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Karasah Erkek B, Sariyildiz Gumusgoz H, Oral A, Yazici B, Akgun A. Low dose radioactive iodine ablation therapy (1.11GBq) for differentiated thyroid cancer in Western Turkey. Rev Esp Med Nucl Imagen Mol 2024:500055. [PMID: 39260799 DOI: 10.1016/j.remnie.2024.500055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/11/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVE Ablation therapy is employed in low-risk differentiated thyroid cancer (DTC) cases to facilitate patient monitoring by reducing thyroglobulin (Tg) levels to measurable levels below after surgery by eliminating residual thyroid tissue. However, there is still uncertainty about the minimum activity dose required for effective ablation. Opting for low-dose [131I]-NaI for ablation offers several advantages for both patients and healthcare services. Particularly in this tumor group with a high life expectancy (approximately 90-95 % at 10 years), [131I]-NaI treatment should not pose a risk to the patient's post-treatment life and should not compromise their quality of life. However, there is a need for a well-defined identification of factors predicting successful ablation. METHODS Clinical data, laboratory findings, and imaging tests of 287 patients with low-dose 1110 MBq (30 mCi) [131I]-NaI ablation therapy for DTC were retrospectively reviewed. Post-ablation imaging and laboratory findings categorized ablation success/failure. The successful ablation group was determined according to the excellent response criteria outlined in ATA criteria. Relationships between clinical, pathological findings, biochemical common variables, and treatment failure were analyzed. RESULTS An excellent response was achieved in 77% of the entire group according to ATA criteria post-ablation. Male gender and high Tg levels on the day of ablation (Tg cut-off: 10 ng/mL and 5.35 ng/mL) were associated with unsuccessful ablation. CONCLUSIONS Our results indicate that a 1110MBq (30mCi) ablation dose is sufficient to achieve an excellent response in most low-risk DTC cases 6-12 months later. When selecting the dose for ablation, besides the histological markers mentioned in guidelines and age, we observed that stimulated Tg values and gender may be important in predicting ablation success.
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Affiliation(s)
- B Karasah Erkek
- Nuclear Medicine Department, Ege University Faculty of Medicine, İzmir, Turkey.
| | - H Sariyildiz Gumusgoz
- Nuclear Medicine Department, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - A Oral
- Nuclear Medicine Department, Ege University Faculty of Medicine, İzmir, Turkey
| | - B Yazici
- Nuclear Medicine Department, Ege University Faculty of Medicine, İzmir, Turkey
| | - A Akgun
- Nuclear Medicine Department, Ege University Faculty of Medicine, İzmir, Turkey
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Heydarzadeh S, Moshtaghie AA, Daneshpour M, Hedayati M. Regulation of iodine-glucose flip-flop in SW1736 anaplastic thyroid cancer cell line. J Endocrinol Invest 2024:10.1007/s40618-024-02377-4. [PMID: 38698299 DOI: 10.1007/s40618-024-02377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/13/2024] [Indexed: 05/05/2024]
Abstract
AIMS AND BACKGROUND The alternative manner of iodide and glucose uptake found in different types of thyroid cancer, referred to flip-flop. ATC cells indicate low iodide uptake and high glucose uptake, which lack the morphology and genetic characteristics of well-differentiated tumors and become increasingly invasive. Importance placed on the discovery of innovative multi-targeted medicines to suppress the dysregulated signaling in cancer. In this research, we aimed to clarify molecular mechanism of Rutin as a phytomedicine on anaplastic thyroid cancer cell line based on iodide and glucose uptake. MATERIAL METHODS The MTT test was employed to test cell viability. Iodide uptake assay was performed using a spectrophotometric assay to determine iodide uptake in SW1736 cells based on Sandell-Kolthoff reaction. For glucose uptake detection, ''GOD-PAP'' enzymatic colorimetric assay was applied to measure the direct glucose levels inside of the cells. Determination of NIS, GLUT1 and 3 mRNA expression in SW1736 cells was performed by qRT-PCR. Determination of NIS, GLUT1 and 3 protein levels in SW1736 cells was performed by western blotting. RESULTS According to our results, Rutin inhibited the viability of SW1736 cells in a time- and dose-dependent manner. Quantitative Real-time RT-PCR analysis exposed that NIS mRNA levels were increased in Rutin treated group compared to the control group. Accordingly, western blot showed high expression of NIS protein and low expression of GLUT 1 and 3 in Rutin treated SW1736 cell line. Rutin increased iodide uptake and decreased glucose uptake in thyroid cancer cell line SW1736 compared to control group. CONCLUSION Multiple mechanisms point to Rutin's role as a major stimulator of iodide uptake and inhibitor of glucose uptake, including effects at the mRNA and protein levels for both NIS and GLUTs, respectively. Here in, we described the flip-flop phenomenon as a possible therapeutic target for ATC. Moreover, Rutin is first documented here as a NIS expression inducer capable of restoring cell differentiation in SW1736 cell line. It also be concluded that GLUTs as metabolic targets can be blocked specifically by Rutin for thyroid cancer prevention and treatment.
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Affiliation(s)
- S Heydarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No.23, Yemen St, Aarabi Street, 193954763, Tehran, Iran
- Department of Biochemistry, Falavarjan Branch Islamic Azad University, Isfahan, Iran
| | - A A Moshtaghie
- Department of Biochemistry, Falavarjan Branch Islamic Azad University, Isfahan, Iran
| | - M Daneshpour
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No.23, Yemen St, Aarabi Street, 193954763, Tehran, Iran
| | - M Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No.23, Yemen St, Aarabi Street, 193954763, Tehran, Iran.
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Soyluoglu S, Andac B, Korkmaz U, Ustun F. Assessment of three different radioiodine doses for ablation therapy of thyroid remnants: Efficiency, complications and patient comfort. Medicine (Baltimore) 2023; 102:e35339. [PMID: 37773808 PMCID: PMC10545237 DOI: 10.1097/md.0000000000035339] [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: 03/24/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ± 0.3, 2.6 ± 0.6, and 2.9 ± 0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.
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Affiliation(s)
- Selin Soyluoglu
- Trakya University, Department of Nuclear Medicine, Edirne, Turkey
| | - Burak Andac
- Trakya University, Faculty of Medicine, Balkan Campus, Department of Endocrinology and Metabolic Diseases, Edirne, Turkey
| | - Ulku Korkmaz
- Trakya University, Department of Nuclear Medicine, Edirne, Turkey
| | - Funda Ustun
- Trakya University, Department of Nuclear Medicine, Edirne, Turkey
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Signore A, Lauri C, Di Paolo A, Stati V, Santolamazza G, Capriotti G, Prosperi D, Tofani A, Valabrega S, Campagna G. Predictive Role of Serum Thyroglobulin after Surgery and before Radioactive Iodine Therapy in Patients with Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15112976. [PMID: 37296937 DOI: 10.3390/cancers15112976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Thyroidectomy followed by radioactive iodine therapy (RAI) is the treatment of choice for differentiated thyroid carcinoma (DTC). Serum thyroglobulin (Tg) measurement has proved to be useful for predicting persistent and/or recurrent disease during follow-up of DTC patients. In our study, we evaluated the risk of disease recurrence in patients with papillary thyroid carcinoma (PTC), who were treated with thyroidectomy and RAI, by measuring serum Tg at different time-points: at least 40 days after surgery, in euthyroidism with TSH < 1.5 and usually 30 days before RAI (Tg-30), on the day of RAI (Tg0), and seven days after RAI (Tg+7). METHODS One hundred and twenty-nine patients with PTC were enrolled in this retrospective study. All patients were treated with 131I for thyroid remnant ablation. Disease relapse (nodal disease or distant disease) during at least 36 months follow-up was evaluated by serum measurements of Tg, TSH, AbTg at different time points and by imaging techniques (neck ultrasonography, 131I-whole body scan (WBS) after Thyrogen® stimulation). Typically, patients were assessed at 3, 6, 12, 18, 24, and 36 months after RAI. We classified patients in five groups: (i) those who developed nodal disease (ND), (ii) those who developed distant disease (DD), (iii) those with biochemical indeterminate response and minimal residual thyroid tissue (R), (iv) those with no evidence of structural or biochemical disease + intermediate ATA risk (NED-I), and (v) those with no evidence of structural or biochemical disease + low ATA risk (NED-L). ROC curves for Tg were generated to find potential discriminating cutoffs of Tg values in all patients' groups. RESULTS A total of 15 out of 129 patients (11.63%) developed nodal disease and 5 (3.88%) distant metastases, during the follow-up. We found that Tg-30 (with suppressed TSH) has the same sensitivity and specificity than Tg0 (with stimulated TSH), and it is slightly better than Tg+7, which can be influenced by the size of the residual thyroid tissue. CONCLUSION Serum Tg-30 value, measured in euthyroidism 30 days before RAI, is a reliable prognostic factor to predict future nodal or distant disease, thus allowing to plan the most appropriate therapy and follow-up.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Arianna Di Paolo
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Valeria Stati
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
- Medical Oncology 2, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Giuliano Santolamazza
- Surgical Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Gabriela Capriotti
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Daniela Prosperi
- Nuclear Medicine Unit, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Anna Tofani
- Nuclear Medicine Unit, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Stefano Valabrega
- Surgical Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00185 Rome, Italy
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Campennì A, Ruggeri RM, Garo ML, Siracusa M, Restuccia G, Rappazzo A, Rosarno H, Nicocia A, Cardile D, Ovčariček PP, Baldari S, Giovanella L. Comparison of 1.1 GBq and 2.2 GBq Activities in Patients with Low-Risk Differentiated Thyroid Cancer Requiring Postoperative 131I Administration: A Real Life Study. Cancers (Basel) 2023; 15:cancers15092416. [PMID: 37173884 PMCID: PMC10177573 DOI: 10.3390/cancers15092416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To compare the efficacy of low and moderate 131I activities in low-risk differentiated thyroid carcinoma (DTC) patients requiring postoperative thyroid remnant ablation in a real-world clinical setting. METHODS We retrospectively reviewed the records of 299 low-risk DTC patients (pT1-T2, Nx(0) Mx) who had undergone (near)-total thyroidectomy followed by 131I therapy, using either low (1.1 GBq) or moderate (2.2 GBq) radioiodine activities. The response to initial treatments was evaluated after 8-12 months, and patient responses were classified according to the 2015 American Thyroid Association guidelines. RESULTS An excellent response was observed in 274/299 (91.6%) patients, specifically, in 119/139 (85.6%) and 155/160 (96.9%) patients treated with low and moderate 131I activities, respectively (p = 0.029). A biochemically indeterminate or incomplete response was observed in seventeen (22.2%) patients treated with low 131I activities and three (1.8%) patients treated with moderate 131I activities (p = 0.001). Finally, five patients showed an incomplete structural response, among which three and two received low and moderate 131I activities, respectively (p = 0.654). CONCLUSIONS When 131I ablation is indicated, we encourage the use of moderate instead of low activities, in order to reach an excellent response in a significantly larger proportion of patients, including patients with the unexpected persistence of the disease.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Human Pathology DETEV, Unit of Endocrinology, University of Messina, 98122 Messina, Italy
| | - Maria Luisa Garo
- Department of Cardiovascular Research, University Campus Biomedico, 00128 Roma, Italy
| | - Massimiliano Siracusa
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Giovanna Restuccia
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Andrea Rappazzo
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Helena Rosarno
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Antonio Nicocia
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Davide Cardile
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, 98125 Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, 8006 Zurich, Switzerland
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Pace-Asciak P, Russell JO, Tufano RP. Review: Improving quality of life in patients with differentiated thyroid cancer. Front Oncol 2023; 13:1032581. [PMID: 36776310 PMCID: PMC9911681 DOI: 10.3389/fonc.2023.1032581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Well differentiated thyroid cancer is a common malignancy diagnosed in young patients. The prognosis tends to be excellent, so years of survivorship is expected with low risk disease. When making treatment decisions, physicians should consider long-term quality of life outcomes when guiding patients. The implications for treating indolent, slow growing tumors are immense and warrant careful consideration for the functioning years ahead. Surgery is the standard of care for most patients, however for a subset of patients, active surveillance is appropriate. For those wishing to treat their cancer in a more active way, novel remote access approaches have emerged to avoid a cervical incision. In the era of "doing less", options have further expanded to include minimally invasive approaches, such as radiofrequency ablation that avoids an incision, time off work, a general anesthetic, and the possibility of post-treatment hypothyroidism. In this narrative review, we examine the health related quality of life effects that surgery has on patients with thyroid cancer, including some of the newer innovations that have been developed to address patient concerns. We also review the impact that less aggressive treatment has on patient care and overall wellbeing in terms of active surveillance, reduced doses of radioactive iodine (RAI) treatment, or minimally invasive techniques such as radiofrequency ablation (RFA) for low risk thyroid disease.
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, ON, Canada,*Correspondence: Pia Pace-Asciak,
| | - Jonathon O. Russell
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Ralph P. Tufano
- Department of Otolaryngology - Head and Neck Surgery, Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, Sarasota, FL, United States
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Sunavala-Dossabhoy G, Petti S. Effect of recombinant human thyroid stimulating hormone on long-term salivary gland dysfunction in thyroid cancer patients treated with radioactive iodine. A systematic review. Oral Oncol 2023; 136:106280. [PMID: 36525783 DOI: 10.1016/j.oraloncology.2022.106280] [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: 07/29/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Adjuvant radioactive iodine (RAI) is administered to thyroid cancer patients following thyroidectomy for remnant tissue ablation and metastatic disease management. Patients are prepared with thyroid hormone withdrawal (THW) or recombinant human thyroid stimulating hormone (rhTSH). Long-term salivary gland dysfunction (LT-SGD) is a common, dosage-dependent, RAI adverse effect. Although rhTSH preparation seems to reduce LT-SGD, this effect could be due to lower RAI activity generally used in rhTSH-prepared patients. Therefore, this meta-analysis investigated the effect of preparation type on LT-SGD development. Literature search (PubMed, Medline, EmBase, Cochrane, Web of Science, LILACS, Google Scholar) was performed four times (January-November 2022) and studies reporting LT-SGD incidence ≥1 year after RAI in patients prepared with rhTSH/THW were identified. The LT-SGD risk ratio (RR) was estimated with various models considered for sensitivity analysis (fixed-effect, random-effects, study-quality adjusted, publication-bias adjusted, individual-patient-data meta-analysis adjusted for RAI). Subgroup analysis according to RAI activity (<3.7/≥3.7 GBq) also was performed. Literature search resulted in five studies (321 rhTSH, 632 THW patients). The pooled RRs according to various models were 0.65 (95% confidence interval -95CI, 0.49-0.86; fixed-effect); 0.62 (95CI, 0.38-1.02; random-effects); 0.72 (95CI, 0.54-0.96; quality adjusted); 0.76 (95CI, 0.58-0.99; publication-bias adjusted); 0.0.80 (95CI, 0.55-1.14; individual-patient-data meta-analysis). The pooled RRs stratified for RAI activity were 0.26 (95CI, 0.05-1.30) for <3.7 GBq; 0.75 (95CI, 0.57-0.98) for ≥3.7 GBq. The number of patients needed to be prepared with rhTSH to prevent one case of LT-SGD ranged between seven and thirty-seven. There is moderate-quality scientific evidence that rhTSH preparation may consistently protect salivary gland function.
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Affiliation(s)
- Gulshan Sunavala-Dossabhoy
- Department of Biochemistry and Molecular Biology, Louisiana State University Health and Feist Weiller Cancer Center, Shreveport, LA, United States
| | - Stefano Petti
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
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Pacini F, Fuhrer D, Elisei R, Handkiewicz-Junak D, Leboulleux S, Luster M, Schlumberger M, Smit JW. 2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer? Eur Thyroid J 2022; 11:e210046. [PMID: 34981741 PMCID: PMC9142814 DOI: 10.1530/etj-21-0046] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022] Open
Abstract
Modern use of post-operative radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC) should be implemented in line with patients' risk stratification. Although beneficial effects of radioiodine are undisputed in high-risk patients, controversy remains in intermediate-risk and some low-risk patients. Since the last consensus on post-surgical use of RAI in DTC patients, new retrospective data and results of prospective randomized trials have been published, which have allowed the development of a new European Thyroid Association (ETA) statement for the indications of post-surgical RAI therapy in DTC. Questions about which patients are candidates for RAI therapy, which activities of RAI can be used, and which modalities of pre-treatment patient preparation should be used are addressed in the present guidelines.
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Affiliation(s)
- Furio Pacini
- Section of Endocrinology, University of Siena, Siena, Italy
- Correspondence should be addressed to F Pacini:
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism, West German Cancer Centre (WTZ), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rossella Elisei
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Sophie Leboulleux
- Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Martin Schlumberger
- Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France
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Kukulska A, Krajewska J, Gawkowska M, Paliczka-Cieslik E, Handkiewicz-Junak D, Kropińska A, Puch Z, Olczyk T, Roskosz J, Jarzab B. Thyroid remnant ablation with radioiodine activity of 30, 60, and 100 mCi in patients with differentiated thyroid cancer - a prospective comparison of long-term outcomes. Arch Med Sci 2022; 18:1241-1247. [PMID: 36160333 PMCID: PMC9479704 DOI: 10.5114/aoms.2020.97803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 06/24/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this prospective study was to evaluate long-term outcomes in differentiated thyroid cancer (DTC) patients postoperatively treated with distinct RAI activities of 30 mCi, 60 mCi, and 100 mCi. MATERIAL AND METHODS The analysis involved 277 low-risk and 46 intermediate-risk patients, who underwent radioiodine (RAI) ablation with 30 mCi, 60 mCi or 100 mCi under prospective, randomized clinical trials. Seventy-eight patients from the low-risk group received 30 mCi, whereas 125 and 74 patients received 60 mCi and 100 mCi, respectively. Regarding the intermediate-risk group, 20 patients were given 60 mCi, and 26 subjects were given 100 mCi. The mean time of follow-up was 11 years. RESULTS An excellent treatment response was obtained in 88%, 89% and 90% of low-risk patients treated with 30 mCi, 60 mCi, and 100 mCi, respectively, and in 85% of intermediate-risk patients, who were administered 60 or 100 mCi. An indeterminate response was achieved in 9.4% and 6.5%, whereas an incomplete structural response was obtained in 1.4% and 6.5% of low-risk and intermediate-risk patients, respectively. An incomplete biochemical response was observed only in 2.2% of intermediate-risk patients. The differences in treatment response regarding RAI activity were not significant. CONCLUSIONS RAI activity of 30 mCi demonstrates a comparable efficacy as 60 mCi and 100 mCi in low-risk DTC. RAI activity of 60 mCi seems to be effective in intermediate-risk DTC.
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Affiliation(s)
- Aleksandra Kukulska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marzena Gawkowska
- Third Clinic of Radiotherapy and Chemotherapy, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Ewa Paliczka-Cieslik
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aleksandra Kropińska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Zbigniew Puch
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Tomasz Olczyk
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jozef Roskosz
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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James DL, Ryan ÉJ, Davey MG, Quinn AJ, Heath DP, Garry SJ, Boland MR, Young O, Lowery AJ, Kerin MJ. Radioiodine Remnant Ablation for Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:544-552. [PMID: 33792650 DOI: 10.1001/jamaoto.2021.0288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Postoperative radioactive iodine (RAI) remnant ablation for differentiated thyroid cancer (DTC) facilitates the early detection of recurrence and represents an adjuvant therapy that targets persistent microscopic disease. The optimal activity of RAI in low- and intermediate-risk DTC remains controversial. Objective To evaluate the long-term cure rate of different RAI activities in low- and intermediate-risk DTC. Secondary outcomes included successful remnant ablation, adverse effects, and hospital length of stay. Data Source A systematic search of the databases PubMed, Cochrane Collaboration, Embase, Scopus, and Web of Science was performed to identify randomized clinical trials (RCTs) and observational studies that compared long-term outcomes (>12 months) for American Thyroid Association-classified low- and intermediate-risk DTC based on receipt of either low-activity or high-activity RAI postoperatively. Study Selection All RCTs or observational studies evaluating patients with low- and intermediate-risk DTC who were treated initially with total/near-total thyroidectomy, followed by remnant RAI ablation with either low or high activities. Eligible studies had to present odds ratio, relative risk (RR), or hazard ratio estimates (with 95% CIs), standard errors, or the number of events necessary to calculate these for the outcome of interest rate. Data Extraction Two investigators reviewed the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Dichotomous variables were pooled as risk ratios and continuous data as weighted-mean differences. Quality assessment of the included studies was performed using the Newcastle-Ottawa and Jadad scales. Main Outcomes and Measures Disease recurrence was the primary outcome. Secondary outcomes included successful ablation, adverse effects, and length of stay. Results Ten studies that included 3821 patients met inclusion criteria, including 6 RCTs and 4 observational studies. There was no difference in long-term cure recurrence rates (RR, 0.88; 95% CI, 0.62-1.27, P = .50) or successful remnant ablation (RR, 0.95; 95% CI, 0.87-1.03; P = .20) between low-activity and high-activity RAI. Conclusions and Relevance In this systematic review and meta-analysis, low-activity RAI was comparable with high-activity RAI regarding successful ablation and recurrence rates. This suggests that low-activity RAI is preferable to high-activity in low- and intermediate-risk DTC because of its similar efficacy but reduced morbidity. Trial Registration PROSPERO Identifier: CRD42020166780.
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Affiliation(s)
- Danielle L James
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Alanna Jane Quinn
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - David P Heath
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Stephen James Garry
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Orla Young
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
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11
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Schumm MA, Pyo HQ, Kim J, Tseng CH, Yeh MW, Leung AM, Chiu HK. Recombinant human thyroid-stimulating hormone versus thyroid hormone withdrawal preparation for radioiodine ablation in differentiated thyroid cancer in children, adolescents and young adults. Clin Endocrinol (Oxf) 2021; 95:344-353. [PMID: 33704813 DOI: 10.1111/cen.14457] [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: 12/24/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Recombinant human TSH (rhTSH) is commonly used to prepare patients for postoperative radioiodine (I-131) ablation after surgery for differentiated thyroid cancer (DTC). In adults, rhTSH is associated with equivalent oncologic efficacy in comparison to thyroid hormone withdrawal (THW), but its use has not been well studied in children. We aimed to measure time to disease progression after rhTSH stimulation vs. THW in paediatric patients under the age of 21 with DTC following total thyroidectomy. DESIGN Retrospective cohort study (March 2001-July 2018). PATIENTS Sixteen children and adolescents (75% female, median age, 17.4 years) who received rhTSH were compared to 29 historical controls (72% female, median age, 18.5 years) prepared with THW, followed for a median of 2.4 years (range, 0.5-14). MEASUREMENTS Stimulated serum TSH concentrations prior to I-131 ablation and time to disease progression, as determined by a component outcome variable encompassing both structural and biochemical disease persistence/recurrence. RESULTS No differences were observed in tumour characteristics and I-131 dose (median 2.3 [1.8-2.90] mCi/kg rhTSH) between groups. Patients who received rhTSH achieved a similar median stimulated TSH level (163 [127-184] mU/L), compared to those who underwent THW (136 [94.5-197] mU/L; p = .20). Both groups exhibited similar time to progression (p = .13) and disease persistence/recurrence rates (rhTSH 31% vs. THW 59%, p = .14). CONCLUSION In this cohort of children and adolescents with DTC, we observed similar time to disease progression among those who received rhTSH or underwent THW prior to postoperative I-131 ablation.
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Affiliation(s)
- Max A Schumm
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Howard Q Pyo
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jiyoon Kim
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Harvey K Chiu
- Division of Endocrinology, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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12
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Kim K, Bae JS, Kim JS. Long-Term Oncological Outcome Comparison between Intermediate- and High-Dose Radioactive Iodine Ablation in Patients with Differentiated Thyroid Carcinoma: A Propensity Score Matching Study. Int J Endocrinol 2021; 2021:6642971. [PMID: 33708253 PMCID: PMC7929686 DOI: 10.1155/2021/6642971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Radioactive iodine (RAI) ablation is recommended for most patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy (TT). We aimed to compare long-term outcomes between intermediate-dose (100 mCi) and high-dose (150 mCi) RAI ablation therapy in patients with DTC using propensity score matching analysis. METHODS This was a retrospective study of 1448 patients with DTC who underwent RAI ablation after TT. Propensity score matching was performed using the extent of operation, tumor size, extrathyroidal extension, multifocality, lymphatic invasion, vascular invasion, perineural invasion, number of positive lymph nodes (LNs), ATA risk stratification system, T stage, N stage, TNM stage, preoperative serum Tg and TgAb levels, and post-RAI serum Tg and TgAb levels. RESULTS Recurrence rates in the intermediate- and high-dose groups were 3.1% and 5.6%, respectively. After propensity score matching, LN ratio >0.22 (HR, 2.915; 95% CI, 1.228-6.918; p=0.015) and serum Tg >10 ng/mL after RAI (HR, 3.976; 95% CI, 1.839-8.595; p < 0.001) were significant predictors of recurrence. Kaplan-Meier analysis showed no significant difference in DFS before or after propensity score matching (p=0.074 and p=0.378, respectively). CONCLUSIONS Intermediate-dose RAI ablation for the adjuvant treatment of DTC is sufficient as compared to high-dose RAI ablation. Further prospective or multicenter studies should be conducted to clarify the prognosis of intermediate-dose RAI ablation.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Ahtiainen V, Vaalavirta L, Tenhunen M, Joensuu H, Mäenpää H. Randomised comparison of 1.1 GBq and 3.7 GBq radioiodine to ablate the thyroid in the treatment of low-risk thyroid cancer: a 13-year follow-up. Acta Oncol 2020; 59:1064-1071. [PMID: 32603613 DOI: 10.1080/0284186x.2020.1785003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: The optimal activity of radioiodine (I-131) administered for ablation therapy in papillary and follicular thyroid cancer after thyroidectomy remains unknown in a long-term (> 10 year) follow-up. Some, shorter follow-up studies suggest that activities 1.1 GBq and 3.7 GBq are equally effective. We evaluated the long-term outcomes after radioiodine treatment to extend current knowledge about the optimal ablative dose of I-131.Methods: One hundred and sixty consecutive adult patients (129 females, 31 males; mean age 46 ± 14 y, range 18-89 y) diagnosed with histologically confirmed differentiated thyroid cancer, were randomised in a prospective, phase III, open-label, single-centre study, to receive either 1.1 GBq or 3.7 GBq of I-131 after thyroidectomy. At randomisation, patients were stratified according to the histologically verified cervical lymph node status and were prepared for ablation using thyroid hormone withdrawal. No uptake in the whole-body scan with I-131 and serum thyroglobulin concentration less than 1 ng/mL at 4-8 months after treatment was considered successful ablation.Results: Median follow-up time was 13.0 years (mean 11.0 ± 4.8 y; range 0.3-17.1 y). Altogether 81 patients received 1.1 GBq with successful ablation in 45 (56%) patients. In the original study, thirty-six patients (44%) needed one or more extra administrations to replete the ablation. Of these, 4 (8.9%) and 5 (14%) patients relapsed during the follow-up, respectively. Of the 79 patients treated with 3.7 GBq 45 (57%) had successful ablation after one administration of radioiodine and 34 (43%) needed several treatments. Of these, 2 (4.4%) and 9 (26.5%) patients relapsed, respectively. The groups did not differ in the proportion of patients relapsing (p = .591).Conclusion: During follow-up of median 13 years, 3.7 GBq is not superior to 1.1 GBq in the radioiodine treatment after thyroidectomy in papillary and follicular thyroid cancer.
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Affiliation(s)
- Veera Ahtiainen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Doctoral School in Health Sciences, University of Helsinki, Helsinki, Finland
| | - Leila Vaalavirta
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Tenhunen
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Joensuu
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Mäenpää
- Department of Radiation Oncology, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
- Department of Radionuclear Treatments, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
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14
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Vardarli I, Weidemann F, Aboukoura M, Herrmann K, Binse I, Görges R. Longer-term recurrence rate after low versus high dose radioiodine ablation for differentiated thyroid Cancer in low and intermediate risk patients: a meta-analysis. BMC Cancer 2020; 20:550. [PMID: 32539683 PMCID: PMC7296693 DOI: 10.1186/s12885-020-07029-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023] Open
Abstract
Background Regarding the longer-term recurrence rate the optimal activity for the remnant thyroid ablation in patients with differentiated thyroid cancer (DTC) is discussed controversially. For the short-term ablation success rate up to 12 months there are already several meta-analyses. In this study we performed the first meta-analysis regarding the longer-term recurrence rate after radioactive 131-I administration. Methods We conducted an electronic search using PubMed/MEDLINE, EMBASE and the Cochrane Library. All randomized controlled trials (RCTs) assessed the recurrence rate after radioactive iodine ablation in patients with DTC, with a follow-up of at least two years were selected. Statistics were performed by using Review Manager version 5.3 and Stata software. Results Four RCTs were included in the study, involving 1501 patients. There was no indication for heterogeneity (I2 = 0%) and publication bias. The recurrence rate among patients who had a low dose 131-iodine ablation was not higher than for a high dose activity (odds ratio (OR) 0.93 [95% confidence interval (CI) 0.53–1.63]; P = 0.79). The mean follow-up time was between 4.25 and 10 years. The subgroup analysis regarding the TSH stimulated thyroglobulin values (< 10 ng/mL versus < 2 ng/mL versus ≤1 ng/mL) showed no influence on recurrence rate. Conclusions For the first time we showed that the longer-term, at least 2-year follow-up, recurrence rate among patients who had 131-iodine ablation with 1.1 GBq was not higher than with 3.7 GBq.
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Affiliation(s)
- I Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Dorstener Str. 151, 45657, Recklinghausen, Germany.
| | - F Weidemann
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Dorstener Str. 151, 45657, Recklinghausen, Germany
| | - M Aboukoura
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Dorstener Str. 151, 45657, Recklinghausen, Germany
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - I Binse
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - R Görges
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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15
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SEOM clinical guideline thyroid cancer (2019). Clin Transl Oncol 2020; 22:223-235. [PMID: 32006340 DOI: 10.1007/s12094-019-02284-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
Thyroid carcinoma is the most frequent endocrine malignancy and accounts for around 3% of global cancer incidence. Different histologies and clinical scenarios make necessary a multidisciplinary approach that includes new diagnostic methods and surgical, radiopharmaceutical and systemic therapies. This guideline updates several aspects of management of thyroid cancer.
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16
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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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17
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Assessment of the impact of 2015 American Thyroid Association guidelines in management of differentiated thyroid cancer patients. Eur J Nucl Med Mol Imaging 2019; 47:547-553. [PMID: 31707429 DOI: 10.1007/s00259-019-04582-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/15/2019] [Indexed: 12/22/2022]
Abstract
The 2015 American Thyroid Association (ATA) guideline have suggested modifications in the risk stratification (RS) for differentiated thyroid cancer (DTC) patients, introduced the concept of dynamic risk stratification (DRS) and redefined the role of radioactive iodine (RAI) in treatment algorithm. The aim of this retrospective audit was to assess the practical implications of these modifications in management of DTC. METHODS A total of 138 DTC patients were stratified according to ATA 2009 and 2015 guidelines into low (LR), intermediate (IR) and high (HR) risk groups. Change in RS and in intention of RAI use was calculated. Deviation in administered RAI dosage from the guidelines was assessed. 1-year follow-up data was audited to assess how the DRS modified the initial risk estimate. RESULTS A total of 11.6% of patients changed their RS categories in 2015 guidelines. A total of 10.1% got upstaged to HR, and 1.4% got downstaged to LR. In 2.17% of patients' intention of RAI use changed to remnant ablation from adjuvant therapy and 65% of the LR patients won't require any RAI therapy. A total of 26.7% of patients had received significantly more RAI dosage according to ATA 2015. At 1-year follow-up according to DRS 84% of LR, 75% of IR and 44% of HR patients showed excellent response (ER). CONCLUSION More patients changed RS to HR than to LR. Intention of RAI use changed in only a small number of patients. Significantly higher dosage of RAI is being administered to patients in current practice. The effect of DRS in modifying the initial RS was most prominent in IR, with most showing ER to initial therapy.
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18
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Sia Y, Dave RV, Nour D, Miller JA, Skandarajah AR, Tasevski R. Radioactive iodine ablation post differentiated thyroid cancer surgery: an analysis of use and impact of the American Thyroid Association guidelines. ANZ J Surg 2019; 89:E502-E506. [PMID: 31674140 DOI: 10.1111/ans.15522] [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: 11/02/2018] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The 2009 American Thyroid Association (ATA) three-tiered risk stratification, and its updated version in 2015, provided clearer guidance on the use of radioactive iodine (RAI) ablation in differentiated thyroid cancer (DTC) patients. This study examines the impact of these guidelines on RAI use in our institution. METHODS Patients diagnosed with DTC during three different time periods (group 1: 2002-2006, group 2: 2010-2014 and group 3: 2017-2018) were identified and risk stratified according to the ATA guidelines. RAI use and extent of surgery were compared between the three groups. Categorical variables were analysed using Fisher's exact (2 × 2) and chi-squared (>2 × 2) tests. RESULTS A total of 415 patients were included (group 1 = 88, group 2 = 215, group 3 = 112). The proportion of patients having total thyroidectomy were 84.6, 84.7 and 69.6% in groups 1, 2 and 3, respectively (P = 0.003). Central lymph node dissection was significantly higher in the more contemporary groups compared to group 1 (9.1 versus 41.9 versus 64.3%, P < 0.001). Overall, fewer patients received RAI in more recent times (76.6 versus 54.8 versus 26.8%, P < 0.001), most evident in the low-risk patients (70 versus 29.1 versus 5.1%, P < 0.001). In the high risk group, the majority received RAI, with no difference between the groups. CONCLUSION Comparing DTC patients treated in our unit before and after publications of the 2009 and 2015 ATA guidelines, more nodal surgery was performed with less RAI administered in the latter groups. Better risk stratification according to the ATA guidelines has allowed more judicious use of RAI ablation.
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Affiliation(s)
- Yi Sia
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rajiv V Dave
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Daniel Nour
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Julie A Miller
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita R Skandarajah
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Tasevski
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Mínguez P, Rodeño E, Genollá J, Domínguez M, Expósito A, Sjögreen Gleisner K. Analysis of activity uptake, effective half-life and time-integrated activity for low- and high-risk papillary thyroid cancer patients treated with 1.11 GBq and 3.7 GBq of 131I-NaI respectively. Phys Med 2019; 65:143-149. [DOI: 10.1016/j.ejmp.2019.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022] Open
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20
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Wang C, Diao H, Ren P, Wang X, Wang Y, Zhao W. Efficacy and Affecting Factors of 131I Thyroid Remnant Ablation After Surgical Treatment of Differentiated Thyroid Carcinoma. Front Oncol 2019; 8:640. [PMID: 30619772 PMCID: PMC6306449 DOI: 10.3389/fonc.2018.00640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: Radioiodine (131I) thyroid remnant ablation is an important treatment of differentiated thyroid carcinoma (DTC) and various factors affecting its efficacy have been reported but not well defined. The aim of our study was to evaluate the efficacy and the affecting factors of 131I ablation after total or near-total thyroidectomy in a relative large DTC cohort. Methods: 261 DTC patients with negative thyroglobulin antibody received 100-200 mCi 131I for thyroid remnant ablation after total or near-total thyroidectomy between January 2012 and October 2015 in our hospital. The efficacy and affecting factors of 131I ablation therapy were retrospectively investigated. Results: The success rate of the first 131I thyroid remnant ablation was 65.90%. Univariate analysis demonstrated that larger tumor size, higher level of pre-ablation stimulated thyroglobulin (sTg), intermediate to high risk stratification for recurrence, and lymph node and distant metastases were associated with a lower success rate of the first 131I ablation (all p < 0.05). Multivariate logistic regression analysis showed that tumor size, pre-ablation sTg, and lymph node and distant metastases were independent factors affecting the efficacy of the first 131I ablation. Areas under receiver operating characteristic curves for sTg, sTg/TSH ratio, and tumor size to predict unsuccessful ablation were 0.831, 0.824, and 0.648, respectively. The threshold values were 4.595 ng/ml, 0.046 mg/IU, and 1.350 cm, respectively. The sensitivities were 95.51, 96.63, and 73.03% and the specificities were 64.54, 61.63, and 49.41%, respectively. The excellent response (ER) ratio of the successful group was significantly higher than that of the unsuccessful group. Conclusions: The efficacy of the first 131I thyroid remnant ablation after surgical treatment of DTC is well demonstrated, and tumor size, pre-ablation sTg, lymph node, and distant metastases are independent factors affecting its efficacy.
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Affiliation(s)
- Chen Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongcui Diao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ping Ren
- Department of Endocrine, Yiyuan County People's Hospital, Zibo, China
| | - Xufu Wang
- Department of Nuclear Medicine, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Zhao
- Department of Endocrine and Metabolic Diseases, the Affiliated Hospital of Qingdao University, Qingdao, China
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Ullmann TM, Gray KD, Moore MD, Zarnegar R, Fahey TJ. Current controversies and future directions in the diagnosis and management of differentiated thyroid cancers. Gland Surg 2018; 7:473-486. [PMID: 30505769 DOI: 10.21037/gs.2017.09.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the development of novel diagnostic, surgical, and chemotherapeutic approaches to differentiated thyroid cancers (DTCs), the diagnosis and management of these tumors remains controversial. The most recent American Thyroid Association (ATA) guidelines, released in 2015, reflect a recent shift towards less aggressive management for patients with DTCs. However, many clinicians have expressed concern that more conservative management will put patients at risk for disease recurrence and metastasis. In particular, the management of indeterminate nodules on fine needle aspiration (with special attention to genetic and epigenetic markers of malignancy), the extent of surgery for known differentiated cancers, the role of adjuvant radioactive iodine (RAI) therapy, and novel targeted treatments with tyrosine kinase inhibitors (TKIs) represent current areas of uncertainty and opportunities for future research. In this review, we examine the current state of the art in these areas, and address some of the questions that remain.
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Affiliation(s)
- Timothy M Ullmann
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Maureen D Moore
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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Avram AM, Dewaraja YK. Thyroid Cancer Radiotheragnostics: the case for activity adjusted 131I therapy. Clin Transl Imaging 2018; 6:335-346. [PMID: 30911535 DOI: 10.1007/s40336-018-0291-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotheragnostics represents the systematic integration of diagnostic imaging and therapeutics using radionuclides targeting specific characteristics of tumor biology. Radioiodine (131I) is the classic radiotheragnostic agent used for the diagnosis and treatment of differentiated thyroid cancer (DTC) based on sodium-iodine symporter expression in normal and neoplastic thyroid tissue. Application of radiotheragnostics principles in thyroid cancer involves using pre-ablation diagnostic scans (Dx Scans) for detection of iodine-avid regional and distant metastatic disease and patient-individualized targeted 131I therapy with goal of maximizing the benefits of the first therapeutic 131I administration. Clinically available nuclear medicine imaging technology has significantly evolved over the past 10 years with the introduction of hybrid SPECT/CT and PET/CT systems, as well as advances in iterative image reconstruction with modeling of image degrading physical factors. This progress makes possible the acquisition of accurate diagnostic radioiodine scintigraphy capable of identifying regional and distant metastatic disease, which can be used for 131I treatment planning and delivery of activity adjusted 131I therapy for achieving intended treatment goals (e.g. remnant ablation, adjuvant 131 I treatment and targeted 131-I treatment). The overarching aim of thyroid cancer radiotheragnostics is to optimize the balance between 131I therapeutic efficacy and potential side-effects on non-target tissues.
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuni K Dewaraja
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
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Park SY, Kim HI, Choi JY, Choe JH, Kim JH, Kim JS, Oh YL, Hahn SY, Shin JH, Ahn SH, Kim K, Jeong JG, Kim SW, Chung JH, Kim TH. Low versus high activity radioiodine remnant ablation for differentiated thyroid carcinoma with gross extrathyroidal extension invading only strap muscles. Oral Oncol 2018; 84:41-45. [PMID: 30115474 DOI: 10.1016/j.oraloncology.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The efficacy of radioiodine remnant ablation (RRA) for patients with differentiated thyroid carcinoma (DTC) with gross extrathyroidal extension (ETE) is well described in observational studies. However, its role in gross ETE invading only strap muscles, T3b category in the newly proposed eighth edition of the TNM staging system, is currently unknown. METHODS This study retrospectively analyzed 260 DTC patients with ETE invading only strap muscles who underwent thyroidectomy at a tertiary Korean hospital between 1994 and 2005. Cancer-specific survival (CSS) and recurrence-free survival (RFS) in the no RRA (n = 13), low RRA activity (<3.7 GBq, n = 80), and high RRA activity (≥3.7 GBq, n = 167) groups were studied. RESULTS No significant differences were observed between low and high activity RRA groups in terms of 10-year CSS (97.3% versus 99.3%; HR 0.23, 95% CI 0.02-2.57; p = .235) and RFS (86.8% versus 88.8%; 0.90, 0.40-2.03; p = .804). In the no RRA group, no patients died of cancer, and only one developed structural recurrence. In Cox regression analyses with inverse probability of treatment weighting adjusted for clinicopathologic risk factors, high activity RRA was not related to recurrence outcomes compared to low activity (HR 0.60, 95% CI 0.26-1.35; p = .214). CONCLUSIONS Long term oncologic outcomes did not significantly differ between low versus high activity RRA groups, which suggests that low activity RRA might be sufficient in patients with DTC with gross ETE invading only strap muscles. Further studies are needed to clarify the optimal activity of RRA in these patients.
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Affiliation(s)
- So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine and Molecular Imaging, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jong Gill Jeong
- Department of Surgery, Yeosu Chonnam Hospital, Yeosu, Republic of Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Comparison of treatment efficacy 1 and 2 years after thyroid remnant ablation with 1110 versus 5550 MBq of iodine-131 in patients with intermediate-risk differentiated thyroid cancer. Nucl Med Commun 2018; 38:927-931. [PMID: 28834790 DOI: 10.1097/mnm.0000000000000730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Radioiodine ablation may be associated with improved survival in patients with intermediate-risk follicular cell differentiated thyroid cancer (FCDTC). The aim of this study was to compare ablation efficacy of 1110 versus 5500 MBq of iodine-131 (I) in FCDTC patients with intermediate risk. METHODS Thirty-nine patients with intermediate-risk FCDTC (T3N0, T1-2N1b and T1-3N1a) were treated with 1110 MBq of I and compared with 43 age-matched and sex-matched patients who received 5550 MBq of I. Patients with invasive histology, extensive lymph node involvement, and preablation thyroglobulin (Tg) of more than 100 ng/ml were excluded from the study. All patients underwent total or near total thyroidectomy with or without lymph node dissection. Response to treatment was evaluated 1 and 2 years after I treatment. RESULTS We studied four male and 78 female patients, age range 21-69 years. Preablation Tg level was 12.7±17.8 and 15.8±22.6 ng/ml in patients in the low-dose and high-dose groups, respectively (P=0.48). Anti-Tg antibody level as well as T and N staging were not significantly different in the two groups (P>0.2). One and 2 years after treatment, an excellent response was noted in 19 and 22 patients in the low-dose group and in 16 and 23 patients in the high-dose group, respectively (P>0.3). Using logistic regression analysis, preablation Tg was the only significant factor in the prediction of an incomplete response 2 years after therapy. CONCLUSION 1110 MBq of I was as effective as 5550 MBq of I in the treatment of FCDTC patients with intermediate risk 1 and 2 years after therapy.
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Park KW, Wu JX, Du L, Leung AM, Yeh MW, Livhits MJ. Decreasing Use of Radioactive Iodine for Low-Risk Thyroid Cancer in California, 1999 to 2015. J Clin Endocrinol Metab 2018; 103:1095-1101. [PMID: 29267880 DOI: 10.1210/jc.2017-02269] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/12/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines. OBJECTIVE To assess recent stage-specific trends in use of RAI ablation. DESIGN, SETTING, AND PATIENTS Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry. Statistical analysis included standardized differences, P values, and multivariable analyses using RAI as the predictor variable. MAIN OUTCOME MEASURES Trends and drivers of RAI ablation for low-risk DTC. RESULTS Of 46,906 patients with DTC who underwent near-total or total thyroidectomy [mean age 48.2 ± 15.5 (standard deviation) years, 77% female), 25,457 (54%) received RAI. The proportion of patients with regional/distant disease who received RAI remained stable at 68%. Use of RAI for patients with localized disease (no extrathyroidal extension, lymph node, or distant metastases) decreased from 55% (1999) to 30% (2015), with the most substantial change occurring in tumors <1 cm (39% to 11%). The rate also decreased for localized tumors between 1 and 2 cm (62% to 34%) and 2 and 4 cm (67% to 49%) and remained stable at 59% for tumors >4 cm. In multivariable analyses, patients with localized disease were less likely to receive RAI if they were >65 years old [odds ratio (OR) 0.77, 95% confidence interval (CI): 0.71 to 0.83], had tumors <1 cm (OR 0.33, 95% CI: 0.31 to 0.35), or were treated in an academic hospital (OR 0.71, 95% CI: 0.67 to 0.75). CONCLUSIONS The rate of RAI ablation decreased over time, mainly attributable to decreased use for localized DTCs <2 cm. Many patients with low-risk DTC still receive RAI unnecessarily.
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Affiliation(s)
- Ki Wan Park
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - James X Wu
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Lin Du
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michael W Yeh
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Masha J Livhits
- Section of Endocrine Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
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Lv RB, Wang QG, Liu C, Liu F, Zhao Q, Han JG, Ren DL, Liu B, Li CL. Low versus high radioiodine activity for ablation of the thyroid remnant after thyroidectomy in Han Chinese with low-risk differentiated thyroid cancer. Onco Targets Ther 2017; 10:4051-4057. [PMID: 28860813 PMCID: PMC5565371 DOI: 10.2147/ott.s135145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM The aim of this study was to compare the efficacy and adverse effects of radioiodine (131I) therapy between two groups of patients with low-risk differentiated thyroid cancer (DTC) who received 30 mCi or 100 mCi radioiodine for ablation of the thyroid remnant after total thyroidectomy. METHODS The study cohort was 173 patients, 85 of whom were given 30 mCi of radioiodine and the others were given 100 mCi of radioiodine. Follow-up involved neck ultrasonography, measurement of serum levels of thyroglobulin and whole-body scans to evaluate the response of radioiodine treatment. All patients were assessed for adverse effects. RESULTS Of the 173 patients, 170 (98.3%) patients finally achieved successful ablation. The prevalence of successful ablation was 77.6% in the low-dose group versus 71.5% in the high-dose group after the first dose administration (P=0.36), 79% in the low-dose group versus 88% in the high-dose group after the second dose administration (P=0.416), and 97.6% in the low-dose group versus 98.9% in the high-dose group after the final ablation (P=0.54). We found no significant differences between the two groups. No patient had an adverse effect with a severity grade ⩾2 and the prevalence of adverse effects in the high-dose group was higher than that in the low-dose group, especially for nausea, neck pain, and sore throat. CONCLUSION These data suggest that a low dose of radioiodine is as effective as a high dose of radioiodine for ablation of the thyroid remnant after total thyroidectomy for low-risk DTC. Moreover, low-dose radioiodine therapy is associated with a lower prevalence of adverse events.
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Affiliation(s)
- Rong-Bin Lv
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Shandong University, Shandong, People's Republic of China.,Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Qing-Gang Wang
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Chao Liu
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Fang Liu
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Qing Zhao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian-Guo Han
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Dao-Ling Ren
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Bin Liu
- Department of Nuclear Medicine, Taian City Central Hospital, Shandong, People's Republic of China
| | - Cheng-Li Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Shandong University, Shandong, People's Republic of China
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Haymart MR, Esfandiari NH, Stang MT, Sosa JA. Controversies in the Management of Low-Risk Differentiated Thyroid Cancer. Endocr Rev 2017; 38. [PMID: 28633444 PMCID: PMC5546880 DOI: 10.1210/er.2017-00067] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Controversy exists over optimal management of low-risk differentiated thyroid cancer. This controversy occurs in all aspects of management, including surgery, use of radioactive iodine for remnant ablation, thyroid hormone supplementation, and long-term surveillance. Limited and conflicting data, treatment paradigm shifts, and differences in physician perceptions contribute to the controversy. This lack of physician consensus results in wide variation in patient care, with some patients at risk for over- or undertreatment. To reduce patient harm and unnecessary worry, there is a need to design and implement studies to address current knowledge gaps.
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Affiliation(s)
- Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
| | - Julia Ann Sosa
- Division of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina 27710
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Andresen NS, Buatti JM, Tewfik HH, Pagedar NA, Anderson CM, Watkins JM. Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity. Eur Thyroid J 2017; 6:187-196. [PMID: 28868259 PMCID: PMC5567113 DOI: 10.1159/000468927] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/03/2017] [Indexed: 11/19/2022] Open
Abstract
Management recommendations for differentiated thyroid cancer are evolving. Total thyroidectomy is the backbone of curative-intent therapy, with radioiodine ablation (RAI) of the thyroid remnant routinely performed, in order to facilitate serologic surveillance and reduce recurrence risk. Several single-institution series have identified patient subsets for whom recurrence risk is sufficiently low that RAI may not be indicated. Further, the appropriate dose of RAI specific to variable clinicopathologic presentations remains poorly defined. While recent randomized trials demonstrated equivalent thyroid remnant ablation rates between low- and high-dose RAI, long-term oncologic endpoints remain unreported. While RAI may be employed to facilitate surveillance following total thyroidectomy, cancer recurrence risk reduction is not demonstrated in favorable-risk patients with tumor size ≤1 cm without high-risk pathologic features. When RAI is indicated, in patients without macroscopic residual disease or metastasis, the evidence suggests that the rate of successful remnant ablation following total thyroidectomy is equivalent between doses of 30-50 mCi and doses ≥100 mCi, with fewer acute side effects; however, in the setting of subtotal thyroidectomy or when preablation diagnostic scan uptake is >2%, higher doses are associated with improved ablation rates. Historical series demonstrate conflicting findings of long-term cancer control rates between dose levels; long-term results from modern series have yet to be reported. For high-risk patients, including those with positive surgical margins, gross extrathyroidal extension, lymph node involvement, subtotal thyroidectomy, or >5% uptake, higher-dose RAI therapy appears to provide superior rates of ablation and cancer control.
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Affiliation(s)
| | - John M. Buatti
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | | | - Nitin A. Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Carryn M. Anderson
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
| | - John M. Watkins
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
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Ma C, Feng F, Wang S, Fu H, Wu S, Ye Z, Chen S, Wang H. Chinese Data of Efficacy of Low- and High-Dose Iodine-131 for the Ablation of Thyroid Remnant. Thyroid 2017; 27:832-837. [PMID: 28401794 DOI: 10.1089/thy.2015.0658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chinese data on the efficacy of low- and high-dose radioiodine for thyroid remnant are still absent. The aim of the study was to investigate whether a low dose of radioiodine is as effective as a high dose for remnant ablation in Chinese patients. METHODS Patients presenting for radioiodine ablation in the authors' department were included. Inclusion criteria were aged ≥16 years, total or near-total thyroidectomy, tumor-node-metastasis (TNM) stage of pT1-3, any N stage, and M0. All patients were randomly allocated to either the high-dose group of 3700 MBq or the low-dose group of 1850 MBq for remnant ablation. The response to treatment was defined as successful or unsuccessful after a six- to nine-month interval. Ablation was considered to be successful if patients fulfilled the following criteria: no tracer uptake in the thyroid bed on diagnosis whole-body scanning and a negative level of serum thyroglobulin. RESULTS There were 327 patients enrolled between January 2013 and December 2014. More than 95% had papillary thyroid cancer. Data could be analyzed for 278 cases (Mage = 44 years; 71.6% women), 155 in the low-dose group and 123 in the high-dose group. The rate of initial successful ablation was 84.2% in all patients, 82.6% in the low-dose group, and 86.2% in the high-dose group. There was no difference between the two groups (p = 0.509). CONCLUSIONS In Chinese patients with differentiated thyroid carcinoma, the low dose of 1850 MBq radioiodine activity is as effective as a high dose of 3700 MBq for thyroid remnant ablation.
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Affiliation(s)
- Chao Ma
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Fang Feng
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Shaoyan Wang
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Hongliang Fu
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Shuqi Wu
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Zhiyi Ye
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Suyun Chen
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
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Marti JL, Morris LGT, Ho AS. Selective use of radioactive iodine (RAI) in thyroid cancer: No longer "one size fits all". Eur J Surg Oncol 2017; 44:348-356. [PMID: 28545679 DOI: 10.1016/j.ejso.2017.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 12/12/2022] Open
Abstract
A remarkable, evidence-based trend toward de-escalation has reformed the practice of radioactive iodine (RAI) administration for thyroid cancer patients. Updated guidelines have supported both decreased RAI doses for select populations, as well as expanded definitions of low-risk and intermediate-risk patients that may not require RAI. Correspondingly, there is now increased flexibility for hemithyroidectomy without need for RAI, and relaxed TSH suppression targets for low-risk thyroidectomy patients. Clinical judgment remains indispensable where multiple risk factors co-exist that individually are not indications for RAI. This is especially salient in intermediate-risk patients with a less than excellent response to therapy, determined through thyroglobulin and ultrasound surveillance. Such judgment, however, may lead to patterns of inappropriate RAI practices or overuse with little benefit to the patient and unnecessary harm. A multidisciplinary, risk-adapted approach is ever more important and obliges the surgeon to understand the likelihood that their patients will receive RAI. The risks and benefits of RAI, its evolved role in contemporary guidelines, and current patterns of use among endocrinologists are reviewed, as well as the practical implications for thyroid surgeons.
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Affiliation(s)
- J L Marti
- Department of Surgery, New York Presbyterian/Lower Manhattan Hospital, Weill Cornell Medicine, 156 William Street, 12th Floor New York, NY 10038, USA
| | - L G T Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue New York, NY 10065, USA
| | - A S Ho
- Department of Surgery, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 590W, Los Angeles, CA 90048, USA.
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Clinical outcomes of low-dose and high-dose postoperative radioiodine therapy in patients with intermediate-risk differentiated thyroid cancer. Nucl Med Commun 2017; 38:228-233. [PMID: 27984538 DOI: 10.1097/mnm.0000000000000636] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent studies have suggested that a low dose (LD) of radioiodine (RAI) is sufficient to treat differentiated thyroid cancer (DTC) even in patients with intermediate risk. However, these studies evaluated the efficacy of RAI therapy, irrespective of the results of the whole-body scan (WBS). The aim of the present study was to evaluate the response to LD and high-dose (HD) RAI therapy using two different criteria (with and without WBS results) and the reclassification system according to the revised 2015 guidelines of the American Thyroid Association in Korean intermediate-risk DTC patients. In addition, we evaluated the long-term clinical outcomes of treatment with LD and HD RAI. MATERIALS AND METHODS In total, 204 intermediate-risk DTC patients who underwent postoperative RAI therapy at two tertiary referral hospitals from 2003 to 2004 were enrolled in the present retrospective study. One hundred and twenty-four patients were treated with 3.7 and 5.55 GBq (HD) of RAI in one center and 80 patients were treated with 1.11 GBq (LD) in the other center. The success rate of RAI therapy was assessed with or without the inclusion of WBS results in the analysis. In addition, the response to therapy during the first 2 years of follow-up after the initial RAI therapy was categorized according to the reclassification system of 2015 American Thyroid Association guidelines as excellent response, indeterminate response, biochemical incomplete response, or structural incomplete response. Recurrence was defined as a newly detected cytologically or pathologically confirmed lesion. RESULTS There were no significant differences between the success rates of the HD and LD groups irrespective of the inclusion of WBS results in the analysis (with WBS: 54.84 vs. 45.0%, P=0.23; without WBS: 60.48 vs. 62.5%, P=0.77). The response to HD and LD RAI therapy was excellent in 54.84 and 45.0% of the patients, respectively; indeterminate in 34.68 and 30.0% of the patients, respectively; biochemical incomplete in 4.03 and 13.75% of the patients, respectively; and structural incomplete in 6.45% and in 11.25% of the patients, respectively (P=0.04). In particular, the biochemical or structural incomplete response rate was lower in patients treated with HD than in patients treated with LD (HD, 10.48%; LD, 25.0%, P=0.01). At the last follow-up (HD, median 11 years; LD, median 10 years), patients who achieved an excellent response showed no evidence of disease. After the initial RAI therapy, eight patients in the HD group and 18 patients in the LD group who achieved either indeterminate response or biochemical incomplete response received additional RAI therapy. Seven patients (indeterminate response in five patients; biochemical incomplete response in two patients) in the HD group and seven patients (indeterminate response in five patients; biochemical incomplete response in two patients) in the LD group showed recurrences. CONCLUSION LD RAI therapy after thyroidectomy appears to be insufficient in Korean DTC patients with intermediate risk. The patients in the LD group predominantly showed biochemical or structural incomplete response to initial RAI therapy and additional RAI therapy was required.
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In Patients With Low- to Intermediate-Risk Thyroid Cancer, a Preablative Thyrotropin Level of 30 μIU/mL Is Not Adequate to Achieve Better Response to 131I Therapy. Clin Nucl Med 2017; 41:454-8. [PMID: 26914559 DOI: 10.1097/rlu.0000000000001167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The optimal preablative level of thyrotropin (TSH) for patients with differentiated thyroid cancer (DTC) to achieve better response after I ablation remains unknown. The objective of this study was to assess whether a higher preablative TSH level above 30 μIU/mL is associated with better response to I therapy in low- to intermediate-risk DTC and to explore the potential factors that may impact their responses. PATIENTS AND METHODS A total of 204 consecutive non-high-risk patients were retrospectively reviewed. Serum TSH and thyroglobulin (Tg) levels were measured right before I treatment after thyroxine hormone withdrawal (THW). Patients were categorized by their preablative TSH level grouping of 30 to less than 60 (n = 11), 60 to less than 90 (n = 61), 90 to less than 120 (n = 56), 120 to less than 150 (n = 33), and 150 μIU/mL or greater (n = 43). Responses to I therapy were evaluated as excellent, indeterminate, biochemical incomplete, or structural incomplete response (ER, IDR, BIR, or SIR) after a mean follow-up of 20.3 months. Initial risk factors (age, sex, T and N status by AJCC/UICC TNM staging system, and thyroid remnant), the administered dose of I and response to I therapy were compared among different preablative TSH groups. Multivariate analysis was further performed to identify factors associated with incomplete response (IR, including BIR and SIR). RESULTS Except the significant correlation between younger age and higher preablative TSH level (P = 0.001), the 5 TSH groups did not differ in other related prognostic factors or dose of I (all P > 0.05). Among each ascending TSH group, ER was observed in 54.5%, 68.9%, 73.2%, 69.7%, and 60.5%, respectively, whereas IR was observed in 18.2%, 18.0%, 7.1%, 9.1%, and 20.9%, respectively. Group 90 to less than 120 μIU/mL presented the highest rate of ER and lowest rate of IR. In the multivariate analysis, preablative TSH level, in addition to preablative Tg, was also an associated factor for response to I therapy (P = 0.048). CONCLUSIONS A preablative TSH level of 90 to less than 120 μIU/mL might be more appropriate for patients with low- to intermediate-risk DTC to achieve better response to I therapy.
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Low- and high-dose radioiodine therapy for low-/intermediate-risk differentiated thyroid cancer: a preliminary clinical trial. Ann Nucl Med 2016; 31:71-83. [DOI: 10.1007/s12149-016-1133-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
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Onimode YA, Ejeh JE, Orunmuyi AT. Adverse Reactions to Radioiodine 131I Therapy of Goiter in West African Tertiary Hospital. Mol Imaging Radionucl Ther 2016; 25:128-133. [PMID: 27751975 PMCID: PMC5100084 DOI: 10.4274/mirt.13007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/08/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Radioactive iodine therapy (RAIT) is established as an efficient means of treating toxic goiter (TG) globally. The field of nuclear medicine (NM) still appears novel to many Nigerian clinicians and patients. A culturally embedded dread of radiation may raise ethical and moral concerns about potential adverse effects in the wake of RAIT in our setting. An adverse drug reaction may be described as "a response to a drug which is noxious and unintended, and which occurs at doses normally used in man". This study therefore, seeks to review adverse reactions (ARs) experienced following RAIT. We would also like to improve patient and physician education about the safety profile of RAIT. METHODS This is a retrospective analysis of all patients who had received RAIT for thyroid disease from August 2006 to June 2015. RESULTS Forty typical ARs were experienced following 36 therapy sessions (18.65%) with RAIT in 35 patients (21.47%) aged 17-78 years, of which three had multiple sessions for well-differentiated thyroid carcinoma (WDTC). CONCLUSION RAIT remains a safe option for the treatment of benign and TG. The experienced ARs are mainly mild to moderate in severity and mostly short-lived. As larger doses of radioactive iodine for WDTC and TG were more commonly associated with ARs, our study suggests that these patients merit stronger prophylactic measures as well as closer monitoring for earlier detection and management of these reactions.
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Affiliation(s)
- Yetunde A Onimode
- University of Ibadan College of Medicine, Department of Radiation Oncology, Nuclear Medicine Unit, Ibadan, Nigeria, Phone: +2347087821065 E-mail:
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Castagna MG, Cantara S, Pacini F. Reappraisal of the indication for radioiodine thyroid ablation in differentiated thyroid cancer patients. J Endocrinol Invest 2016; 39:1087-94. [PMID: 27350556 DOI: 10.1007/s40618-016-0503-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/08/2016] [Indexed: 02/05/2023]
Abstract
Radioactive iodine therapy is administered to patients with differentiated thyroid cancer (DTC) for eradication of thyroid remnant after total thyroidectomy or, in patients with metastatic disease, for curative or palliative treatment. In past years, thyroid remnant ablation was indicated in almost every patient with a diagnosis of DTC. Nowadays, careful revision of patients' outcome has introduced the concept of risk-based selection of patients candidate to thyroid remnant ablation. The present review aims to underline the indications for thyroid remnant ablation and to address methodologies to be employed.
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Affiliation(s)
- M G Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - S Cantara
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - F Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
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Shengguang Y, Ji-Eun C, Lijuan HL. I-131 for Remnant Ablation in Differentiated Thyroid Cancer After Thyroidectomy: A Meta-Analysis of Randomized Controlled Evidence. Med Sci Monit 2016; 22:2439-50. [PMID: 27406262 PMCID: PMC4957627 DOI: 10.12659/msm.896535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this study was to compare the success rate of various levels of I-131 activity for use in remnant ablation in low-risk differentiated thyroid cancer. Material/Methods We identified eligible studies in 5 electronic databases up to December 2014 and the reference lists of original studies and review articles were hand searched for additional articles on this topic. Summary relative risks with their 95% confidence intervals were calculated with a random-effects model. Heterogeneity was assessed using I2 statistics. Results Fourteen randomized clinical trials met the eligibility criteria. The data suggest that the pooled successful ablation rate is 5% lower (95% CI, 1–9% lower) when using 30 mCi compared with 100 mCi (test for heterogeneity, p=0.468, I2=0.0%). In stratified analysis, ablation success rates using 30 mCi are similar to 100 mCi in Asia (SRRs=0.91; 95%CI=0.72–1.14). However, the results favor 100 mCi in Europe (SRRs=0.95; 95%CI=0.91–0.99). Ablation success rates using 30 mCi are similar to 100 mCi in patients who underwent TT/NTT (total thyroidectomy/near total thyroidectomy) (SRRs=0.96; 95%CI=0.92–1.00) and TT/STT (SRRs=0.98; 95%CI=0.73–1.31). However, the result favor 100 mCi in patients who underwent ST/HT (subtotal thyroidectomy/ hemithyroidectomy) (SRRs=0.80; 95%CI=0.65–0.99). There was no publication bias in the present meta-analysis. Conclusions High radioiodine activity is better than low activity in terms of successful ablation rate in low-risk differentiated thyroid cancer, but the advantage of high activity seems to only exist in patients who underwent hemithyroidectomy/subtotal thyroidectomy, but not lymph node involvement, preparation before ablation, and definition of successful ablation.
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Affiliation(s)
- Yan Shengguang
- International Education Center, North China University of Science and Technology, Tangshan, Hebei, China (mainland)
| | - Choi Ji-Eun
- Department of Education, Jeonju University, Jeonju-si, South Korea
| | - He Li Lijuan
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, Hebei, China (mainland)
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Ben Ghachem T, Yeddes I, Meddeb I, Bahloul A, Mhiri A, Slim I, Ben Slimene MF. A comparison of low versus high radioiodine administered activity in patients with low-risk differentiated thyroid cancer. Eur Arch Otorhinolaryngol 2016; 274:655-660. [PMID: 27225282 DOI: 10.1007/s00405-016-4111-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
Abstract
Post-surgical therapeutic management of differentiated thyroid cancer (DTC) is still a controversial subject. Indeed, there is no consensus on the dose of 131I to be administered, although the current trend towards therapy easing through mini-cures for patients with good prognosis. To confirm the non-inferiority in terms of effectiveness of an ablative mini-cure from 1.11 to 1.85 GBq, over a cure of 3.7 GBq, in patients with DTC operated for low and very low risk. We retrospectively studied 157 patients with very low and low risk DTC, followed in the Nuclear Medicine Department of the Salah Azaiez Institute between 2002 and 2012. These patients had a complementary radioiodine therapy with either low dose (group A) or high dose (group B) with an evaluation at 6 months post treatment and in long-term. The study took place at a referral center. The average age was 42.8 ± 13.7 years with a female predominance (86.7 %). The DTC papillary represented the most common etiology (95 %) with a predominance of pure papillary (68 %) on the follicular variant (27 %). The first cure evaluation did not show statistically significant difference between the two approaches in terms of therapeutic ablative efficiency (p = 0.13). The overall success rate was 77 % (121/157), with 83 % (54/65) in group A and 72.8 % (67/92) in group B. The likelihood of having a remission from the first cure was 1.83 times greater for patients treated with low doses (OR = 1.83, 95 % CI 0.23-1.29). At the end of follow, we have noted one case of refractory disease. The male gender (adjusted OR = 2.71, 95 % CI 0.51-4.23, p = 0.03), and the baseline Tg ≥ 10 (ng/ml) (adjusted OR = 3.48, 95 % CI 1.25-9.67, p = 0.01) were significantly independent predictors of successful first cure ablation. The results provide that mini-dose protocol is not less effective for ablation of the thyroid remnant than 3.7 GBq activity.
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Affiliation(s)
- T Ben Ghachem
- Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - I Yeddes
- Salah Azaiez Institute, Tunis, Tunisia. .,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - I Meddeb
- Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - A Bahloul
- Salah Azaiez Institute, Tunis, Tunisia
| | - A Mhiri
- Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - I Slim
- Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - M F Ben Slimene
- Salah Azaiez Institute, Tunis, Tunisia.,Faculty of Medecine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Different Radioiodine Dose for Remnant Thyroid Ablation in Patients With Differentiated Thyroid Cancer: A Meta-analysis. Clin Nucl Med 2016. [PMID: 26204220 DOI: 10.1097/rlu.0000000000000914] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Remnant thyroid ablation is crucial in the management of patients with differentiated thyroid cancer. However, the optimal dose of radioactive I for ablation is still controversial. This study aimed to compare the success rate of different activities of I for postoperative remnant ablation in randomized controlled trials (RCTs) and to determine the optimal dose. PATIENTS AND METHODS Sources were retrieved from the Cochrane Library, Medline, Embase, Scopus, and Google Scholar until March 2014. All RCTs that assessed the efficacy of different doses of I for ablation were selected. After data extraction, statistics were performed by Review Manager 5.2 software. RESULTS Seventeen RCTs were considered eligible, involving 3737 patients. The overall methodological quality of the studies was good. The rate of successful remnant ablation of low versus moderate I activities (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.80-1.00; P = 0.06) and moderate versus high I activities (RR, 0.94; 95% CI, 0.89-1.00; P = 0.05) showed no significant differences. However, high I activities had 11% higher successful ablation rate than low activities with an RR of 0.89 (95% CI, 0.81-0.97; P = 0.008), which was significant. CONCLUSIONS We summarized all available randomized evidence to demonstrate that high dose of I was significantly better than low dose to achieve successful remnant thyroid ablation.
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Xu D, Wang L, Long B, Ye X, Ge M, Wang K, Guo L, Li L. Radiofrequency ablation for postsurgical thyroid removal of differentiated thyroid carcinoma. Am J Transl Res 2016; 8:1876-1885. [PMID: 27186311 PMCID: PMC4859916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. Surgical removal with radioactive iodine therapy is recommended for recurrent thyroid carcinoma, and the postsurgical thyroid removal is critical. This study evaluated the clinical values of radiofrequency ablation (RFA) in the postsurgical thyroid removal for DTC. 35 DTC patients who had been treated by subtotal thyroidectomy received RFA for postsurgical thyroid removal. Before and two weeks after RFA, the thyroid was examined by ultrasonography and (99m)TcO4 (-) thyroid imaging, and the serum levels of free triiodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) were detected. The efficacy and complications of RFA were evaluated. Results showed that, the postsurgical thyroid removal by RFA was successfully performed in 35 patients, with no significant complication. After RFA, the average largest diameter and volume were significantly decreased in 35 patients (P > 0.05), and no obvious contrast media was observed in ablation area in the majority of patients. After RFA, the serum FT3, FT4 and Tg levels were markedly decreased (P < 0.05), and TSH level was significantly increased (P < 0.05). After RFA, radioiodine concentration in the ablation area was significantly reduced in the majority of patients. The reduction rate of thyroid update was 0.69±0.20%. DTC staging and interval between surgery and RFA had negative correlation (Pearson coefficient = -0.543; P = 0.001), with no obvious correlation among others influential factors. RFA is an effective and safe method for postsurgical thyroid removal of DTC.
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Affiliation(s)
- Dong Xu
- Department of Ultrasound, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Lipin Wang
- Department of Ultrasound, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Bin Long
- Department of Nuclear Medicine, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Xuemei Ye
- Department of Nuclear Medicine, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Minghua Ge
- Department of Head and Neck Surgery, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Kejing Wang
- Department of Head and Neck Surgery, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Liang Guo
- Department of Head and Neck Surgery, Zhejiang Cancer HospitalHangzhou 310022, China
| | - Linfa Li
- Department of Nuclear Medicine, Zhejiang Cancer HospitalHangzhou 310022, China
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Fatima N, Zaman MU, Zaman A, Zaman U, Tahseen R. Comparable Ablation Efficiency of 30 and 100 mCi of I-131 for Low to Intermediate Risk Thyroid Cancers Using Triple Negative Criteria. Asian Pac J Cancer Prev 2016; 17:1115-8. [DOI: 10.7314/apjcp.2016.17.3.1115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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41
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Reply to: Meta-analysis on Successful Ablation After Low- Versus High-Dose Radioiodine Therapy in Patients With Differentiated Thyroid Carcinoma. Clin Nucl Med 2016; 41:675. [PMID: 27055127 DOI: 10.1097/rlu.0000000000001190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The incidence of thyroid cancer has been increasing. After total thyroidectomy of well-differentiated thyroid tumors with intermediate- or high-risk features on pathology, radioiodine remains one of the mainstays of therapy for both thyroid remnant ablation as well as for treatment of metastatic disease. SPECT/CT, a relatively new modality, has been shown to play a pivotal role predominantly in the post-therapy setting by changing the risk stratification of patients with thyroid cancer. In the case of radioiodine treatment failure, FDG-PET/CT may provide prognostic information based on extent and intensity of metabolically active metastatic sites as well as serve as an important imaging test for response assessment in patients treated with chemotherapy, targeted therapies, or radiotherapy, thereby affecting patient management in multiple ways. The role of newer redifferentiation drugs has been evaluated with the use of I-124 PET/CT.
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Affiliation(s)
- Ravinder K Grewal
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Alan Ho
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Pacini F, Brianzoni E, Durante C, Elisei R, Ferdeghini M, Fugazzola L, Mariotti S, Pellegriti G. Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian Society of Endocrinology. J Endocrinol Invest 2016; 39:341-7. [PMID: 26264386 PMCID: PMC4761012 DOI: 10.1007/s40618-015-0375-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/28/2015] [Indexed: 02/08/2023]
Abstract
UNLABELLED Post-surgical ablation of thyroid remnant with radioactive iodine (RAI) in differentiated thyroid cancer (DTC) is aimed to destroy any thyroid remnant in the thyroid bed (remnant ablation) and any microscopic foci of cancer cells eventually present within the thyroid remnant (adjuvant therapy). The present text is an attempt to offer practice guidelines for the indication of thyroid ablation and the preparation of DTC patients considering the latest achievement in the field and the changing epidemiology of DTC observed in the last 10 years. METHODOLOGY The executive committee of the Italian Society of Endocrinology appointed a task force of thyroid cancer expert including Nuclear Medicine Physicians and Endocrinologists to provide a consensus on the post-surgical ablation in thyroid cancer patients. The task force had no conflict of interest and had no commercial support. A number of specific topics were selected and the members selected relevant papers by searching in the Pubmed for articles published from 2000 to January 2015. Selected studies were categorized by level of evidence, and the recommendations were graded according to the level of evidence as high (A), moderate (B), or low (C).
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Affiliation(s)
- F Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
- Department of Endocrinology, University of Siena, Via Bracci, 53100, Siena, Italy.
| | - E Brianzoni
- Nuclear Medicine Unit, Ospedale Civile di Macerata, Macerata, Italy
| | - C Durante
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Ferdeghini
- Nuclear Medicine Unit, University of Verona, Verona, Italy
| | - L Fugazzola
- Endocrine Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - S Mariotti
- Department Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - G Pellegriti
- Endocrinology Division, Garibaldi Nesima Hospital, Palermo, Italy
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Buffet C, Ghander C, le Marois E, Leenhardt L. Indications for radioiodine administration in follicular-derived thyroid cancer. ANNALES D'ENDOCRINOLOGIE 2016; 76:1S2-7. [PMID: 26826479 DOI: 10.1016/s0003-4266(16)30008-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Indications for radioiodine administration after thyroid cancer surgery have shifted in recent years toward personalized management, adapted to the individual risk of tumor progression. The most recent guidelines and studies favor de-escalation in indications for administration, dosage and means of preparation with exogenous recombinant TSH stimulation as treatment of choice. Radioiodine administration has 3 possible objectives: • ablation of normal thyroid tissue remnants in patients with low risk of progression, using low radioiodine activity levels, with the advantage of completing disease staging on whole-body scintigraphy performed after administration of the radioiodine capsule, and of facilitating follow-up by thyroglobulin assay; • adjuvant treatment for suspected microscopic metastases in patients with intermediate or high risk of progression, using higher activity levels, with the theoretic aim of limiting recurrence and mortality; • curative treatment in high-risk patients with proven metastases, using exclusively high activity levels, with a view to improving specific survival. In future, indications for ablation and/or activity prescription may be governed by an algorithm incorporating individual baseline progression risk (essentially founded of pTNM staging) and postoperative data such as thyroglobulin level and neck ultrasound results.
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Affiliation(s)
- C Buffet
- Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France
| | - C Ghander
- Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France
| | - E le Marois
- Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France
| | - L Leenhardt
- Unité thyroïde-tumeurs endocrines, Institut d'endocrinologie E3M et Service de médecine nucléaire, Hôpital Pitié-Salpêtrière, Université Pierre-et-Marie-Curie/Institut Universitaire du Cancer, 83, boulevard de L'Hôpital, 75013 Paris, France.
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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: 8685] [Impact Index Per Article: 1085.6] [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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Recombinant TSH stimulated remnant ablation therapy in thyroid cancer: the success rate depends on the definition of ablation success--an observational study. PLoS One 2015; 10:e0120184. [PMID: 25793762 PMCID: PMC4367989 DOI: 10.1371/journal.pone.0120184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/02/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Patients with differentiated thyroid cancer (DTC) are treated with (near)-total thyroidectomy followed by remnant ablation. Optimal radioiodine-131 (131I) uptake is achieved by withholding thyroid hormone (THW), pretreatment with recombinant human Thyrotropin Stimulating Hormone (rhTSH) is an alternative. Six randomized trials have been published comparing THW and rhTSH, however comparison is difficult because an uniform definition of ablation success is lacking. Using a strict definition, we performed an observational study aiming to determine the efficacy of rhTSH as preparation for remnant ablation. PATIENTS AND METHODS Adult DTC patients with, tumor stage T1b to T3, Nx, N0 and N1, M0 were included in a prospective multicenter observational study with a fully sequential design, using a stopping rule. All patients received remnant ablation with 131I using rhTSH. Ablation success was defined as no visible uptake in the original thyroid bed on a rhTSH stimulated 150 MBq 131I whole body scan (WBS) 9 months after remnant ablation, or no visible uptake in the original thyroid bed on a post therapeutic WBS when a second high dose was necessary. RESULTS After interim analysis of the first 8 patients, the failure rate was estimated to be 69% (90% confidence interval (CI) 20-86%) and the inclusion of new patients had to be stopped. Final analysis resulted in an ablation success in 11 out of 17 patients (65%, 95% CI 38-86%). CONCLUSION According to this study, the efficacy of rhTSH in the preparation of 131I ablation therapy is inferior, when using a strict definition of ablation success. The current lack of agreement as to the definition of successful remnant ablation, makes comparison between different ablation strategies difficult. Our results point to the need for an international consensus on the definition of ablation success, not only in routine patient's care but also for scientific reasons. TRIAL REGISTRATION Dutch Trial Registration NTR2395.
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Du P, Jiao X, Zhou Y, Li Y, Kang S, Zhang D, Zhang J, Lv L, Patel R. Low versus high radioiodine activity to ablate the thyroid after thyroidectomy for cancer: a meta-analysis of randomized controlled trials. Endocrine 2015; 48:96-105. [PMID: 24997645 DOI: 10.1007/s12020-014-0333-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
It is not known whether low-dose radioiodine is as effective as high-dose radioiodine for treating patients with differentiated thyroid cancer after surgery. This study compared ablation success rates of different doses of radioiodine in patients with differentiated thyroid cancer after thyroidectomy. Fifteen randomized controlled trials were obtained from PubMed, Embase, and Cochrane Library (1966 to February 2013). Stata version 12.0 was used to pool the outcomes. Mantel-Haenszel (MH) and inverse variance (IV) methods were used in a fixed-effects and random-effects model, respectively. The relative risk (RR) with 95% confidence interval (CI) was used to compare the success rates of different doses of radioiodine. There were a total of 3,046 patients. The pooled RR for comparing ablation success with low- and high-dose radioiodine was 0.90 (95% CI 0.83-0.98, IV). Excluding a study with a distinctive outcome, sensitivity analysis showed that the pooled RR was 0.95 (95% CI 0.92-0.99, MH). In subgroup analysis, the pooled RR of three studies that only administrated radioiodine to patients with pT2-4 cancer was 0.93 (95% CI 0.83-1.04, MH); the pooled RR of five studies with total thyroidectomy for all patients was 0.96 (95% CI 0.92-1.00, MH); and the pooled RR of four studies that used thyrotropin α to stimulate serum thyrotropin was 0.96 (95% CI 0.90-1.02, MH). The pooled RRs for comparing ablation success for moderate-dose versus high-dose and low-dose radioiodine were 0.94 (95% CI 0.85-1.04, IV) and 0.87 (95% CI 0.73-1.04, IV), respectively. Low-dose radioiodine can be used in patients undergoing total thyroidectomy. For those who receive insufficient surgical treatment, high-dose radioiodine is more appropriate.
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Affiliation(s)
- Peizhun Du
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
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Zaman MU, Fatima N, Padhy AK, Zaman U. Controversies about radioactive iodine-131 remnant ablation in low risk thyroid cancers: are we near a consensus? Asian Pac J Cancer Prev 2015; 14:6209-13. [PMID: 24377506 DOI: 10.7314/apjcp.2013.14.11.6209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review is an attempt to update readers about the previous and existing practice based on results of non- randomized trials and evolving trends fueled by recently published randomized studies.
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Affiliation(s)
- Maseeh Uz Zaman
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan E-mail :
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Miranti A, Giostra A, Richetta E, Gino E, Pellerito RE, Stasi M. Comparison of mathematical models for red marrow and blood absorbed dose estimation in the radioiodine treatment of advanced differentiated thyroid carcinoma. Phys Med Biol 2015; 60:1141-57. [DOI: 10.1088/0031-9155/60/3/1141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grenfell S, Roos D, Rijken J, Higgs B, Kirkwood I. Comparison of effective I-131 half-life between thyroid hormone withdrawal and recombinant human thyroid-stimulating hormone for thyroid cancer: A retrospective study. J Med Imaging Radiat Oncol 2014; 59:248-54. [DOI: 10.1111/1754-9485.12238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/17/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Solveig Grenfell
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Daniel Roos
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; School of Medicine; Adelaide South Australia Australia
| | - James Rijken
- Department of Medical Physics; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Braden Higgs
- Department of Radiation Oncology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Ian Kirkwood
- Department of Nuclear Medicine; Royal Adelaide Hospital; Adelaide South Australia Australia
- University of Adelaide; School of Medicine; Adelaide South Australia Australia
- SA Medical Imaging; SA Health; Adelaide South Australia Australia
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