1
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Tran TVT, Rubino C, Allodji R, Andruccioli M, Bardet S, Diallo I, Dottorini M, Garsi J, Hall P, Henry-Amar M, Lamart S, Le Thai F, Lönn S, Ricard M, Schvartz C, Schlumberger M, Journy N, de Vathaire F. Breast cancer risk among thyroid cancer survivors and the role of I-131 treatment. Br J Cancer 2022; 127:2118-2124. [PMID: 36224404 PMCID: PMC9726818 DOI: 10.1038/s41416-022-01982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/07/2022] [Accepted: 09/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Female thyroid cancer survivors are more likely to have a higher risk of breast cancer compared to the general population, and the underlying causes are yet to be understood. The potential role of I-131 treatment on this association remains controversial. METHODS We pooled individual data of women who were treated for differentiated thyroid cancer from 1934 to 2005 in France, Italy and Sweden. Standardized incidence ratios (SIRs) for breast cancer were estimated by comparison with age, sex and calendar-year expected values of the general population in each country. We estimated breast cancer risk in relation to I-131 treatment using time-dependent Poisson models. RESULTS Of 8475 women (mean age at diagnosis: 45 years, range 2-90 years), 335 were diagnosed with breast cancer [SIR = 1.52, 95% confidence interval (CI): 1.36-1.69] during a median follow-up time of 12.7 years since diagnosis. Overall, breast cancer risk did not differ between women treated or not with I-131 (relative risk=1.07, 95% CI 0.84-1.35). However, breast cancer risk increased with increasing cumulative I-131 activity, without significant departure from linearity (excess relative risk per 100 mCi=17%, 95% CI: 2% to 38%). The higher risk associated with a cumulative I-131 activity of ≥100 mCi and ≥400 mCi was translated into 4 (95% CI -4 to 13) and 42 (95% CI -8 to 93) excess breast cancer cases per 10,000 person-years, respectively. CONCLUSIONS An elevated risk was observed for the highest cumulative administered activity (>=400 mCi), and a significant dose-dependent association was observed among thyroid cancer survivors who were treated with I-131. However, overall, I-131 treatment might only explain partly the increase in breast cancer risk among female thyroid cancer survivors.
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Affiliation(s)
- Thi-Van-Trinh Tran
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Carole Rubino
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
| | - Rodrigue Allodji
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Milena Andruccioli
- Department of Nuclear Medicine, Sant'Anna Hospital, via Napoleona 60, 22100, Como, Italy
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Ibrahima Diallo
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Massimo Dottorini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Perugia General Hospital, Perugia, Italy
| | - Jérome Garsi
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 65, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Plateforme de Recherche Clinique Ligue Contre le Cancer, Centre François Baclesse, 3 Avenue Général Harris, 14076, Caen, Cedex 5, France
| | - Stephanie Lamart
- Laboratoire d'Évaluation de la Dose Interne, Institut de Radioprotection et de Sûreté Nucléaire, IRSN/PSE-SANTE/SDOS/LEDI, 31 avenue de la Division Leclerc, 92260, Fontenay-aux-Roses, France
| | | | - Stefan Lönn
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Marcel Ricard
- Department of Physics, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Claire Schvartz
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
- Thyroid Cancer Registry of Marne-Ardennes, Institut Godinot, 1, rue du Général-Koenig, 51100, Reims, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, 94800, Villejuif, France
| | - Neige Journy
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France
- University of Paris Saclay, Kremlin-Bicêtre, France
| | - Florent de Vathaire
- Radiation Epidemiology Team, INSERM U1018, Center for Research in Epidemiology and Population Health (CESP), F-94805, Villejuif Cedex, France.
- Department of Research, Gustave Roussy, F-94805, Villejuif Cedex, France.
- University of Paris Saclay, Kremlin-Bicêtre, France.
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2
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Ha H, Kim HJ, Park JH, Shin A, Lee KN, Han K, Lee NR, Hong J. Epidemiologic outlook of therapy-related myeloid neoplasms and selection of high-risk patients: A Korean nationwide study. Cancer 2022; 128:3888-3896. [PMID: 36069361 DOI: 10.1002/cncr.34453] [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: 05/17/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although a considerable proportion of patients with cancer receive chemotherapy (CT) or radiotherapy (RT), only a very few patients eventually develop therapy-related myeloid neoplasms (t-MNs). METHODS To identify subsets of cancer patients who have substantially elevated risk of developing t-MNs. Incidences and risks of t-MNs after contemporary CT or RT in patients newly diagnosed major cancers during 2009-2013 were analyzed. By merging two Korean nationwide health care big data sets, patients were selected and observed on follow-up to until t-MN development or December 2019. RESULTS Among 250,155 patients, 555 (0.22%) were diagnosed with t-MNs with a standard incidence ratio (SIR) of 3.40 (95% CI, 3.13-3.70). Patients had bone/joint cancers (SIR, 94.25; 95% CI, 50.71-137.80) and a remarkably high SIR for t-MN development. Patients receiving both CT and RT had the highest SIR (4.64; 95% CI, 4.08-5.20), followed by those receiving CT only (SIR, 3.30; 95% CI, 2.89-3.70). Contrarily, RT alone did not increase t-MN risk (SIR, 1.16; 95% CI, 0.76-1.56). More exposure to leukemogenic agents resulted in the higher t-MNs development. CONCLUSIONS The increased risk of developing acute myeloid leukemia or myelodysplastic syndrome after CT and/or RT was confirmed and subsets with substantially elevated risk for developing t-MNs were found. Such patients would be suitable for a prospective cohort for investigating t-MN pathogenesis by time series analyses.
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Affiliation(s)
- Hyerim Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Hyo Jeong Kim
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Ju Hyun Park
- Korea Institute for Health and Social Affairs (KIHASA), Sejong-si, South Korea
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Na Lee
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, South Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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3
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Personalized Dosimetry in the Context of Radioiodine Therapy for Differentiated Thyroid Cancer. Diagnostics (Basel) 2022; 12:diagnostics12071763. [PMID: 35885666 PMCID: PMC9320760 DOI: 10.3390/diagnostics12071763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/02/2022] Open
Abstract
The most frequent thyroid cancer is Differentiated Thyroid Cancer (DTC) representing more than 95% of cases. A suitable choice for the treatment of DTC is the systemic administration of 131-sodium or potassium iodide. It is an effective tool used for the irradiation of thyroid remnants, microscopic DTC, other nonresectable or incompletely resectable DTC, or all the cited purposes. Dosimetry represents a valid tool that permits a tailored therapy to be obtained, sparing healthy tissue and so minimizing potential damages to at-risk organs. Absorbed dose represents a reliable indicator of biological response due to its correlation to tissue irradiation effects. The present paper aims to focus attention on iodine therapy for DTC treatment and has developed due to the urgent need for standardization in procedures, since no unique approaches are available. This review aims to summarize new proposals for a dosimetry-based therapy and so explore new alternatives that could provide the possibility to achieve more tailored therapies, minimizing the possible side effects of radioiodine therapy for Differentiated Thyroid Cancer.
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4
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Eilsberger F, Reinecke M, Luster M. Genetic damage associated to 131I therapy and secondary cancer risk. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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5
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Mariani G, Tonacchera M, Grosso M, Orsolini F, Vitti P, Strauss HW. The Role of Nuclear Medicine in the Clinical Management of Benign Thyroid Disorders, Part 1: Hyperthyroidism. J Nucl Med 2020; 62:304-312. [PMID: 33008929 DOI: 10.2967/jnumed.120.243170] [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: 05/26/2020] [Accepted: 09/02/2020] [Indexed: 12/15/2022] Open
Abstract
Benign thyroid disorders, especially hyper- and hypothyroidism, are the most prevalent endocrine disorders. The most common etiologies of hyperthyroidism are autoimmune hyperthyroidism (Graves disease, GD), toxic multinodular goiter (TMNG), and toxic thyroid adenoma (TA). Less common etiologies include destructive thyroiditis (e.g., amiodarone-induced thyroid dysfunction) and factitious hyperthyroidism. GD is caused by autoantibodies against the thyroid-stimulating hormone (TSH) receptor. TMNG and TA are caused by a somatic activating gain-of-function mutation. Typical laboratory findings in patients with hyperthyroidism are low TSH, elevated free-thyroxine and free-triiodothyronine levels, and TSH-receptor autoantibodies in patients with GD. Ultrasound imaging is used to determine the size and vascularity of the thyroid gland and the location, size, number, and characteristics of thyroid nodules. Combined with lab tests, these features constitute the first-line diagnostic approach to distinguishing different forms of hyperthyroidism. Thyroid scintigraphy with either radioiodine or 99mTc-pertechnetate is useful to characterize different forms of hyperthyroidism and provides information for planning radioiodine therapy. There are specific scintigraphic patterns for GD, TMNG, TA, and destructive thyroiditis. Scintigraphy with 99mTc-sestamibi allows differentiation of type 1 from type 2 amiodarone-induced hyperthyroidism. The radioiodine uptake test provides information for planning radioiodine therapy of hyperthyroidism. Hyperthyroidism can be treated with oral antithyroid drugs, surgical thyroidectomy, or 131I-iodide. Radioiodine therapy is generally considered after failure of treatment with antithyroid drugs, or when surgery is contraindicated or refused by the patient. In patients with TA or TMNG, the goal of radioiodine therapy is to achieve euthyroid status. In GD, the goal of radioiodine therapy is to induce hypothyroidism, a status that is readily treatable with oral thyroid hormone replacement therapy. Dosimetric estimates based on the thyroid volume to be treated and on radioiodine uptake should guide selection of the 131I-activity to be administered. Early side effects of radioiodine therapy (typically mild pain in the thyroid) can be handled by nonsteroidal antiinflammatory drugs. Delayed side effects after radioiodine therapy for hyperthyroidism are hypothyroidism and a minimal risk of radiation-induced malignancies.
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Affiliation(s)
- Giuliano Mariani
- Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - Massimo Tonacchera
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mariano Grosso
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy; and
| | - Francesca Orsolini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - H William Strauss
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York
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6
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Kaewput C, Pusuwan P. Outcomes following I-131 treatment with cumulative dose exceeding or equal to 600 mCi in differentiated thyroid carcinoma patients. World J Nucl Med 2020; 20:54-60. [PMID: 33850490 PMCID: PMC8034781 DOI: 10.4103/wjnm.wjnm_49_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/04/2022] Open
Abstract
To evaluate treatment outcomes following radioactive iodine (RAI) treatment with a cumulative dose of ≥≥600 mCi in differentiated thyroid carcinoma (DTC) patients, a retrospective review of medical records was done in 176 DTC patients with a cumulative dose of ≥600 mCi from January 1993 to December 2013. All patients were followed up for at least 2 years after receiving 600 mCi of I-131 treatment. Remission criteria were no clinical and imaging evidence of disease and low serum thyroglobulin levels during thyroid-stimulating hormone suppression of <0.2 ng/ml or of <1 ng/ml after stimulation in the absence of interfering antibodies. A total of 176 patients were included in the study: 137 - papillary thyroid cancer, 29 - follicular thyroid cancer, 9 - mixed papillary and follicular thyroid cancer, and 1 - Hurthle cell carcinoma. Most of the patients (118, 67%) had locoregional metastasis, whereas 48 patients (27%) had distant metastases at presentation. The median cumulative dose was 900 mCi (range: 600-2200 mCi). The mean follow-up period was 82.84 ± 42.41 months. Only 16 patients (9.1%) met remission criteria at the end of treatment. The rest of patients (160, 90.9%) were not remitted: stable disease in 94 (53.4%), at least 1 metastasis without I-131 uptake in 34 (19.3%), progressive disease in 21 (11.9%), and death during the whole follow-up period in 11 (6.3%). Two patients (1.1%) developed second primary malignancy. Eighteen cases were suspected of bone marrow suppression (14 cases [7.9%] had anemia and 5 cases [2.8%] had neutropenia). Seven patients (3.9%) developed permanent salivary gland dysfunction. Although the complications after receiving RAI treatment with a cumulative dose of ≥≥600 mCi were low and not severe, the patients with remission were in <10%. Our study suggests that the decision to administer further treatments should be made on an individual basis because beneficial effects may be controversial.
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Affiliation(s)
- Chalermrat Kaewput
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawana Pusuwan
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Campennì A, Amato E, Laudicella R, Alibrandi A, Cardile D, Pignata SA, Trimarchi F, Ruggeri RM, Auditore L, Baldari S. Recombinant human thyrotropin (rhTSH) versus Levo-thyroxine withdrawal in radioiodine therapy of differentiated thyroid cancer patients: differences in abdominal absorbed dose. Endocrine 2019; 65:132-137. [PMID: 30875058 DOI: 10.1007/s12020-019-01897-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/07/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE In DTC patients, 131-radioiodine therapy has routinely been used for many years for thyroid remnant ablation after thyroid surgery. To date, two different strategies can be used to achieve sufficient TSH stimulation on thyroid remnant: (I) Levo-thyroxine withdrawal or (II) rhTSH stimulation. The aim of our study was to compare the abdominal absorbed dose ratio between differentiated thyroid cancer patients who underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. METHODS We reviewed the records of 63 patients affected by differentiated thyroid cancer. All patients underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. A post-therapy whole-body scan was obtained 5 days after 131-radioiodine therapy. Qualitative and quantitative image analysis was performed. Quantitative analysis was performed by drawing seven regions of interest on the abdomen (anterior and posterior views) to estimate both the activity ratio (AR) and absorbed dose ratio (DR) obtained in patients treated in hypothyroidism or after rhTSH stimulation. RESULTS The values of the activity and absorbed dose ratios obtained on each abdomen region (liver, stomach, ascending colon, transverse colon, descending colon, rectum, and small intestine) were always higher in patients treated after L-T4 withdrawal than after rhTSH stimulation with p-values of 0.000, 0.000, 0.001, 0.000, 0.022, 0.007, and 0.002, respectively. CONCLUSIONS DTC patients treated with 131-radioiodine after rhTSH stimulation have lower abdominal radioiodine activity than hypothyroid patients. Our data could be of practical relevance in terms of patient management. The potential impact on rare radioiodine-related gastrointestinal side effects is to be established in specifically designed prospective studies.
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Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Davide Cardile
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Salvatore Antonio Pignata
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Francesco Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Lucrezia Auditore
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
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8
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Hindié E, Récher C, Zerdoud S, Leenhardt L, Avram AM. Risk of Hematologic Malignancies After Radioactive Iodine Treatment of Thyroid Cancer: An Unjustified Warning. J Clin Oncol 2018; 36:1881-1882. [PMID: 29723097 DOI: 10.1200/jco.2018.78.1096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elif Hindié
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Christian Récher
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Slimane Zerdoud
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Laurence Leenhardt
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
| | - Anca M Avram
- Elif Hindié, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France; Christian Récher and Slimane Zerdoud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Laurence Leenhardt, Pitié Salpêtrière University Hospital, Paris, France; and Anca M. Avram, University of Michigan, Ann Arbor, MI
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9
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Zerdoud S, Leboulleux S, Clerc J, Leenhardt L, Bournaud C, Al Ghuzlan A, Keller I, Bardet S, Giraudet AL, Groussin L, Sebag F, Garrel R, Lamy PJ, Toubert ME, Mirallié É, Hindié E, Taïeb D. Traitement par iode 131 des cancers thyroïdiens différenciés : recommandations 2017 des sociétés françaises SFMN/SFE/SFP/SFBC/AFCE/SFORL. MEDECINE NUCLEAIRE-IMAGERIE FONCTIONNELLE ET METABOLIQUE 2017. [DOI: 10.1016/j.mednuc.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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10
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Nielsen SM, White MG, Hong S, Aschebrook-Kilfoy B, Kaplan EL, Angelos P, Kulkarni SA, Olopade OI, Grogan RH. The Breast-Thyroid Cancer Link: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2016; 25:231-8. [PMID: 26908594 DOI: 10.1158/1055-9965.epi-15-0833] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rates of thyroid cancer in women with a history of breast cancer are higher than expected. Similarly, rates of breast cancer in those with a history of thyroid cancer are increased. Explanations for these associations include detection bias, shared hormonal risk factors, treatment effect, and genetic susceptibility. With increasing numbers of breast and thyroid cancer survivors, clinicians should be particularly cognizant of this association. Here, we perform a systematic review and meta-analysis of the literature utilizing PubMed and Scopus search engines to identify all publications studying the incidence of breast cancer as a secondary malignancy following a diagnosis of thyroid cancer or thyroid cancer following a diagnosis of breast cancer. This demonstrated an increased risk of thyroid cancer as a secondary malignancy following breast cancer [OR = 1.55; 95% confidence interval (CI), 1.44-1.67] and an increased risk of breast cancer as a secondary malignancy following thyroid cancer (OR = 1.18; 95% CI, 1.09-1.26). There is a clear increase in the odds of developing either thyroid or breast cancer as a secondary malignancy after diagnosis with the other. Here, we review this association and current hypothesis as to the cause of this correlation.
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Affiliation(s)
- Sarah M Nielsen
- Department of Medicine, Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois
| | - Michael G White
- Endocrine Surgery Research Program, Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Susan Hong
- Breast Cancer Survivorship Program, Center for Clinical Cancer Genetics and Global Health, Department of Medicine, The University of Chicago, Chicago, Illinois
| | | | - Edwin L Kaplan
- Endocrine Surgery Research Program, Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Peter Angelos
- Endocrine Surgery Research Program, Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Swati A Kulkarni
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Olufunmilayo I Olopade
- Department of Medicine, Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, Illinois
| | - Raymon H Grogan
- Endocrine Surgery Research Program, Department of Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois.
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11
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Padovani RP, Tuttle RM, Grewal R, Larson SM, Boucai L. Complete blood counts are frequently abnormal 1 year after dosimetry-guided radioactive iodine therapy for metastatic thyroid cancer. Endocr Pract 2016; 20:213-20. [PMID: 24126230 DOI: 10.4158/ep13172.or] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) has been associated with hematologic abnormalities. Previous research has shown that even a single dose of RAI can cause changes in the peripheral complete blood count (CBC). It is unclear if the use of dosimetry guidance would prevent the effects of high doses of RAI on bone marrow suppression. METHODS CBC at baseline was compared to a CBC obtained 1 year after the last RAI treatment in 50 thyroid cancer patients that received ≥250 mCi RAI during the course of their disease. Cumulative dose, number of treatments, patients' age, and the use of external beam radiation therapy (EBRT) were considered in the analysis. RESULTS We observed a small but statistically significant decrease in hemoglobin (Hb), hematocrit (Hct), and platelet (Plt) counts at 1 year in 50 patients who had received ≥250 mCi RAI. We did not find a significant change in white blood cell count (WBC). Approximately 60% of patients who developed anemia had concomitant WBC and Plt abnormalities. RAI dose, number of treatments, and age at diagnosis did not confer a higher risk of bone marrow suppression. CONCLUSION High cumulative activities of RAI administered under dosimetric guidance are associated with a small but statistically significant decreases in Hb, Hct, and Plt counts. The clinical implications of these changes, if any, are unclear. The benefits obtained with high doses of RAI, when indicated, are likely to outweigh the minimal hematologic risks observed in the present study.
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Affiliation(s)
| | - R Michael Tuttle
- Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ravinder Grewal
- Nuclear Medicine Services, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Steve M Larson
- Nuclear Medicine Services, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Endocrinology, Memorial Sloan-Kettering Cancer Center, New York, New York
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Hirsch D, Shohat T, Gorshtein A, Robenshtok E, Shimon I, Benbassat C. Incidence of Nonthyroidal Primary Malignancy and the Association with (131)I Treatment in Patients with Differentiated Thyroid Cancer. Thyroid 2016; 26:1110-6. [PMID: 27302111 DOI: 10.1089/thy.2016.0037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The occurrence of nonthyroidal primary malignancy (NTPM) and the potential association of with radioiodine (RAI) treatment are important concerns in patients with differentiated thyroid cancer (DTC), but incidence data are conflicting. The aims of the present study were to investigate the incidence of NTPM and its association with RAI treatment in a cohort of DTC patients treated at a single tertiary medical center. METHODS The data of 1943 patients with DTC recorded in the Rabin Medical Center Thyroid Cancer Registry were cross-matched with data from the Israeli National Cancer Registry to identify those diagnosed with an NTPM. Patient medical files were reviewed. Second primary malignancy (SPM) was defined as new malignancy diagnosed at least two years after DTC diagnosis. RESULTS For 1434 of the 1943 patients (73.8%), the American Joint Committee on Cancer TNM stage was 1-2. The mean follow-up was 9.3 years. Of the 1943 patients, 1574 (81%) were treated with RAI, and 1467 were followed for at least 2 years, and of these, 1145 patients (78%) received a cumulative dose of ≤200 mCi. A total of 409 NTPMs were diagnosed in 368/1943 patients with DTC (18.9%; 265 female, mean age 53.9 ± 15 years), including 173 SPMs (42.3%) in 166/368 patients. The most common NTPM and SPM was breast cancer followed by hematologic malignancies. In patients followed for ≥2 years, SPMs were diagnosed in 9% of RAI-treated patients and 10.5% of non-RAI-treated patients. SPM rates were 10.2% and 7.8% for a cumulative RAI dose of ≤100 mCi and >100 mCi respectively. Hazard ratios for SPM in patients that received/did not receive RAI treatment was 1.27 (95% confidence interval 0.88-1.82; p = 0.1). There was no correlation between first or cumulative RAI dose and diagnosis of SPM. CONCLUSIONS NTPMs are not uncommon in patients with DTC and usually antecede the DTC. In a population of mostly low-risk DTC patients, in whom limited activities of RAI are usually administered, this treatment is apparently not associated with an overall increased risk of SPMs compared with subjects not receiving RAI treatment.
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Affiliation(s)
- Dania Hirsch
- 1 Institute of Endocrinology , Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Tzippy Shohat
- 3 Statistics Unit , Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Alex Gorshtein
- 1 Institute of Endocrinology , Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eyal Robenshtok
- 1 Institute of Endocrinology , Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Ilan Shimon
- 1 Institute of Endocrinology , Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Carlos Benbassat
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
- 4 Endocrine Institute , Assaf Harofeh Medical Center, Zerifin, Israel
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Bhattacharyya N, Chien W. Risk of Second Primary Malignancy after Radioactive Iodine Treatment for Differentiated Thyroid Carcinoma. Ann Otol Rhinol Laryngol 2016; 115:607-10. [PMID: 16944659 DOI: 10.1177/000348940611500806] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The association between second primary malignancy (SPM) and radioactive iodine (RAI) is controversial. We examined the association between RAI and SPM after treatment of differentiated thyroid carcinoma (DTC) using a large cohort from a national cancer database. Methods: From the Surveillance, Epidemiology and End Results (SEER) database, all index cases of DTC (papillary or follicular) were extracted for the years 1988 to 2001. Two cohorts were constructed: 1) patients with DTC who were not treated with RAI, and 2) patients with DTC who were treated with RAI. For each cohort, we tabulated all subsequent malignancies for each patient, identifying patients in each group with 1 or more SPMs. Results: According to inclusion criteria, 18,882 cases of DTC treated without RAI (mean follow-up, 55.5 months) and 10,349 cases treated with RAI (mean follow-up, 61.8 months) were identified. The most common SPM sites were breast or prostate followed by colon or lung for both groups. On univariate analysis, SPMs developed in 6.7% of patients without RAI versus 4.8% of those with RAI (p > .001, univariate χ2). However, on multivariate analysis, only age and male gender had statistically significant hazard ratios (1.052 and 1.438, respectively; p > .001); follicular carcinoma histology and use of RAI did not influence occurrence of SPM after DTC (p = .180 and p = .789, respectively). Conclusions: Use of RAI does not elevate the risk of SPM. Concern about SPM induction should not adversely affect the decision to administer RAI for DTC.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts 02115, USA
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Souza MCD, Momesso DP, Vaisman F, Vieira Neto L, Martins RAG, Corbo R, Vaisman M. Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:9-15. [PMID: 26222230 PMCID: PMC10118921 DOI: 10.1590/2359-3997000000078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. MATERIALS AND METHODS Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. RESULTS During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received RAI-131 treatment (0.96 vs . 0.87; p = 0.06), what was not affected by age at DTC diagnosis. CONCLUSION In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors.
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Affiliation(s)
| | | | - Fernanda Vaisman
- Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional do Cancer, Brazil
| | | | | | - Rossana Corbo
- Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional do Cancer, Brazil
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ACR Practice Parameter for the Performance of Therapy With Unsealed Radiopharmaceutical Sources. Clin Nucl Med 2016; 41:106-17. [DOI: 10.1097/rlu.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Teng CJ, Hu YW, Chen SC, Yeh CM, Chiang HL, Chen TJ, Liu CJ. Use of Radioactive Iodine for Thyroid Cancer and Risk of Second Primary Malignancy: A Nationwide Population-Based Study. J Natl Cancer Inst 2015; 108:djv314. [DOI: 10.1093/jnci/djv314] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 10/01/2015] [Indexed: 11/12/2022] Open
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 714] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Shafaghati N, Hedayati M, Hosseinimehr SJ. Protective effects of curcumin against genotoxicity induced by 131-iodine in human cultured lymphocyte cells. Pharmacogn Mag 2014; 10:106-10. [PMID: 24914274 PMCID: PMC4048555 DOI: 10.4103/0973-1296.131020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/15/2013] [Accepted: 04/17/2014] [Indexed: 01/10/2023] Open
Abstract
Background: 131-radioiodine has been widely used as an effective radionuclide for treatment of patients with thyroid diseases. The purpose of the present study is to investigate the radioprotective effects of curcumin as a natural product that protects against the genotoxic effects of 131I in human cultured lymphocytes. Materials and Methods: Whole blood samples from human volunteers were incubated with curcumin at doses of 5, 10, and 50 μg/mL. After 1-hour incubation, the lymphocytes were incubated with 131I (100 μCi/1.5 ml) for 2 hours. The lymphocyte cultures were then mitogenically stimulated to allow for evaluation of the number of micronuclei in cytokinesis-blocked binucleated cells. Results: Incubation of lymphocytes with 131I at dose 100 μCi/1.5 mL induced genotoxicity shown by increase in micronuclei frequency in human lymphocytes. Curcumin at 5, 10, and 50 μg/mL doses significantly reduced the micronuclei frequency. Maximal protective effects and greatest decrease in micronuclei frequency were observed when whole blood was incubated with 50 μg/mL dose of curcumin with 52%. Conclusion: This study has important implications for patients undergoing 131I therapy. Our results indicate a protective role for curcumin against the genetic damage and side effects induced by 131I administration.
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Affiliation(s)
- Nayereh Shafaghati
- Department of Radiopharmacy, Faculty of Pharmacy and Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Monireh Hedayati
- Department of Radiopharmacy, Faculty of Pharmacy and Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy and Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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19
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Genotoxicity induced by iodine-131 in human cultured lymphocytes. Interdiscip Toxicol 2013; 6:74-6. [PMID: 24179432 PMCID: PMC3798859 DOI: 10.2478/intox-2013-0013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 11/20/2022] Open
Abstract
131-radioiodine has been widely used as an effective radionuclide for treatment of patients with thyroid diseases. The purpose of this study was to investigate the genotoxic effects of iodine-131 in human cultured lymphocytes. Whole blood samples from human volunteers were incubated with iodine-131 (10, 50, 100 µCi/1.5ml) for 2 h. The lymphocytes were mitogenically stimulated to allow for evaluation of the number of micronuclei in cytokinesis-blocked binucleated cells. At the dose 100 µCi, iodine-131 induced genotoxicity by an 8.5 fold increase in the frequency of micronuclei in human lymphocytes compared with the control group.
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Noaparast Z, Hosseinimehr SJ. Radioprotective agents for the prevention of side effects induced by radioiodine-131 therapy. Future Oncol 2013; 9:1145-59. [DOI: 10.2217/fon.13.79] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Radioiodine 131 (131I) has been used worldwide for the ablation of remnant thyroidal tissue after surgery or as the first-line treatment for Graves’ disease. Although the use of 131I is becoming increasingly prevalent, there is evidence suggesting that this treatment is associated with side effects such as salivary gland dysfunction and an increased risk of leukemia. This article aims to review the potential use of radioprotective agents and the side effects induced by 131I therapy. Several synthetic and natural compounds have been investigated in preclinical and clinical studies. The protective agents reduced the toxicity of 131I, mainly in the salivary glands, and mitigated the genetic damage through different mechanisms. There are limited clinical studies evaluating the use of radioprotective agents in patients undergoing radioiodine therapy. However, lemon candies, lemon juice and sugarless chewing gum have been proposed to be beneficial for minimizing the side effects of radioiodine within the salivary glands.
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Affiliation(s)
- Zohreh Noaparast
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Welsh L, Powell C, Pratt B, Harrington K, Nutting C, Harmer C, Newbold K. Long-term outcomes following low-dose radioiodide ablation for differentiated thyroid cancer. J Clin Endocrinol Metab 2013; 98:1819-25. [PMID: 23493434 DOI: 10.1210/jc.2013-1197] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Randomized trials show that low-dose (1.1 GBq [30 mCi]) radioiodide (RAI) has efficacy equivalent to high-dose RAI (3.7 GBq [100 mCi]) in thyroid remnant ablation (TRA) for differentiated thyroid cancer. Long-term follow-up is required to ensure detection of late recurrences and to confirm equivalence in terms of survival end points. However, median follow-up duration within randomized trials is currently limited. PATIENTS AND SETTING We studied 53 patients undergoing TRA for differentiated thyroid cancer with long-term follow-up in the Thyroid Unit of The Royal Marsden Hospital (Sutton, United Kingdom). INTERVENTION Patients were treated with TRA using low-dose (1.1 GBq) RAI. MAIN OUTCOME MEASURES Disease-free survival, overall survival, and the incidence of second malignancies were measured. Multivariable analysis was used to determine clinical risk factors for failure to achieve TRA after low-dose RAI. RESULTS Median follow-up was 24 (range, 4-34) years. Low-dose RAI TRA was successful in 26 (49%) patients (successful ablation [SA] group), whereas 27 (51%) patients required further treatment (unsuccessful ablation [UA] group). Thirty-year disease-free survival was 92% in the SA group vs 87% in the UA group (P = .601). Thirty-year overall survival was 81% in the SA group vs 62% in the UA group (P = .154). Nine (17%) patients developed second malignancies (4 in the SA group and 5 in the UA group). Predictors of failure to achieve TRA with low-dose RAI were male sex and stage pT4 disease. CONCLUSIONS There is no evidence from long-term follow-up of our cohort that treatment outcomes are compromised for patients that fail TRA with low-dose RAI and subsequently receive high-dose RAI.
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Affiliation(s)
- Liam Welsh
- Thyroid Unit, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
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22
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Hedayati M, Shafaghati N, Hosseinimehr SJ. Resveratrol mitigates genotoxicity induced by iodine-131 in primary human lymphocytes. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2013; 52:287-291. [PMID: 23435954 DOI: 10.1007/s00411-013-0461-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 02/06/2013] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to investigate the radioprotective effects of resveratrol as a natural product that protects against genotoxic actions of (131)I in cultured human lymphocytes. Whole-blood samples from human volunteers were treated with resveratrol at doses of 0.5, 1, 5, and 50 μg/mL for 1 h, after which the lymphocytes were incubated with (131)I (100 μCi/1.5 mL) for 2 h. The lymphocyte cultures were then mitogenically stimulated to enable evaluation of the number of micronuclei in cytokinesis-blocked binucleated cells. Incubation of lymphocytes with (131)I induced genotoxicity, which was reflected by an increase in micronuclei frequency. At the doses tested, resveratrol significantly reduced micronuclei frequency. Maximal protective effects occurred at a dose of 1 μg/mL, with total micronuclei values being reduced by 65 % compared to controls. In conclusion, our results indicate protective effects of resveratrol at low doses against genetic damage and adverse effects induced by (131)I administration.
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Affiliation(s)
- Monireh Hedayati
- Department of Radiopharmacy, Faculty of Pharmacy and Pharmaceutical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Stone MB, Stanford JB, Lyon JL, VanDerslice JA, Alder SC. Childhood thyroid radioiodine exposure and subsequent infertility in the intermountain fallout cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:79-84. [PMID: 23099433 PMCID: PMC3553427 DOI: 10.1289/ehp.1104231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/24/2012] [Indexed: 05/15/2023]
Abstract
BACKGROUND Above-ground and underground nuclear weapon detonation at the Nevada Test Site (1951-1992) has resulted in radioiodine exposure for nearby populations. Although the long-term effect of environmental radioiodine exposure on thyroid disease has been well studied, little is known regarding the effect of childhood radioiodine exposure on subsequent fertility. OBJECTIVES We investigated early childhood thyroid radiation exposure from nuclear testing fallout (supplied predominantly by radioactive isotopes of iodine) and self-reported lifetime incidence of male or female infertility or sterility. METHODS Participants were members of the 1965 Intermountain Fallout Cohort, schoolchildren at the time of exposure who were reexamined during two subsequent study phases to collect dietary and reproductive histories. Thyroid radiation exposure was calculated via an updated dosimetry model. We used multivariable logistic regression with robust sandwich estimators to estimate odds ratios for infertility, adjusted for potential confounders and (in separate models) for a medically confirmed history of thyroid disease. RESULTS Of 1,389 participants with dosimetry and known fertility history, 274 were classified as infertile, including 30 classified as sterile. Childhood thyroid radiation dose was possibly associated with infertility [adjusted odds ratio (AOR) = 1.17; 95% CI: 0.82, 1.67 and AOR = 1.35; 95% CI: 0.96, 1.90 for the middle and upper tertiles vs. the first tertile of exposure, respectively]. The odds ratios were attenuated (AOR = 1.08; 95% CI: 0.75, 1.55 and AOR = 1.29; 95% CI: 0.91, 1.83 for the middle and upper tertiles, respectively) after adjusting for thyroid disease. There was no association of childhood radiation dose and sterility. CONCLUSION Our findings suggest that childhood radioiodine exposure from nuclear testing may be related to subsequent adult infertility. Further research is required to confirm this.
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Affiliation(s)
- Mary Bishop Stone
- University of Utah Department of Family and Preventive Medicine, Salt Lake City, Utah 84108, USA
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24
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Patel SS, Goldfarb M. Well-differentiated thyroid carcinoma: The role of post-operative radioactive iodine administration. J Surg Oncol 2012. [DOI: 10.1002/jso.23295] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Differentiated thyroid cancer: management of patients with radioiodine nonresponsive disease. J Thyroid Res 2012; 2012:618985. [PMID: 22530159 PMCID: PMC3316972 DOI: 10.1155/2012/618985] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 01/03/2023] Open
Abstract
Differentiated thyroid carcinoma (papillary and follicular) has a favorable prognosis with an 85% 10-year survival. The patients that recur often require surgery and further radioactive iodine to render them disease-free. Five percent of thyroid cancer patients, however, will eventually succumb to their disease. Metastatic thyroid cancer is treated with radioactive iodine if the metastases are radioiodine avid. Cytotoxic chemotherapies for advanced or metastatic noniodine avid thyroid cancers show no prolonged responses and in general have fallen out of favor. Novel targeted therapies have recently been discovered that have given rise to clinical trials for thyroid cancer. Newer aberrations in molecular pathways and oncogenic mutations in thyroid cancer together with the role of angiogenesis in tumor growth have been central to these discoveries. This paper will focus on the management and treatment of metastatic differentiated thyroid cancers that do not take up radioactive iodine.
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Tratamiento supresor de la TSH en el cáncer diferenciado de tiroides. Un dogma en revisión. ACTA ACUST UNITED AC 2012; 59:125-30. [DOI: 10.1016/j.endonu.2011.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/14/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
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Lin JD, Lin KJ, Chao TC, Hseuh C, Tsang NM, Huang BY. Clinical presentations of thyroid cancer patients with multiple primary cancers. J Endocrinol Invest 2011; 34:824-30. [PMID: 21613811 DOI: 10.3275/7747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In thyroid cancer patients with multiple primary cancers, primary cancers tend to be more aggressive. AIMS We analyzed multiple primary cancers in thyroid cancer patients and determined the differences between the incidence and the characteristics of primary cancers. MATERIALS AND METHODS A total of 3070 patients with thyroid cancer underwent a thyroidectomy and follow-up examination at a single medical center. The times of diagnosis of the primary cancers were categorized as antecedent, synchronous, or subsequent to the diagnosis of thyroid cancer. RESULTS After a mean follow-up period of 8.8 ± 0.5 yr, the presence of multiple primary cancers was histopathologically confirmed in 163 patients (5.3%). Patients with multiple primary cancers had a lower female-to-male ratio, an older mean age, advanced tumor-node-metastasis (TNM) stage, higher total mortality, and higher therapeutic radioactive iodide (131I) doses than patients without multiple primary cancers. Hematological malignancy and renal cell carcinoma, neither of which are among the 10 most common cancers observed in the general population of Taiwan, were the most common multiple cancers among women and men with thyroid cancer. Patient age, thyroid cancer tumor size, and thyroid cancer mortality in the antecedent, synchronous, and subsequent groups were not significantly different. CONCLUSIONS Patients with multiple primary cancers in advanced stages had shorter disease-free survival period after treatment. Thyroid cancer patients with multiple primary cancers should be closely followed up for the occurrence of other secondary cancers in order to improve total mortality.
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Affiliation(s)
- J D Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin St Kweishan county, Taoyuan Hsien, Taiwan, Republic of China.
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Klubo-Gwiezdzinska J, Van Nostrand D, Burman KD, Vasko V, Chia S, Deng T, Kulkarni K, Wartofsky L. Salivary gland malignancy and radioiodine therapy for thyroid cancer. Thyroid 2010; 20:647-51. [PMID: 20470209 DOI: 10.1089/thy.2009.0466] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The risk of second primary malignancies in patients with well-differentiated thyroid cancer is of special interest because of the common use of radioactive iodine (RAI) ablation and/or treatment of these patients and the theoretical risk of subsequent nonthyroid malignancies associated with the radiation exposure. This brief report focuses specifically on the occurrence of second primary malignancies of the salivary glands. RAI residency within salivary tissues is known to have both acute and chronic consequences on salivary function, but secondary neoplasia is quite unusual. SUMMARY We present a very rare case of a patient with papillary thyroid cancer treated with 600 mCi of RAI, who subsequently developed salivary gland cancer. CONCLUSIONS We recommend salivary gland protection to diminish potential side effects after the exposure to radioiodine. On the basis of our experience we suggest administration of sialogogues (such as lemon juice) continuously, every 30-60 minutes for 24 hours, after RAI administration.
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Affiliation(s)
- Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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30
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Gregoire O, Cleland MR. Novel approach to analyzing the carcinogenic effect of ionizing radiations. Int J Radiat Biol 2009; 82:13-9. [PMID: 16546899 DOI: 10.1080/09553000600567624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Cancer incidence of ionizing radiations exposure is considered to be proportional to the absorbed dose. However, there are disagreements between substantial amounts of epidemiological studies. In this study, we question the basic relationship of the risk estimate with total accumulated dose, and reanalyse available data on the basis of a daily dose concept. MATERIALS AND METHODS The data analysed were relative mortality risk from all cancers vs. total-body dose on a daily basis. References have been selected on the basis of objective criteria. RESULTS We found that this relationship removes major discrepancies. It revises estimates of low-level exposures, with consequences regarding nuclear power plants safety, wastes management, medical applications or homeland security. CONCLUSIONS The idea that the dose rate may have a significant impact on health effects of ionizing radiations is not new, but has always been considered as a parameter in models based on integrated dose. The novel approach in this paper is to consider the primary relevant parameter as an average of dose rate over a time period of one day. This is an argument to revise the whole philosophy in radioprotection, and place regulatory limits on specific locations instead of annual limits relevant to individual persons.
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Ma C, Kuang A, Xie J. Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. Cochrane Database Syst Rev 2009; 2009:CD006988. [PMID: 19160311 PMCID: PMC7212000 DOI: 10.1002/14651858.cd006988.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases has been observed in follow-up studies. The management of this condition remains controversial. Most studies support blind radioactive iodine treatment while others negate this approach. OBJECTIVES To assess the effects of radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. SEARCH STRATEGY Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese. SELECTION CRITERIA Randomised controlled clinical trials and prospective controlled clinical trials. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and interviewed authors of all potentially relevant studies by electronic mail to verify randomisation procedures. One author entered data into a data extraction form and the second one verified the results of this procedure. MAIN RESULTS Because of the absence of any suitable randomised or prospective controlled trial in this area, results currently cannot be presented. AUTHORS' CONCLUSIONS The currently available evidence is insufficient to reliably assess the potential of radioiodine treatment for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases.
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Affiliation(s)
- Chao Ma
- Department of Nuclear Medicine, Affiliated Hospital of Medical College Qingdao University, Jiangsu Road 16, Qingdao, Shandong Province, China, 266003.
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Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJG, Tennvall J, Bombardieri E. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2009; 35:1941-59. [PMID: 18670773 DOI: 10.1007/s00259-008-0883-1] [Citation(s) in RCA: 412] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of the present guidelines on the radioiodine therapy (RAIT) of differentiated thyroid cancer (DTC) formulated by the European Association of Nuclear Medicine (EANM) Therapy Committee is to provide advice to nuclear medicine clinicians and other members of the DTC-treating community on how to ablate thyroid remnant or treat inoperable advanced DTC or both employing large 131-iodine ((131)I) activities. DISCUSSION For this purpose, recommendations have been formulated based on recent literature and expert opinion regarding the rationale, indications and contraindications for these procedures, as well as the radioiodine activities and the administration and patient preparation techniques to be used. Recommendations also are provided on pre-RAIT history and examinations, patient counselling and precautions that should be associated with (131)I iodine ablation and treatment. Furthermore, potential side effects of radioiodine therapy and alternate or additional treatments to this modality are reviewed. Appendices furnish information on dosimetry and post-therapy scintigraphy.
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Affiliation(s)
- M Luster
- Department of Nuclear Medicine, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
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Omür O, Ozcan Z, Yazici B, Akgün A, Oral A, Ozkiliç H. Multiple primary tumors in differentiated thyroid carcinoma and relationship to thyroid cancer outcome. Endocr J 2008; 55:365-72. [PMID: 18277003 DOI: 10.1507/endocrj.k07e-058] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM Patients with differentiated thyroid carcinoma (DTC) have long-life expectancy and are at risk for developing a second primary cancer. Aim of this study was to assess the occurrence of DTC in conjunction with other primary neoplasms. It was also aimed to explore the possibility of synchronous or metachronous other malignancies having an impact on clinical course of thyroid carcinoma. MATERIAL & METHODS Clinical records of 1680 DTC patients treated and followed in our institution over last twenty years were reviewed. Forty-five second primary tumors were found in 42 patients. These patients were classified into 3 groups as antecedent (group I), synchronous (group II) or subsequent (group III) according to the timing of occurrence of non-thyroidal malignancy. The initial characteristics of thyroid neoplasm were compared between patients with DTC plus another tumor and DTC only. Kaplan-Meier Survival Analysis was used to estimate the survival probability for patients with DTC alone and DTC plus another primary tumor. RESULTS There were 15 synchronous and 30 metachronous tumors in 42 patients. Three of them had triple tumors. The most common second primary was lympho-haematological and upper aero digestive system tumors in group I and II respectively, whereas a variety of tumors were noted in group III. Despite the more common occurrence of unfavourable prognostic factors in patients with multiple cancers than thyroid cancer alone, complete response to radioiodine therapy and recurrence free survival rate was similar in both groups (p>0.05). CONCLUSION The results of the current series imply that the occurrence of multiple primary tumors is not uncommon in patients with DTC. Close medical surveillance and the use of advanced screening modalities might lead to the detection of second primary tumors in DTC. However, the presence of second primary seems not to affect the clinical course of DTC.
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Affiliation(s)
- Ozgür Omür
- Ege University, Medical Faculty, Department of Nuclear Medicine, Izmir, Turkey
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Brown AP, Chen J, Hitchcock YJ, Szabo A, Shrieve DC, Tward JD. The risk of second primary malignancies up to three decades after the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab 2008; 93:504-15. [PMID: 18029468 DOI: 10.1210/jc.2007-1154] [Citation(s) in RCA: 271] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The 10-yr survival rate of patients with differentiated thyroid cancer exceeds 90%. These patients may be at elevated risk for secondary cancers. METHODS The risk of nonthyroid second primary malignancies after differentiated thyroid cancer was determined in 30,278 patients diagnosed between 1973 and 2002 from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Median follow-up was 103 months (range, 2-359 months). Risk was further assessed for the addition of radioisotope therapy, gender, latency to development of secondary cancer, and age at thyroid cancer diagnosis. RESULTS There were 2158 patients who developed a total of 2338 nonthyroid second primary malignancies, significantly more than that expected in the general population [observed/expected (O/E) = 1.09; 95% confidence interval (CI), 1.05-1.14; P < 0.05; absolute excess risk per 10,000 person-years (AER) = 6.39]. A significantly greater risk of second primary malignancies over that expected in the general population was for patients treated with radioisotopes (O/E = 1.20; 95% CI, 1.07-1.33; AER = 11.8) as well as for unirradiated patients (O/E = 1.05; 95% CI, 1.00-1.10; AER = 3.53). However, the increased risk was greater for the irradiated vs. the unirradiated cohort (relative risk = 1.16; 95% CI, 1.05-1.27; P < 0.05). Gender did not affect risk. The greatest risk of second primary cancers occurred within 5 yr of diagnosis and was elevated for younger patients. CONCLUSIONS The overall risk of second primary malignancies is increased for thyroid cancer survivors and varies by radioisotope therapy, latency, and age at diagnosis.
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Affiliation(s)
- Aaron P Brown
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Salt Lake City, Utah 84112-5560, USA
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Subramanian S, Goldstein DP, Parlea L, Thabane L, Ezzat S, Ibrahim-Zada I, Straus S, Brierley JD, Tsang RW, Gafni A, Rotstein L, Sawka AM. Second primary malignancy risk in thyroid cancer survivors: a systematic review and meta-analysis. Thyroid 2007; 17:1277-88. [PMID: 18020916 DOI: 10.1089/thy.2007.0171] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk of second primary malignancies (SPMs) in thyroid cancer survivors. DESIGN We performed a systematic review and meta-analysis examining the standardized incidence ratios (SIRs) of SPMs in thyroid cancer survivors (compared to individuals without thyroid cancer). Two independent reviewers screened citations and reviewed all full-text papers deemed potentially relevant. Final consensus was reached on inclusion of papers in the review. Data were pooled using fixed effects models. MAIN OUTCOMES Thirteen full-text papers were included. The incidence of SPMs in thyroid cancer survivors was increased with an SIR of 1.20 (95% confidence interval 1.17, 1.24) (based on pooled data from six studies of 70,844 thyroid cancer survivors). The SIR of the following SPMs was significantly increased: salivary gland, stomach, colon/colorectal, breast, prostate, kidney, brain/central nervous system, soft tissue sarcoma, non-Hodgkin's lymphoma, multiple myeloma, leukemia, bone/joints, and adrenal. A significantly reduced risk of lung and cervical cancers was observed. CONCLUSIONS Thyroid cancer survivors are at increased risk of SPMs, which may be related to disease-specific treatments or genetic predisposition.
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Abstract
Two patients with papillary thyroid cancer were seen in consultation after they had been treated in other medical centers. Their cancers measured 1 and 1.2 mm, respectively. Both patients were treated by two thyroid operations and (131)I ablation. We believe that, apart from lobectomy, these therapies were not justified. We draw attention to this to provide a topic for debate and to attempt to prevent this happening to other patients.
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Affiliation(s)
- I Ross McDougall
- Division of Nuclear Medicine and Molecular Imaging Program at Stanford, Department of Radiology, Stanford University Hospital and Clinics, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Silver SR, Hiratzka SL, Schubauer-Berigan MK, Daniels RD. Chronic lymphocytic leukemia radiogenicity: a systematic review. Cancer Causes Control 2007; 18:1077-93. [PMID: 17694421 DOI: 10.1007/s10552-007-9048-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Accepted: 07/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic lymphocytic leukemia (CLL) is generally considered to be non-radiogenic and is excluded from several programs that compensate workers for illnesses resulting from occupational exposures. Questions about whether this exclusion is justified prompted a Congressional mandate to the National Institute for Occupational Safety and Health (NIOSH) to, further, examine the radiogenicity of CLL. This study revisits the question of CLL radiogenicity by examining epidemiologic evidence from occupationally and medically-exposed populations. METHODS A systematic review of radiation-exposed cohorts was conducted to investigate the association between radiation and CLL. Exploratory power calculations for a pooled occupational study were performed to examine the feasibility of assessing CLL radiogenicity epidemiologically. RESULTS There is a bias against reporting CLL results, because of the disease's presumed non-radiogenicity. In medical cohort studies that provide risk estimates for CLL, risk is elevated, though non-significantly, in almost all studies with more than 15 years average follow-up. The results of occupational studies are less consistent. CONCLUSIONS Studies with adequate follow-up time and power are needed to better understand CLL radiogenicity. Power analyses show that a pooled study might detect risk on the order of radiation induced non-CLL leukemia, but is unlikely to detect smaller risks.
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Affiliation(s)
- Sharon R Silver
- Division of Surveillance, Hazard Evaluations, and Field Studies (DSHEFS), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH, USA.
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Consenso europeo para el tratamiento de los pacientes con carcinoma tiroideo diferenciado del epitelio folicular. ENDOCRINOLOGÍA Y NUTRICIÓN 2007. [DOI: 10.1016/s1575-0922(07)71468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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McDougall IR, Hay ID. ATA Guidelines: do patients with stage I thyroid cancer benefit from (131)I? Thyroid 2007; 17:595-6; author reply 596-7. [PMID: 17614785 DOI: 10.1089/thy.2007.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gutiérrez Cardo A, Rodríguez Rodríguez J, Borrego Dorado I, Navarro González E, Tirado Hospital J, Vázquez Albertino R. Pacientes tratados por carcinoma diferenciado de tiroides con rastreos de 131I negativos y niveles de tiroglobulina elevada. Una evolución posible. ACTA ACUST UNITED AC 2007. [DOI: 10.1157/13102483] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gutiérrez Cardo A, Rodríguez Rodríguez J, Borrego Dorado I, Navarro González E, Tirado Hospital J, Vázquez Albertino R. Patients treated for differentiated thyroid cancer with negative 131I whole-body scanning and elevated thyroglobulin levels. A possible course. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1578-200x(07)70054-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Weigel RJ, McDougall IR. The Role of Radioactive Iodine in the Treatment of Well-differentiated Thyroid Cancer. Surg Oncol Clin N Am 2006; 15:625-38. [PMID: 16882501 DOI: 10.1016/j.soc.2006.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The prognosis in differentiated thyroid cancer is excellent. The completeness of thyroidectomy and removal of involved regional metastases are the most important elements of management. Iodine 131 has a role in ablating residual thyroid and treating regional and distant metastases. The effectiveness of the treatment is confirmed by negative follow-up scans and low or undetectable Tg. This therapy is relatively specific, but other tissues can receive meaningful doses of radiation and acute and long-term complications can occur. Therefore, whether the patient will have a better prognosis after treatment with 131I and whether the benefits of treatment are greater than the side effects must be determined for every patient.
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Affiliation(s)
- Ronald J Weigel
- Department of Surgery, University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Room 1516 JCP, Iowa City, IA 52242-1086, USA.
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Lee SH, Eom KS, Lee S, Kim HJ, Min CK, Kim SY, Cho BS, Lee H, Park CK, Cho SG, Kim DW, Lee JW, Min WS, Kim CC. A Case of Acute Promyelocytic Leukemia after Iodine-131 Treatment for Thyroid Cancer. THE KOREAN JOURNAL OF HEMATOLOGY 2006. [DOI: 10.5045/kjh.2006.41.4.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sang Hun Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Ki Seong Eom
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Hee-Je Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Chang-Ki Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Sung Yong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Byung Sik Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Hyuk Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Chan-Kwon Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Seok-Goo Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Dong-Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Jong-Wook Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Woo-Sung Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
| | - Chun Choo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
- Catholic HSCT Center, Seoul, Korea
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Rosário PWS, Cardoso LD, Barroso AL, Padrão EL, Rezende LL, Purisch S. [Safety of radioiodine therapy in patients with thyroid carcinoma younger than 21 years]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2005; 49:241-5. [PMID: 16184252 DOI: 10.1590/s0004-27302005000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We studied 20 patients with differentiated thyroid carcinoma undergoing radioiodine therapy (> or = 100 mCi dose) before the age of 21: 10 patients without distant metastases received a mean dose of 145 mCi and 10 with lung involvement received 270 mCi. One or more years after ablative therapy, xerostomia was present in two patients but was not accompanied by more severe complications such as oral ulcers or fissures, and 99mTcO4- scintigraphy confirmed salivary dysfunction. One patient showed keratoconjunctivitis sicca. Blood counts did not reveal abnormalities caused by radioiodine therapy. FSH was normal in 18 patients. Patients with elevated levels had received radioiodine just over a year ago and repetition of the exam after 6 months showed that FSH had returned to normal. The 6 male patients had normal LH and testosterone levels. Analysis did not reveal signs of pulmonary fibrosis secondary to treatment in the 10 cases with iodine-accumulating metastases in this organ. Our data suggest that ablative therapy employing a dose of 100 to 300 mCi is safe in young individuals, but persistent complications such as salivary dysfunction and conjunctivitis may occur.
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Affiliation(s)
- Pedro Weslley S Rosário
- Departamento de Tireóide, Clínica de Endocrinologia e Metabologia, Serviço de Medicina Nuclear, Santa Casa de Belo Horizonte, MG.
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Ogawa M, Hori H, Hirayama M, Kobayashi M, Shiraishi T, Watanabe Y, Komada Y. Anaplastic transformation from papillary thyroid carcinoma with increased serum CA19-9. Pediatr Blood Cancer 2005; 45:64-7. [PMID: 15770642 DOI: 10.1002/pbc.20375] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A 24-year-old woman presented with anaplastic transformation from papillary thyroid carcinoma with increased serum CA19-9. The patient had been diagnosed as having papillary thyroid carcinoma with lung metastasis at 11 years of age. She received a total thyroidectomy with cervical lymph node dissection followed by iodine-131 ((131)I) therapy over 12 years, but died due to sudden onset of rapid dissemination. Elevated serum CA19-9 was detected in the terminal stage, and anaplastic transformation was confirmed by post-mortem examination. Although there are few clinical reports suggesting a prognostic indicator for anaplastic thyroid carcinoma, CA19-9 may be a useful serum marker for this tumor.
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Affiliation(s)
- Masahiro Ogawa
- Department of Pediatrics, Mie University School of Medicine, Tue, Mie 514-8507, Japan.
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Rubino C, Adjadj E, Doyon F, Shamsaldin A, Abbas TM, Caillou B, Colonna M, Cecarreli C, Schvartz C, Bardet S, Langlois C, Ricard M, Schlumberger M, de Vathaire F. Radiation exposure and familial aggregation of cancers as risk factors for colorectal cancer after radioiodine treatment for thyroid carcinoma. Int J Radiat Oncol Biol Phys 2005; 62:1084-9. [PMID: 15990012 DOI: 10.1016/j.ijrobp.2004.12.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Revised: 12/10/2004] [Accepted: 12/16/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE In thyroid cancer patients, radioiodine treatment has been shown to be associated with an increased risk of colon carcinoma. The aim of this study in thyroid cancer patients was to evaluate the role of familial factors in the risk of colorectal cancer and their potential interaction with radioiodine exposure. METHODS AND MATERIALS We performed a case-control study on 15 colorectal cancer patients and 76 matched control subjects, nested in a cohort of 3708 thyroid cancer patients treated between 1933 and 1998. For each patient, the radiation dose delivered to the colon by radioiodine was estimated by use of standard tables. In those who received external radiation therapy, the average radiation doses delivered to the colon and rectum were estimated by use of DOS_Eg software. A complete familial history was obtained by face-to-face interviews, and a familial index was defined to evaluate the degree of familial aggregation. RESULTS The risk of colorectal cancer increased with familial aggregation of colorectal cancer (p = 0.02). After adjustment for the radiation dose delivered to the colon and rectum, the risk of colorectal cancer was 2.8-fold higher (95% CI, 1.0-8.0) for patients with at least one relative affected by colorectal cancer than for patients without such a family history (p = 0.05). The radiation dose delivered to the colon and rectum by (131)I and external radiation therapy was associated with an increase of risk near the significance threshold (p = 0.1). No significant interaction was found between radiation dose and having an affected relative (p = 0.9). CONCLUSIONS The role of familial background in the risk of colorectal cancer following a differentiated thyroid carcinoma appears to increase with the radiation dose delivered to the colon and rectum. However, the study population was small and no interaction was found between these two factors.
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Affiliation(s)
- Carole Rubino
- National Institute of Public Health and Medical Research, INSERM, Unit 605, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
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Sapienza MT, Endo IS, Campos Neto GC, Tavares MGM, Marone MMS. Tratamento do carcinoma diferenciado da tireóide com iodo-131: intervenções para aumentar a dose absorvida de radiação. ACTA ACUST UNITED AC 2005; 49:341-9. [PMID: 16543987 DOI: 10.1590/s0004-27302005000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Analisar medidas tomadas para aumentar a dose de radiação absorvida (DOSE) durante o tratamento do carcinoma diferenciado da tireóide (CDT) com iodo-131. MÉTODOS: As abordagens para aumentar a DOSE na radioiodoterapia são: redução da competição com iodo não-radioativo, estímulo da captação/retenção celular e aumento da atividade administrada. Revisaram-se os fundamentos e resultados de cada um destes métodos. RESULTADOS: Apesar de ser difícil confirmar aumento de sobrevida, existe relação direta entre a DOSE e a resposta no CDT. Diferentes abordagens permitem o aumento da DOSE nos tecidos, inferindo-se uma possível melhora na resposta dos tumores ao tratamento com iodo-131. Apesar do prognóstico relativamente benigno da doença, a melhoria da resposta é importante nos casos de alto risco, em que as alternativas de tratamento são limitadas. CONCLUSÕES: As intervenções descritas permitem aumentar a DOSE durante o tratamento do CDT, podendo ser empregadas para casos de alto risco.
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Abstract
A 27-year-old male developed Philadelphia chromosome-positive chronic myeloid leukemia (CML) 13 years after a first dose of radioiodine (131I) therapy for papillary thyroid carcinoma. He had received a cumulative 131I dose of 670 mCi, in 8 divided doses over 8 years, up to April 1998, for ablation of 131I avid tissues over the anterior neck region. The leukemogenic potential of radioactive iodine has been pointed out by many authors, but most reported cases have been acute leukemias. A literature review disclosed only 9 cases similar to ours. At present, there is no evidence to prove whether the development of CML after thyroid carcinoma represents a treatment-induced complication, a coincidence, or an increased susceptibility to secondary malignancies due to the malignant process itself.
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Affiliation(s)
- Kang-Ling Wang
- Armed Forces Tao-Yuan General Hospital, Taipei, Taiwan, ROC
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49
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Affiliation(s)
- Masud Haq
- Thyroid Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
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50
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Hoyes KP, Owens SE, Millns MM, Allan E. Differentiated thyroid cancer: radioiodine following lobectomy — a clinical feasibility study. Nucl Med Commun 2004; 25:245-51. [PMID: 15094442 DOI: 10.1097/00006231-200403000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The surgical management of differentiated thyroid cancer remains controversial. Total thyroidectomy has been associated with higher rates of post-operative morbidity than more conservative surgery, but radioiodine ablation of residual thyroid tissue is considered to be particularly difficult after lobectomy. The purpose of this retrospective study was to assess the feasibility of 131I ablation after lobectomy, compared with total thyroidectomy, in patients who had undergone surgery for differentiated thyroid carcinoma. A retrospective analysis was performed of 225 post-surgical thyroid cancer patients treated with 3500 MBq 131I for the ablation of thyroid remnants. One hundred and sixty-five patients (73%) had previously undergone total thyroidectomy, whilst 60 patients (27%) had been treated by lobectomy. All patients underwent diagnostic scintigraphy, with 40 MBq 131I, 2 days prior to ablative therapy and at 3 months post-ablation. The median pre-ablative 131I neck uptake values were 3.3% and 20.1% in patients treated by total thyroidectomy and lobectomy, respectively (P < 0.001). Pre-ablation neck uptake correlated strongly with the whole-body 131I burden 2 days after 131I therapy (P < 0.001), and the biological half-life of the radioiodine was markedly longer after lobectomy than after total thyroidectomy. Ninety-eight per cent of patients treated by total thyroidectomy were successfully ablated by one 131I treatment, compared with 90% after lobectomy (P < 0.05). There were no significant differences in 131I neck uptake or serum thyroglobulin levels between the two patient groups at 3 months post-ablation. These data show that high rates of thyroid ablation can be achieved with a single fixed dose of 131I after thyroid lobectomy. The use of this surgical procedure may result in a longer period of patient isolation than that required after total thyroidectomy. However, the clear correlation between pre-ablation neck uptake and 131I burden at 2 days post-therapy enables effective treatment scheduling, so making lobectomy followed by 131I ablation a practical option for the management of differentiated thyroid cancer.
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Affiliation(s)
- Katharine P Hoyes
- North Western Medical Physics, Christie Hospital NHS Trust, Manchester, UK.
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