S.K. Mazumdar Marg, Timarpur, Delhi, India
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Islam MS, Watanuki S, Tashiro M, Watabe H. Internal radiation dose estimation using multiple D-shuttle dosimeters for positron emission tomography (PET): A validation study using NEMA body phantom. Med Phys 2018; 45:4693-4703. [PMID: 30098031 DOI: 10.1002/mp.13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Internal radiation dosimetry plays an important role in ensuring the safe use of positron emission tomography (PET) technology and is a legal requirement in most countries. We propose a new technique to estimate the internal radiation dose in PET studies by means of multiple D-shuttle dosimeters attached on the body surface of the patient. METHODS Radioactivity in a source organ was estimated iteratively using measurements from multiple D-shuttle dosimeters with a maximum-likelihood expectation-maximization (MLEM) algorithm with dose response from a source to a D-shuttle dosimeter computed by Monte Carlo simulation. To validate our technique, we performed a phantom study using a National Electrical Manufacturers Association (NEMA) body phantom. The fillable compartments (torso cavity and six spheres) of the phantom were filled with 18 F-FDG mixed with pure water using an 800:1 sphere-to-background radioactivity concentration ratio. The radioactivity concentrations present in the torso cavity and six spheres were 0.00165 MBq/mL and 1.32 MBq/mL, respectively. The initial radioactivities of the torso cavity and six spheres (treated as source organs) were 15.9 MBq (torso cavity), 34.7 MBq (37 mm sphere), 15.1 MBq (28 mm sphere), 7.27 MBq (22 mm sphere), 3.26 MBq (17 mm sphere), 1.54 MBq (13 mm sphere), and 0.697 MBq (10 mm sphere). Eleven D-shuttle dosimeters were attached to the NEMA body phantom surface to obtain information on body surface dose and a mathematical NEMA body phantom has been modeled in the Heavy Ion Transport Code System (PHITS) Monte Carlo simulation code. RESULTS Radioactivity was estimated in 2 min intervals over a 110-min total dose time using our proposed technique. A significant correlation (R2 = 0.992) was found between actual radioactivity and estimated radioactivity at every 2 min interval for each source organ. The estimated initial radioactivity (mean with standard deviation) was 16.5 ± 0.311 MBq (torso cavity), 33.0 ± 0.624 MBq (37 mm sphere), 15.7 ± 0.189 MBq (28 mm sphere), 7.11 ± 0.738 MBq (22 mm sphere), 4.17 ± 0.083 MBq (17 mm sphere), 1.48 ± 0.469 MBq (13 mm sphere), and 0.865 ± 0.313 MBq (10 mm sphere), which were very close to the actual initial radioactivity measurements for each source organ. CONCLUSIONS The phantom study showed that our technique worked successfully. This technique could be used to estimate internal radiation dosimetry in a clinical PET study.
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Affiliation(s)
- Md Shahidul Islam
- Division of Radiation Protection and Safety Control, Cyclotron and Radioisotope Centre, Tohoku University, Sendai, 980-8578, Japan.,Radiation Control Division, Bangladesh Atomic Energy Regulatory Authority, Dhaka, 1207, Bangladesh.,Bangladesh Atomic Energy Commission, E-12/A, Agargaon, Dhaka, 1207, Bangladesh
| | - Shoichi Watanuki
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Centre, Tohoku University, Sendai, 980-8578, Japan
| | - Manabu Tashiro
- Division of Cyclotron Nuclear Medicine, Cyclotron and Radioisotope Centre, Tohoku University, Sendai, 980-8578, Japan
| | - Hiroshi Watabe
- Division of Radiation Protection and Safety Control, Cyclotron and Radioisotope Centre, Tohoku University, Sendai, 980-8578, Japan
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