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Buscombe J. Controversies in the Radioiodine Treatment of Patients With Differentiated Thyroid Cancer. Semin Nucl Med 2023; 53:475-480. [PMID: 36813671 DOI: 10.1053/j.semnuclmed.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/22/2023] [Indexed: 02/22/2023]
Abstract
The use of radioiodine (I-131) in the management of patients suffering differentiated thyroid cancer (DTC) has changed little in the past 40 years. The use of a standardized approach has served the majority of patients well over that time. However, there have been recent doubts concerning this approach in some low risk patients and if so, how can these patients recognized and which patients who may need more intensive treatment. A number of clinical trials have questioned the paradigms used in the treatment of DTC including what activity of I-131 should be used for ablation and which low risk patients should be treated with I-131 especially as there remains some doubts as to the long-term safety of I-131. Should a dosimetric approach be used to optimize the use of I-131 even though at present this approach has not been shown to improve outcomes in a formal clinical trial. The era of precision oncology represents a challenge and opportunity to nuclear medicine with a move away from a regime of standard care to one of highly individualized care based on the genetic profiling of the patient and their cancer. The treatment of DTC with I-131 is about to become very interesting.
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Affiliation(s)
- John Buscombe
- Department of Nuclear Medicine, St Bartholemew's Hospital, London, UK.
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Sparano C, Moog S, Hadoux J, Dupuy C, Al Ghuzlan A, Breuskin I, Guerlain J, Hartl D, Baudin E, Lamartina L. Strategies for Radioiodine Treatment: What’s New. Cancers (Basel) 2022; 14:cancers14153800. [PMID: 35954463 PMCID: PMC9367259 DOI: 10.3390/cancers14153800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.
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Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Sophie Moog
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Julien Hadoux
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Corinne Dupuy
- UMR 9019 CNRS, Université Paris-Saclay, Gustave Roussy, 94800 Villejuif, France
| | - Abir Al Ghuzlan
- Département de Biologie et Pathologie Médicales, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Dana Hartl
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence:
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Fama’ F, Sindoni A, Sun H, Kim HY, Geraci G, Colonna MR, Mazzeo C, Brenta G, Galeano M, Benvenga S, Dionigi G. Development of Histologically Verified Thyroid Diseases in Women Operated for Breast Cancer: A Review of the Literature and a Case Series. J Clin Med 2022; 11:jcm11113154. [PMID: 35683541 PMCID: PMC9181259 DOI: 10.3390/jcm11113154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The possible relationships between breast and thyroid diseases have been reported in the literature. The purpose of our study was to evaluate the occurrence of histologically verified thyroid pathologies in women who were diagnosed with breast cancer and, after mastectomy/quadrantectomy complemented by oncological treatment, were thyroidectomized based on their periodic thyroid evaluation. Patients and Methods: Our series consist of 31 women with a mean age of 62.9 ± 10.9 years (range, 45–81) treated for breast cancer (18 right-sided, 11 left-sided, and 2 bilateral), of whom 29 were thyroidectomized, since two women who developed Graves’ disease refused thyroidectomy. These 31 women belong to a cohort of 889 women who referred to the Breast Surgery Unit of our university hospital during the period January 2010 through December 2020. Results: The mean time interval between breast cancer and thyroid pathologies was 48.1 ± 23.4 months (range, 12–95). The final diagnosis at histopathology was infiltrating ductal breast carcinoma in 26 women (with 2/26 patients having bilateral carcinoma) and infiltrating lobular breast carcinoma in the other 5 women. Ten of the twenty-nine thyroidectomized women (34.5%) had a thyroid malignancy on histology: five papillary carcinomas, three papillary micro-carcinomas and two follicular carcinomas. Two of the five women with papillary carcinoma also had histological evidence of chronic lymphocytic thyroiditis/Hashimoto’s thyroiditis, which was also detected in another five women with benign thyroid diseases. Conclusions: We suggest that breast cancer survivors should be made aware of the possible increased risk of thyroid pathologies (including thyroid malignancy) so that they can undergo screening and follow-up.
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Affiliation(s)
- Fausto Fama’
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino” of Messina, 98125 Messina, Italy; (M.R.C.); (C.M.); (M.G.)
- Correspondence: ; Tel.: +39-090-221-2644
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
- New Hospital of Prato S. Stefano, Azienda USL Toscana Centro, 59100 Prato, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun 130033, China;
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Girolamo Geraci
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90100 Palermo, Italy;
| | - Michele Rosario Colonna
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino” of Messina, 98125 Messina, Italy; (M.R.C.); (C.M.); (M.G.)
| | - Carmelo Mazzeo
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino” of Messina, 98125 Messina, Italy; (M.R.C.); (C.M.); (M.G.)
| | - Gabriela Brenta
- Division of Endocrinology, Cesar Milstein Hospital, Buenos Aires C1221 ABE, Argentina;
| | - Mariarosaria Galeano
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino” of Messina, 98125 Messina, Italy; (M.R.C.); (C.M.); (M.G.)
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University Hospital “G. Martino” of Messina, 98125 Messina, Italy;
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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