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Ju SH, Lee SE, Yi S, Choi NR, Kim KH, Kim SM, Koh JY, Kim SK, Kim SY, Heo JY, Park JO, Park S, Koo BS, Kang YE. Transcriptomic characteristics according to tumor size and SUV max in papillary thyroid cancer patients. Sci Rep 2024; 14:11005. [PMID: 38745021 PMCID: PMC11094162 DOI: 10.1038/s41598-024-61839-0] [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: 08/07/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
The SUVmax is a measure of FDG uptake and is related with tumor aggressiveness in thyroid cancer, however, its association with molecular pathways is unclear. Here, we investigated the relationship between SUVmax and gene expression profiles in 80 papillary thyroid cancer (PTC) patients. We conducted an analysis of DEGs and enriched pathways in relation to SUVmax and tumor size. SUVmax showed a positive correlation with tumor size and correlated with glucose metabolic process. The genes that indicate thyroid differentiation, such as SLC5A5 and TPO, were negatively correlated with SUVmax. Unsupervised analysis revealed that SUVmax positively correlated with DNA replication(r = 0.29, p = 0.009), pyrimidine metabolism(r = 0.50, p < 0.0001) and purine metabolism (r = 0.42, p = 0.0001). Based on subgroups analysis, we identified that PSG5, TFF3, SOX2, SL5A5, SLC5A7, HOXD10, FER1L6, and IFNA1 genes were found to be significantly associated with tumor aggressiveness. Both high SUVmax PTMC and macro-PTC are enriched in pathways of DNA replication and cell cycle, however, gene sets for purine metabolic pathways are enriched only in high SUVmax macro-PTC but not in high SUVmax PTMC. Our findings demonstrate the molecular characteristics of high SUVmax tumor and metabolism involved in tumor growth in differentiated thyroid cancer.
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Affiliation(s)
- Sang-Hyeon Ju
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University Hospital and College of Medicine, Daejeon, Republic of Korea
| | - Seong Eun Lee
- Research Center for Endocrine and Metabolic Disease, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Shinae Yi
- Research Center for Endocrine and Metabolic Disease, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Na Rae Choi
- Research Center for Endocrine and Metabolic Disease, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea
| | - Kun Ho Kim
- Department of Nuclear Medicine, Chungnam National University Hospital and College of Medicine, Daejeon, Republic of Korea
| | - Seong Min Kim
- Department of Nuclear Medicine, Chungnam National University Hospital and College of Medicine, Daejeon, Republic of Korea
| | - June-Young Koh
- GENOME INSIGHT THECNOLOGY Inc, Daejeon, 35015, Republic of Korea
| | - Seon-Kyu Kim
- Personalized Genomic Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Seon-Young Kim
- Korea Bioinformation Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Jun Young Heo
- Department of Biochemistry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Junyoung O Park
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, CA, USA
| | - Seongyeol Park
- GENOME INSIGHT THECNOLOGY Inc, Daejeon, 35015, Republic of Korea.
| | - Bon Seok Koo
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University Hospital and College of Medicine, Daejeon, 35015, Republic of Korea.
| | - Yea Eun Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University Hospital and College of Medicine, Daejeon, Republic of Korea.
- Research Center for Endocrine and Metabolic Disease, Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea.
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Pitoia F, Scheffel RS, Califano I, Gauna A, Tala H, Vaisman F, Gonzalez AR, Hoff AO, Maia AL. Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective. Rev Endocr Metab Disord 2024; 25:109-121. [PMID: 37380825 DOI: 10.1007/s11154-023-09818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Radioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world's population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.
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Affiliation(s)
- Fabian Pitoia
- Hospital de Clínicas José de San Martín - University of Buenos Aires, Buenos Aires, Argentina
| | - Rafael Selbach Scheffel
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ines Califano
- Endocrinology Division, Instituto de Oncología AH Roffo, University of Buenos Aires, Buenos Aires, Argentina
| | - Alicia Gauna
- Endocrinology Division, Hospital Ramos Mejía, Gobierno Ciudad de Buenos Aires, Argentina
| | - Hernán Tala
- Centro de tiroides, Facultad de Medicina Clínica Alemana, Clínica Alemana de Santiago, Universidad del desarrollo, Santiago, Chile
| | - Fernanda Vaisman
- Onco endocrinology Service, Endocrinology Service, Faculdade de Medicina, Instituto Nacional do Cancer (INCa), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alejandro Roman Gonzalez
- Deparment of Internal Medicine, Endocrine Section, Universidad de Antioquia. Hospital Universitario San Vicente Fundación. Medellin, Medellín, Colombia
| | - Ana Oliveira Hoff
- Endocrine Oncology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350 - CEP 90035-003, Brazil.
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Shi L, Duan R, Sun Z, Jia Q, Wu W, Wang F, Liu J, Zhang H, Xue X. LncRNA GLTC targets LDHA for succinylation and enzymatic activity to promote progression and radioiodine resistance in papillary thyroid cancer. Cell Death Differ 2023; 30:1517-1532. [PMID: 37031273 PMCID: PMC10244348 DOI: 10.1038/s41418-023-01157-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/10/2023] Open
Abstract
Dysregulation of long noncoding RNAs (lncRNAs) has been associated with the development and progression of many human cancers. Lactate dehydrogenase A (LDHA) enzymatic activity is also crucial for cancer development, including the development of papillary thyroid cancer (PTC). However, whether specific lncRNAs can regulate LDHA activity during cancer progression remains unclear. Through screening, we identified an LDHA-interacting lncRNA, GLTC, which is required for the increased aerobic glycolysis and cell viability in PTC. GLTC was significantly upregulated in PTC tissues compared with nontumour thyroid tissues. High expression of GLTC was correlated with more extensive distant metastasis, a larger tumour size, and poorer prognosis. Mass spectrometry revealed that GLTC, as a binding partner of LDHA, promotes the succinylation of LDHA at lysine 155 (K155) via competitive inhibition of the interaction between SIRT5 and LDHA, thereby promoting LDHA enzymatic activity. Overexpression of the succinylation mimetic LDHAK155E mutant restored glycolytic metabolism and cell viability in cells in which metabolic reprogramming and cell viability were ceased due to GLTC depletion. Interestingly, GLTC inhibition abrogated the effects of K155-succinylated LDHA on radioiodine (RAI) resistance in vitro and in vivo. Taken together, our results indicate that GLTC plays an oncogenic role and is an attractive target for RAI sensitisation in PTC treatment.
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Affiliation(s)
- Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Duan
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhenhua Sun
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Qiong Jia
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, Shanghai, China.
| | - Hao Zhang
- Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
| | - Xue Xue
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Valerio L, Maino F, Castagna MG, Pacini F. Radioiodine therapy in the different stages of differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2023; 37:101703. [PMID: 36151009 DOI: 10.1016/j.beem.2022.101703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Differentiated thyroid cancer is the most frequent type of thyroid cancer with an increasing incidence in the last decades. The initial management is represented by surgical treatment followed by radioactive iodine therapy that includes remnant ablation, adjuvant treatment or treatment of metastatic disease. Radioactive iodine treatment is performed only in selected cases based on the risk of recurrence and mortality during follow up, according to American Joint Committee on Cancer Union for international Cancer Control Tumor, Node, Metastasis (AJCC/TNM) staging system and the 2015 American Thyroid Association (ATA) risk stratification system. This article will review the key factors to consider when planning radioactive iodine therapy in differentiated thyroid cancer patients after surgery and during follow up.
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Affiliation(s)
- Laura Valerio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
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Shi L, You Q, Wang J, Wang H, Li S, Tian R, Yao X, Wu W, Zhang L, Wang F, Lin Y, Li S. Antitumour effects of apatinib in progressive, metastatic differentiated thyroid cancer (DTC). Endocrine 2022; 78:68-76. [PMID: 35767182 PMCID: PMC9474580 DOI: 10.1007/s12020-022-03113-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/11/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Management of progressive, metastatic radioactive iodine refractory differentiated thyroid cancer (RAIR-DTC) has been a great challenge due to its poor prognosis and limited treatment options. Recently, apatinib, an orally anti-angiogenic tyrosine kinase inhibitor (TKI) is reported to be useful for treatment of progressive RAIR-DIC. The aim of this study was to evaluate the antitumour effect of apatinib and the combination therapy with radioactive iodine (RAI) in patients with progressive metastatic DTC. METHODS Five patients (all female, mean age 62 ± 8 years, ranged from 51 to 69 years) with distant metastatic DTC (dmDTC) after total thyroidectomy (TTE) and neck lymph node dissection were treated with apatinib at a dose 500 mg per day after 18F-Fluorodeoxyglucose (18F-FDG) PET/CT. The effects of apatinib on DTC were evaluated at 4 ± 1 months after treatment with apatinib. RAI therapy was then initiated. The response to apatinib and the combination therapy with RAI treatment was evaluated by Response Evaluation Criteria in Solid Tumours (RECIST, version 1.1) and metabolic activity using serum thyroglobulin (Tg) and 18F-FDG PET/CT. RESULTS Positive 18F-FDG PET/CT results were found in all patients before apatinib therapy. The immunohistochemical analysis of primary tumour tissues showed high expression of vascular endothelial growth factor receptor-2 (VEGFR-2). Four patients with follicular thyroid carcinoma (FTC) showed partial response (PR) with significant decrease in tumour size and maximum standardized uptake value (SUVmax) after 4 ± 1 month's treatment with apatinib. Further significant reduction of tumour size and SUVmax were observed in three patients after combination therapy with apatinib and RAI. Only one patient with both FTC and papillary thyroid cancer (PTC) demonstrated progressive disease (PD) after treatment with apatinib alone, however, a decrease in tumour size and SUVmax as well as serum Tg levels was achieved after the combination with RAI therapy and apatinib. CONCLUSIONS Apatinib had significant antitumour effects on progressive distant metastatic DTC. Moreover, beneficial synergistic and complementary effects were shown when apatinib combined with RAI therapy. CLINICAL TRIAL REGISTRATION NCT04180007, Registered November 26, 2019.
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Affiliation(s)
- Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qinqin You
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hanjin Wang
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shaohua Li
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Tian
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaocheng Yao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lele Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China.
| | - Shuren Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
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Tchekmedyian V, Dunn L, Sherman E, Baxi SS, Grewal RK, Larson SM, Pentlow KS, Haque S, Tuttle RM, Sabra MM, Fish S, Boucai L, Walters J, Ghossein RA, Seshan VE, Knauf JA, Pfister DG, Fagin JA, Ho AL. Enhancing Radioiodine Incorporation in BRAF-Mutant, Radioiodine-Refractory Thyroid Cancers with Vemurafenib and the Anti-ErbB3 Monoclonal Antibody CDX-3379: Results of a Pilot Clinical Trial. Thyroid 2022; 32:273-282. [PMID: 35045748 PMCID: PMC9206492 DOI: 10.1089/thy.2021.0565] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Oncogenic activation of mitogen-activated protein kinase (MAPK) signaling is associated with radioiodine refractory (RAIR) thyroid cancer. Preclinical models suggest that activation of the receptor tyrosine kinase erbB-3 (HER3) mitigates the MAPK pathway inhibition achieved by BRAF inhibitors in BRAFV600E mutant thyroid cancers. We hypothesized that combined inhibition of BRAF and HER3 using vemurafenib and the human monoclonal antibody CDX-3379, respectively, would potently inhibit MAPK activation and restore radioactive iodine (RAI) avidity in patients with BRAF-mutant RAIR thyroid cancer. Methods: Patients with BRAFV600E RAIR thyroid cancer were evaluated by thyrogen-stimulated iodine-124 (124I) positron emission tomography-computed tomography (PET/CT) at baseline and after 5 weeks of treatment with oral vemurafenib 960 mg twice daily alone for 1 week, followed by vemurafenib in combination with 1000 mg of intravenous CDX-3379 every 2 weeks. Patients with adequate 124I uptake on the second PET/CT then received therapeutic radioactive iodine (131I) with vemurafenb+CDX-3379. All therapy was discontinued two days later. Treatment response was monitored by serum thyroglobulin measurements and imaging. The primary endpoints were safety and tolerability of vemurafenib+CDX-3379, as well as the proportion of patients after vemurafenb+CDX-3379 therapy with enhanced RAI incorporation warranting therapeutic 131I. Results: Seven patients were enrolled; six were evaluable for the primary endpoints. No grade 3 or 4 toxicities related to CDX-3379 were observed. Five patients had increased RAI uptake after treatment; in 4 patients this increased uptake warranted therapeutic 131I. At 6 months, 2 patients achieved partial response after 131I and 2 progression of disease. Next-generation sequencing of 5 patients showed that all had co-occurring telomerase reverse transcriptase promoter alterations. A deleterious mutation in the SWItch/Sucrose Non-Fermentable (SWI/SNF) gene ARID2 was discovered in the patient without enhanced RAI avidity after therapy and an RAI-resistant tumor from another patient that was sampled off-study. Conclusions: The endpoints for success were met, providing preliminary evidence of vemurafenib+CDX-3379 safety and efficacy for enhancing RAI uptake. Preclinical data and genomic profiling in this small cohort suggest SWI/SNF gene mutations should be investigated as potential markers of resistance to redifferentiation strategies. Further evaluation of vemurafenib+CDX-3379 as a redifferentiation therapy in a larger trial is warranted (ClinicalTrials.gov: NCT02456701).
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Affiliation(s)
| | - Lara Dunn
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Eric Sherman
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | | | | | | | - Sofia Haque
- Department of Radiology, New York, New York, USA
| | - R. Michael Tuttle
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Mona M. Sabra
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Stephanie Fish
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Laura Boucai
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | | | | | | | - Jeffrey A. Knauf
- Department of Human Oncology and Pathogenesis Program; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David G. Pfister
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - James A. Fagin
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Human Oncology and Pathogenesis Program; Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alan L. Ho
- Department of Medicine, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Address correspondence to: Alan L. Ho, MD, PhD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10021, USA
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Chen W, Luo YK, Zhang Y, Song Q, Tang J. Ultrasound-guided implantation of radioactive 125I seed in radioiodine refractory differentiated thyroid carcinoma. BMC Cancer 2021; 21:834. [PMID: 34284748 PMCID: PMC8290620 DOI: 10.1186/s12885-021-08500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma. METHODS Thirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1-3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded. RESULTS The median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24-50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01). CONCLUSION US-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
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Affiliation(s)
- Wei Chen
- Department of Ultrasound, The Seventh Medical Center, Medical College of PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
| | - Ying Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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8
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Donohoe KJ, Aloff J, Avram AM, Bennet KG, Giovanella L, Greenspan B, Gulec S, Hassan A, Kloos RT, Solórzano CC, Stack BC, Tulchinsky M, Tuttle RM, Van Nostrand D, Wexler JA. Appropriate Use Criteria for Nuclear Medicine in the Evaluation and Treatment of Differentiated Thyroid Cancer. J Nucl Med 2020; 61:375-396. [PMID: 32123131 DOI: 10.2967/jnumed.119.240945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kevin J Donohoe
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | - Anca M Avram
- American College of Nuclear Medicine, Reston, Virginia
| | - K G Bennet
- American College of Nuclear Medicine, Reston, Virginia
| | | | | | - Seza Gulec
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | - Aamna Hassan
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
| | | | | | | | - Mark Tulchinsky
- Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia
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9
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McLeod DSA, Zhang L, Durante C, Cooper DS. Contemporary Debates in Adult Papillary Thyroid Cancer Management. Endocr Rev 2019; 40:1481-1499. [PMID: 31322698 DOI: 10.1210/er.2019-00085] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023]
Abstract
An ever-increasing population of patients with papillary thyroid cancer is engaging with health care systems around the world. Numerous questions about optimal management have arisen that challenge conventional paradigms. This is particularly the case for patients with low-risk disease, who comprise most new patients. At the same time, new therapies for patients with advanced disease are also being introduced, which may have the potential to prolong life. This review discusses selected controversial issues in adult papillary thyroid cancer management at both ends of the disease spectrum. These topics include: (i) the role of active surveillance for small papillary cancers; (ii) the extent of surgery in low-risk disease (lobectomy vs total thyroidectomy); (iii) the role of postoperative remnant ablation with radioiodine; (iv) optimal follow-up strategies in patients, especially those who have only undergone lobectomy; and (v) new therapies for advanced disease. Although our current management is hampered by the lack of large randomized controlled trials, we are fortunate that data from ongoing trials will be available within the next few years. This information should provide additional evidence that will decrease morbidity in low-risk patients and improve outcomes in those with distant metastatic disease.
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Affiliation(s)
- Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Ling Zhang
- Department of Head and Neck Surgery, Fudan University Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tsoumakidou G, Mandralis K, Hocquelet A, Duran R, Denys A. Salvage Lymph-Node Percutaneous Cryoablation: Safety Profile and Oncologic Outcomes. Cardiovasc Intervent Radiol 2019; 43:264-272. [DOI: 10.1007/s00270-019-02341-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
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11
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Li C, Zhang J, Wang H. Predictive value of LN metastasis detected by 18F-FDG PET/CT in patients with papillary thyroid cancer receiving iodine-131 radiotherapy. Oncol Lett 2019; 18:1641-1648. [PMID: 31423231 PMCID: PMC6607093 DOI: 10.3892/ol.2019.10500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/17/2019] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to predict the prognostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the metastatic lymph nodes (mLNs) of patients with papillary thyroid carcinoma (PTC) with a negative iodine-131 (131I) whole-body scan (WBS). The present retrospective study included 32 patients with PTC undergoing standard surgery and radioiodine treatment. All patients received 18F-FDG PET/CT imaging prior to and following therapy. All mLNs were divided into an effective treatment group (group A) and ineffective treatment group (group B) based on the PET Response Criteria in Solid Tumors 1.0 guidelines. All the patients were followed up for ≥9 months. A significant difference was identified in the peak standardized uptake value (SULpeak) between group B (7.85±3.20) and group A (5.36±2.19). A cut-off value of 5.85 was used to distinguish ineffective treatment of lesions from mLNs receiving radioactive ablation based on receiver operating characteristic (ROC) curve analysis with an area under the ROC curve of 0.755. Patients with a high SULpeak (P=0.003) and extrathyroidal extension (P=0.030), confirmed by pathology, more frequently exhibited a poor prognosis. In conclusion, tracer uptake of 18F-FDG for cervical metastatic nodes was revealed as a predictor for the clinical outcome of patients with PTC treated with radioiodine therapy. The present results also indicated that high SULpeak and extrathyroidal extension are poor predictors for patients with mLNs receiving 131I therapy.
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Affiliation(s)
- Chao Li
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
| | - Jian Zhang
- Universal Medical Imaging Diagnostic Center, Shanghai 201103, P.R. China
| | - Hui Wang
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, P.R. China
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Aygun N, Uludag M, Ozel A. The Clinical Importance of Tumor Thrombus in Internal Jugular Vein Related to Papillary Thyroid Cancer. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: We aimed to present a case with a previous thyroid surgery, who developed an internal jugular vein thrombus due to papillary thyroid cancer (PTC) in the remnant tissue.
Case: A 54-year-old female patient, with a previous subtotal thyroidectomy, presented with a mass on the left side of her neck. Thyroid ultrasound disclosed a heterogeneous nodule of 67x48x32 mm in the left thyroid lobe. An isoechoic tumor thrombus was observed extending intraluminally from the middle thyroid vein to the internal jugular vein. No lymph node or solid organ invasion were detected in the neck. Fine needle aspiration biopsy revealed cytological findings consistent with PTC. Total thyroidectomy, left sided central neck dissection and partial left jugular vein resection was performed. The pathologic examination revealed mid-differentiated unifocal encapsulated follicular variant of PTC. The whole-body scan performed after the postoperative treatment of 150 mCi of radioactive iodine, revealed multiple lung metastases.
Conclusion: The presence of a tumor thrombus in the thyroid vein or internal jugular vein is strongly suspicious for malignancy even in the absence of malignant findings on cytology. It is an important finding that is highly suspicious for distant metastasis in the cytologically diagnosed patients.
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13
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Dunn LA, Sherman EJ, Baxi SS, Tchekmedyian V, Grewal RK, Larson SM, Pentlow KS, Haque S, Tuttle RM, Sabra MM, Fish S, Boucai L, Walters J, Ghossein RA, Seshan VE, Ni A, Li D, Knauf JA, Pfister DG, Fagin JA, Ho AL. Vemurafenib Redifferentiation of BRAF Mutant, RAI-Refractory Thyroid Cancers. J Clin Endocrinol Metab 2019; 104:1417-1428. [PMID: 30256977 PMCID: PMC6435099 DOI: 10.1210/jc.2018-01478] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT BRAFV600E mutant thyroid cancers are often refractory to radioiodine (RAI). OBJECTIVES To investigate the utility and molecular underpinnings of enhancing lesional iodide uptake with the BRAF inhibitor vemurafenib in patients with RAI-refractory (RAIR). DESIGN This was a pilot trial that enrolled from June 2014 to January 2016. SETTING Academic cancer center. PATIENTS Patients with RAIR, BRAF mutant thyroid cancer. INTERVENTION Patients underwent thyrotropin-stimulated iodine-124 (124I) positron emission tomography scans before and after ~4 weeks of vemurafenib. Those with increased RAI concentration exceeding a predefined lesional dosimetry threshold (124I responders) were treated with iodine-131 (131I). Response was evaluated with imaging and serum thyroglobulin. Three patients underwent research biopsies to evaluate the impact of vemurafenib on mitogen-activated protein kinase (MAPK) signaling and thyroid differentiation. MAIN OUTCOME MEASURE The proportion of patients in whom vemurafenib increased RAI incorporation to warrant 131I. RESULTS Twelve BRAF mutant patients were enrolled; 10 were evaluable. Four patients were 124I responders on vemurafenib and treated with 131I, resulting in tumor regressions at 6 months. Analysis of research tumor biopsies demonstrated that vemurafenib inhibition of the MAPK pathway was associated with increased thyroid gene expression and RAI uptake. The mean pretreatment serum thyroglobulin value was higher among 124I responders than among nonresponders (30.6 vs 1.0 ng/mL; P = 0.0048). CONCLUSIONS Vemurafenib restores RAI uptake and efficacy in a subset of BRAF mutant RAIR patients, probably by upregulating thyroid-specific gene expression via MAPK pathway inhibition. Higher baseline thyroglobulin values among responders suggest that tumor differentiation status may be a predictor of vemurafenib benefit.
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Affiliation(s)
- Lara A Dunn
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Eric J Sherman
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Shrujal S Baxi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Vatche Tchekmedyian
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ravinder K Grewal
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Steven M Larson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Keith S Pentlow
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sofia Haque
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mona M Sabra
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephanie Fish
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jamie Walters
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Venkatraman E Seshan
- Department of Epidemiology–Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ai Ni
- Department of Epidemiology–Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Duan Li
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jeffrey A Knauf
- Human Oncology and Pathogenesis, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - David G Pfister
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - James A Fagin
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Human Oncology and Pathogenesis, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
- Correspondence and Reprint Requests: Alan L. Ho, MD, PhD, Memorial Sloan-Kettering Cancer Center, 300 East 66th Street, New York, New York 10065. E-mail:
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Vaisman F, Tuttle RM. Clinical Assessment and Risk Stratification in Differentiated Thyroid Cancer. Endocrinol Metab Clin North Am 2019; 48:99-108. [PMID: 30717913 DOI: 10.1016/j.ecl.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thyroid cancer management is rapidly evolving to a personalized management approach. Risk stratification systems are designed to assist in personalized management. Differentiating patients who may benefit from aggressive therapy and intense follow-up as opposed to those who can be successfully treated with minimalized initial management options and follow-up is crucial to the development of the right treatment plan for the right patient in order to optimize initial therapy and follow-up testing. This article aims to describe and discuss the risk stratification systems currently recommended for differentiated thyroid cancer.
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Affiliation(s)
- Fernanda Vaisman
- Endocrinology Service, Instituto Nacional do Cancer, Praça da Cruz Vermelha 23, 8° andar, centro, Rio de Janeiro, RJ 20230-130, Brazil.
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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15
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Differentiated Thyroid Cancer Outcomes After Surgery and Activity-Adjusted 131I Theragnostics. Clin Nucl Med 2019; 44:11-20. [PMID: 30371575 DOI: 10.1097/rlu.0000000000002321] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine clinical outcomes in patients with differentiated thyroid cancer after surgery and activity-adjusted I therapy informed by diagnostic I scans with SPECT/CT (Dx scan). METHODS Single-institution retrospective cohort study analysis of clinical outcomes after 1 to 5 years (mean, 39.6 ± 23.4 months) of follow-up in 350 patients with differentiated thyroid cancer associated with histopathologic risk factors, nodal metastases, and/or distant metastases. Postoperatively, all patients underwent Dx scans for completion of staging and risk stratification, and I therapy was based on integration of information from histopathology, stimulated thyroglobulin and scintigraphy. RESULTS Twenty-three patients (6.6%) underwent reoperative neck dissection for removal of unsuspected residual nodal metastases identified on Dx scans. Clinical outcomes were as follows: 84.3% complete response, 1.4% biochemical incomplete response, 2.3% indeterminate response, and 12% structural incomplete response. Of the entire cohort, only 8 patients (2.3%) had persistent iodine-avid metastatic disease, which required repeated I therapy. Of 31 patients with iodine-avid distant metastases identified on Dx scans, 13 patients (42%) achieved complete response with a single I treatment. CONCLUSIONS Detection of regional and distant metastases on postoperative Dx scans permits adjustment of prescribed I activity for targeted treatment, as compared with fixed-activity ablation. This approach resulted in complete response after a single I treatment in 88% patients with histopathologic risk factors and regional metastases and 42% patients with distant metastases. Most patients with structural incomplete response (81%) had elevated thyroglobulin levels with negative follow-up I scans and positive PET/CT and/or CT scans consistent with altered tumor biology (non-iodine-avid disease).
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16
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Prognostic Value of FDG-PET/CT Metabolic Parameters in Metastatic Radioiodine-Refractory Differentiated Thyroid Cancer. Clin Nucl Med 2018; 43:641-647. [PMID: 30015659 DOI: 10.1097/rlu.0000000000002193] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE There are no standardized prognostication algorithms for metastatic radioiodine-refractory (RAI-R) differentiated thyroid cancer (DTC). We hypothesize that [F]-FDG PET/CT may predict progression versus stability of disease based on quantitative analysis of metabolic tumor volume (MTV) and total lesion glycolysis (TLG). METHODS Retrospective study of 62 patients with metastatic RAI-R DTC to determine clinical outcomes with median follow-up from initial diagnosis of 11.1 years (8.38, 14.1) (range, 1.2-20 years). Baseline [F]-FDG PET/CT scans were evaluated qualitatively for regional and distant metastases and quantitatively for tumor burden based on MTV and TLG obtained using gradient segmentation method. RESULTS After diagnosis of metastatic RAI-R disease was established, the 5-year overall survival (OS) probability was 34%, and median OS was 3.56 years (2.87, infinity). The 5-year progression-free survival (PFS) probability was 19%, and median PFS was 1.31 years (1.03, 2.38). TSH-suppressed thyroglobulin (Tg) levels greater than 100 ng/mL and Tg doubling time (Tg-DT) less than 6 months were significantly associated with worse OS and PFS. Higher than median values of MTV and TLG were associated with worse OS (P = 0.06) and PFS (P = 0.007). Higher hazard of death was noted for higher values of log-MTV and log-TLG (HR, 1.17 [95% confidence interval, 0.99-1.39], P = 0.05, and HR, 1.14 [95% confidence interval, 1.00-1.31], P = 0.05, respectively). CONCLUSIONS [F]-FDG PET/CT metabolic parameters can help define the volume and biologic variations of metastatic tumor burden. Metabolic tumor volume and TLG can be used for dynamic risk stratification of patients with metastatic RAI-R DTC regarding PFS and complement Tg-DT for prognosis of clinical disease course.
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17
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Zhang X, Higuchi T, Achmad A, Bhattarai A, Tomonaga H, Thu HN, Yamaguchi A, Hirasawa H, Taketomi-Takahashi A, Tsushima Y. Can 18F-fluorodeoxyglucose positron emission tomography predict the response to radioactive iodine therapy in metastatic differentiated thyroid carcinoma? Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0037-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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18
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Pace L, Klain M, Tagliabue L, Storto G. The current and evolving role of FDG–PET/CT in personalized iodine-131 therapy of differentiated thyroid cancer. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0254-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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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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20
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Okuyama C, Kimura M, Oda M, Kodani N, Aibe N, Yamazaki H. A Case of Thyroid Papillary Carcinoma: Remarkable Decrease in Multiple Lung Metastases within 40 Years after a Single Administration of Radioiodine without Thyroidectomy and with Later Anaplastic Transformation. Case Rep Oncol 2017; 10:928-937. [PMID: 29279694 PMCID: PMC5731137 DOI: 10.1159/000481500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/31/2022] Open
Abstract
Differentiated thyroid carcinoma is an uncommon malignancy of childhood and adolescence that is unique because it has an overall favorable prognosis despite its relatively high rate of nodal and distant metastases. Total thyroidectomy and positive 131I therapy are recommended for cases with pulmonary metastases. In contrast, anaplastic thyroid cancer is one of the most aggressive malignancies that have an unfavorable and miserable prognosis. We report a case with an impressively long history. The patient had multiple pulmonary metastases that had been diagnosed by 131I administration when he was 14 years old, about 45 years before he underwent thyroidectomy. He had been kept unaware of his disease by his family and received no treatment for most of his life. Pulmonary nodules were noted at several medical checkups and showed a remarkable decrease in size during the untreated 44-year period after the 131I administration. At age 58, his thyroid cancer was first detected and total thyroidectomy was performed, with subsequent radioiodine therapy for pulmonary metastases. Unfortunately, anaplastic carcinoma developed and he died of disseminated tumors later.
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Affiliation(s)
- Chio Okuyama
- Shiga Medical Center, Research Institute, Moriyama, Japan.,Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuhiro Kimura
- Department of Otorhinolaryngology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Minori Oda
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan.,Image Communication Corporation, Kyoto, Japan
| | - Naohiro Kodani
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Radiology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideya Yamazaki
- Department of Radiology, Graduate School of Kyoto Prefectural University of Medicine, Kyoto, Japan
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21
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Salvatore B, Klain M, Nicolai E, D’Amico D, De Matteis G, Raddi M, Fonti R, Pellegrino T, Storto G, Cuocolo A, Pace L. Prognostic role of FDG PET/CT in patients with differentiated thyroid cancer treated with 131-iodine empiric therapy. Medicine (Baltimore) 2017; 96:e8344. [PMID: 29049252 PMCID: PMC5662418 DOI: 10.1097/md.0000000000008344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To assess the long-term prognostic value of F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with differentiated thyroid carcinoma (DTC) undergoing empiric radioiodine (RAI) therapy due to raising values of thyroglobulin (Tg). METHODS Forty-nine patients with histological diagnosis of DTC (31 with papillary and 18 with follicular carcinoma) follow-up for a mean period of 7.9 ± 5 years after empiric RAI therapy were retrospectively analyzed. RESULTS FDG-PET/CT was negative in 15 (30.6%) patients and positive in 34 (69.4%), whereas postradioiodine therapy whole body scan (t-WBS) was negative in 16 (32.7%) and positive in 33 (67.3%) patients. FDG-PET/CT and t-WBS were in agreement in 32 patients (7 both negative and 25 both positive); on the contrary, in 17 patients there was disagreement between FDG-PET/CT and t-WBS (P =ns). At short-term follow-up, Tg normalized in 19 (38.8%) patients and was unchanged or increased in 30 (61.2%). Of the 15 patients with negative FDG-PET/CT, 11 (73.3%) showed Tg normalization, whereas of the 34 patients with positive FDG-PET/CT, only 8 (23.5%) had Tg normalization (χ =8.9, P < .005). At multivariate analysis, FDG-PET/CT and Tg normalization at short-term follow-up were independent predictors of disease-free survival (χ =26.3, P < .0001), while Tg normalization was the only variable associated with overall survival χ =7.2, P < .01). CONCLUSION FDG-PET/CT in association with Tg normalization at short-term follow-up may be useful for long-term prognostic stratification in DTC patients.
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Affiliation(s)
| | - Michele Klain
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII
| | | | | | - Gianluca De Matteis
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII
| | - Marco Raddi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII
| | - Rosa Fonti
- Istituto di Biostrutture e Bioimmagini, CNR
| | | | | | - Alberto Cuocolo
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli FedericoII
| | - Leonardo Pace
- Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana,” Università degli Studi di Salerno, Salerno, Italy
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Yang Y, Xia S, Ni X, Ni Z, Zhang L, Wang W, Kong Y, Wang Y, Ye L, Zhan W. MiR-324-5p assists ultrasonography in predicting lymph node metastasis of unifocal papillary thyroid microcarcinoma without extracapsular spread. Oncotarget 2017; 8:83802-83816. [PMID: 29137384 PMCID: PMC5663556 DOI: 10.18632/oncotarget.19717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/30/2017] [Indexed: 01/08/2023] Open
Abstract
Ultrasonography is the first choice of lymph node metastasis (LNM) detection which is crucial for therapeutic options of papillary thyroid cancer (PTC). However, the sensitivity of ultrasonography in detecting LNM of PTC is relatively low; especially in central LNM. MiR-324-5p has been reported to play important roles in the metastasis of various cancers. To explore the relationship between miR-324-5p and LNM in PTC, quantitative real-time polymerase chain reaction was performed in PTC tissue and fine needle aspiration (FNA) washout successively. Its correlation with LNM of PTC was analyzed. The clinicopathological and sonographic factors relating to LNM were also studied. Additionally, the function assay of miR-324-5p in PTC cells was conducted. Current study demonstrated that age was an independent protective factor and multifocality, advanced TNM stage, increased transverse diameter of thyroid nodule, ultrasound suspected LNM were independent risk factors of LNM. MiR-324-5p promoted proliferation, migration and invasion of PTC cell line. MiR-324-5p could serve as a candidate predictor along with ultrasonography in predicting LNM, especially central LNM of unifocal papillary thyroid microcarcinoma without extracapsular spread.
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Affiliation(s)
- Yanhua Yang
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shujun Xia
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongxin Ni
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Zhang
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhan Wang
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanjun Kong
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ye
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasonography, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Yang Z, Flores J, Katz S, Nathan CA, Mehta V. Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. Thyroid 2017; 27:944-952. [PMID: 28446057 DOI: 10.1089/thy.2016.0650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery. METHODS In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors. RESULTS The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HRPTC Stage IV-A = 2.12 [confidence interval (CI) 1.79-2.52]; HRPTC Stage IV-B = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TRPTC Stage IV-B = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HRFTC Stage IV-C = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TRFTC Stage IV-C = 1.98 [CI 1.31-3.00]). CONCLUSIONS Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC.
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Affiliation(s)
- Zao Yang
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
| | - Jose Flores
- 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sanford Katz
- 3 Department of Radiation Oncology, Willis-Knighton Cancer Center , Shreveport, Louisiana
| | - Cherie-Ann Nathan
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
| | - Vikas Mehta
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
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24
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Sherman EJ, Dunn LA, Ho AL, Baxi SS, Ghossein RA, Fury MG, Haque S, Sima CS, Cullen G, Fagin JA, Pfister DG. Phase 2 study evaluating the combination of sorafenib and temsirolimus in the treatment of radioactive iodine-refractory thyroid cancer. Cancer 2017; 123:4114-4121. [PMID: 28662274 DOI: 10.1002/cncr.30861] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with recurrent and/or metastatic, radioactive iodine-refractory thyroid carcinoma have limited treatment options. Sorafenib, an oral kinase inhibitor, is approved by the US Food and Drug Administration for the treatment of radioactive iodine-refractory thyroid carcinoma, although it demonstrated low response rates (12.2%) as a single agent in the first-line setting. The objective of the current study was to determine whether adding the mammalian target of rapamycin inhibitor temsirolimus to sorafenib could improve on these results. METHODS In this single-institution, phase 2 study, 36 patients with metastatic, radioactive iodine-refractory thyroid carcinoma of follicular origin received treatment with the combination of oral sorafenib (200 mg twice daily) and intravenous temsirolimus (25 mg weekly). The receipt of prior systemic treatment with cytotoxic chemotherapy and targeted therapy, including sorafenib, was permitted. The primary endpoint was the radiographic response rate. RESULTS The best response was a partial response in 8 patients (22%), stable disease in 21 (58%), and progressive disease in 1 (3%). Six patients were not evaluable for a response. Patients who had received any prior systemic treatment had a response rate of 10% compared with 38% of those who had not received prior systemic treatment. One of 2 patients with anaplastic thyroid cancer had an objective response. The progression-free survival rate at 1 year was 30.5%. The most common grade 3 and 4 toxicities associated with sorafenib and temsirolimus included hyperglycemia, fatigue, anemia, and oral mucositis. CONCLUSIONS Sorafenib and temsirolimus appear to be an active combination in patients with radioactive iodine-refractory thyroid carcinoma, especially in patients who received no prior treatment compared with historic data from single-agent sorafenib. Activity is also observed in patients who previously received sorafenib. This regimen warrants further investigation. Cancer 2017;123:4114-4121. © 2017 American Cancer Society.
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Affiliation(s)
- Eric J Sherman
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lara A Dunn
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Shrujal S Baxi
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Matthew G Fury
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sofia Haque
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Cami S Sima
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Grace Cullen
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James A Fagin
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - David G Pfister
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
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Metástasis a distancia en cáncer diferenciado de tiroides: diagnóstico y tratamiento. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.raem.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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Xia S, Wang C, Ni X, Ni Z, Dong Y, Zhan W. NONHSAT076754 aids ultrasonography in predicting lymph node metastasis and promotes migration and invasion of papillary thyroid cancer cells. Oncotarget 2017; 8:2293-2306. [PMID: 27906682 PMCID: PMC5356800 DOI: 10.18632/oncotarget.13725] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/22/2016] [Indexed: 12/31/2022] Open
Abstract
Lymph node metastasis (LNM) is the primary challenge in papillary thyroid cancer (PTC). Recurrent cancerous lymph nodes require repeated surgeries, which increases the risk for surgical complications. Thus, the evaluation of LNM before surgery is important. Ultrasonography is the most convenient way to examine cervical LNM, but the sensitivity of ultrasonography in the identification of LNM in cases of PTC is extremely low. A series of lncRNAs (long noncoding RNAs) have been reported as candidate biomarkers in a variety of tumors. This study detected the lncRNA NONHSAT076754 in PTC and analyzed the correlation of NONHSAT076754 with the clinicopathological and ultrasonographic characteristics of patients with PTC. The value of NONHSAT076754 as an auxiliary diagnostic biomarker for use along with ultrasonography in the differentiation of LNM in PTC was assessed. Additionally, the biological function of NONHSAT076754 in PTC cells was demonstrated. Our study indicated that NONHSAT076754 promotes migration and invasiveness of PTC and serves as a valuable auxiliary biomarker that can be used along with ultrasonography in the prediction of cervical LNM.
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Affiliation(s)
- Shujun Xia
- Ultrasound Department, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. of China
| | - Chuandong Wang
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Jiao Tong University School of Medicine & Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, P. R. of China
| | - Xiaofeng Ni
- Ultrasound Department, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. of China
| | - Zhongxin Ni
- Ultrasound Department, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. of China
| | - Yijie Dong
- Ultrasound Department, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. of China
| | - Weiwei Zhan
- Ultrasound Department, Rui Jin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. of China
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27
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Schmidt A, Iglesias L, Klain M, Pitoia F, Schlumberger MJ. Radioactive iodine-refractory differentiated thyroid cancer: an uncommon but challenging situation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:81-89. [PMID: 28225999 PMCID: PMC10522117 DOI: 10.1590/2359-3997000000245] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022]
Abstract
Radioiodine (RAI)-refractory thyroid cancer is an uncommon entity, occurring with an estimated incidence of 4-5 cases/year/million people. RAI refractoriness is more frequent in older patients, in those with large metastases, in poorly differentiated thyroid cancer, and in those tumors with high 18-fluordeoxyglucose uptake on PET/CT. These patients have a 10-year survival rate of less than 10%. In recent years, new therapeutic agents with molecular targets have become available, with multikinase inhibitors (MKIs) being the most investigated drugs. Two of these compounds, sorafenib and lenvatinib, have shown significant objective response rates and have significantly improved the progression-free survival in the two largest published prospective trials on MKI use. However, no overall survival benefit has been achieved yet. This is probably related to the crossover that occurs in most patients who progress on placebo treatment to the open treatment of these studies. In consequence, the challenge is to correctly identify which patients will benefit from these treatments. It is also crucial to understand the appropriate timing to initiate MKI treatment and when to stop it. The purpose of this article is to define RAI refractoriness, to summarize which therapies are available for this condition, and to review how to select patients who are suitable for them.
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Affiliation(s)
- Angelica Schmidt
- Hospital de ClínicasUniversity of Buenos AiresBuenos AiresArgentina Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires Buenos Aires, Argentina
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Laura Iglesias
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michele Klain
- Università Federico II di NapoliNapoliItaliaUniversità Federico II di Napoli, Napoli, Italia
| | - Fabián Pitoia
- Hospital de ClínicasUniversity of Buenos AiresBuenos AiresArgentina Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires Buenos Aires, Argentina
| | - Martin J. Schlumberger
- Institut Gustave RoussyUniversité Paris-SaclayVillejuifFranceInstitut Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Hong CM, Ahn BC. Redifferentiation of Radioiodine Refractory Differentiated Thyroid Cancer for Reapplication of I-131 Therapy. Front Endocrinol (Lausanne) 2017; 8:260. [PMID: 29085335 PMCID: PMC5649198 DOI: 10.3389/fendo.2017.00260] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/20/2017] [Indexed: 01/29/2023] Open
Abstract
Although most differentiated thyroid cancers show excellent prognosis, treating radioiodine refractory differentiated thyroid cancer (RR-DTC) is challenging. Various therapies, including chemotherapy, radiotherapy, and targeted therapy, have been applied for RR-DTC but show limited effectiveness. Redifferentiation followed by radioiodine therapy is a promising alternative therapy for RR-DTC. Retinoic acids, histone deacetylase inhibitors, and peroxisome proliferator-activated receptor-gamma agonists are classically used as redifferentiation agents, and recent targeted molecules are also used for this purpose. Appropriate selection of redifferentiation agents for each patient, using current knowledge about genetic and biological characteristics of thyroid cancer, might increase the efficacy of redifferentiation treatment. In this review, we will discuss the mechanisms of these redifferentiation agents, results of recent clinical trials, and promising preclinical results.
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Affiliation(s)
- Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
- *Correspondence: Byeong-Cheol Ahn,
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Lamartina L, Deandreis D, Durante C, Filetti S. ENDOCRINE TUMOURS: Imaging in the follow-up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach. Eur J Endocrinol 2016; 175:R185-202. [PMID: 27252484 DOI: 10.1530/eje-16-0088] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/31/2016] [Indexed: 12/18/2022]
Abstract
The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is, though, moving toward more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow-up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome.
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Affiliation(s)
- Livia Lamartina
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
| | - Désirée Deandreis
- Department of Nuclear Medicine and Endocrine OncologyGustave Roussy and University Paris Saclay, Villejuif, France
| | - Cosimo Durante
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical SpecialtiesUniversity of Rome Sapienza, Rome, Italy
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30
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Affiliation(s)
- James A Fagin
- From the Department of Medicine and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York (J.A.F.); and the Genetics Branch, National Cancer Institute, Bethesda, MD (S.A.W.)
| | - Samuel A Wells
- From the Department of Medicine and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York (J.A.F.); and the Genetics Branch, National Cancer Institute, Bethesda, MD (S.A.W.)
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31
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Byun BH, Kwon SY, Chong A, Kim J, Yoo SW, Min JJ, Song HC, Bom HHS. Both F-18 FDG-avidity and Malignant Shape of Cervical Lymph Nodes on PET/CT after Total Thyroidectomy Predict Resistance to High-dose I-131 Therapy in Patients with Papillary Thyroid Cancer. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2016; 1:6-13. [PMID: 27408836 PMCID: PMC4937673 DOI: 10.7508/aojnmb.2013.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Resistance of metastatic lymph nodes (LNs) to high dose I-131 therapy is associated with high morbidity in patients with differentiated thyroid cancer. We evaluated the role of F-18 FDG PET/CT in the prediction of resistance to high dose I-131 therapy in patients with papillary thyroid cancer. Methods: The subjects were 307 patients who underwent total or near total thyroidectomy followed by high dose (5.55-6.66 GBq) I-131 therapy. We divided the patients into three subgroups by visual assessment of regional LNs: FDG-avid LNs with a malignant shape on CT (PET/CT-positive group), FDG-avid LNs with a benign shape on CT (PET/CT-intermediate group) and no FDG-avid lesion (PET/CT-negative group). We measured the maximum SUV (SUVmax) of FDG-avid LNs in each patient. The presence or absence of focal increased uptake of I-131 was evaluated by whole body scan (WBS), and was denoted as WBS-positive group or WBS-negative group, respectively. Resistance to therapy was defined as presence of thyroglobulin (Tg) in serum (Tg ≥1.0 ng/ml) 3-6 months after I-131 therapy. Univariate and multivariate analyses were performed to determine the relationship between resistance to I-131 therapy and various clinico-pathologic variables. Results: PET/CT-positive, intermediate, and negative groups included 20 (6.5%), 44 (14.3%) and 243 (79.2%) patients, respectively. The mean SUVmax was significantly higher in the PET/CT-positive group than that of the PET/CT-intermediate group (4.6 vs. 2.7, P <0.001). Univariate analysis revealed that the PET/CT-positive group (P <0.001), T2-4 stage (P <0.001), N1b stage (P = 0.001), lower dose (5.55 GBq) of I-131 (P <0.001), and the WBS-positive group (P = 0.029) were associated with resistance to therapy. In multivariate analysis, the PET/CT-positive group, lower dose of I-131, N1b stage, and T2-4 stage remained significant with odds ratios of 10.07 (P <0.001), 3.82 (P <0.001), 3.58 (P = 0.001), and 2.53 (P = 0.009), respectively. Conclusion: FDG-avidity and malignant shape of cervical LNs on pre-therapy FDG PET/CT were a strong risk factors predicting resistance to high dose I-131 therapy. A lower dose of administered I-131 (5.55 GBq) and more extensive tumors (T2-4 and N1b) were also associated with resistance to high dose I-131 therapy.
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Affiliation(s)
- Byung Hyun Byun
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, Republic of Korea; President, AOFNMB
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Abstract
Well differentiated thyroid cancer (DTC) in children is characterized by a high rate of response to treatment and low disease-specific mortality. Treatment of children with DTC has evolved toward a greater reliance on evaluation and monitoring with serial serum thyroglobulin measurements and ultrasound examinations. Radioiodine therapy is recommended for thyroid remnant ablation in high-risk patients, treatment of demonstrated radioiodine-avid local-regional disease not amenable to surgical resection, or distant radioiodine-avid metastatic disease. Sufficient time should be given for benefits of radioiodine therapy to be realized, with follow-up monitoring. Re-treatment with radioiodine can be deferred until progression of significant disease manifests.
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Affiliation(s)
- Josef Machac
- Nuclear Medicine, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, Box 1141, 1 Gustave Levy Place, New York, NY 10029, USA.
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Triviño Ibáñez EM, Muros MA, Torres Vela E, Llamas Elvira JM. The role of early 18F-FDG PET/CT in therapeutic management and ongoing risk stratification of high/intermediate-risk thyroid carcinoma. Endocrine 2016. [PMID: 26224589 DOI: 10.1007/s12020-015-0708-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little is known about the role in ongoing risk stratification of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) performed early after radioactive iodine (RAI) ablation in differentiated thyroid carcinoma (DTC). The aim of the study is to investigate whether 18F-FDG PET/CT performed early after RAI ablation is useful to detect disease and to influence therapy and ongoing risk stratification. Patients with high/intermediate risk of recurrent DTC were included. 18F-FDG PET/CT scan was performed within 6 months after RAI ablation. We confirmed results with other imaging techniques, pathology reports, or follow-up. We classified the patient response as excellent, acceptable, or incomplete. Modified Hicks criteria were used to evaluate clinical impact. We included 81 patients with high/intermediate risk of recurrent DTC. Forty-one (50.6%) had positive uptake in 18F-FDG PET/CT, with negative (131)I whole-body scan ((131)I WBS). Sensitivity, specificity, and diagnostic accuracy of 18F-FDG PET/CT were 92.5, 90.2, and 91.4%, respectively. 18F-FDG PET/CT results had an impact on therapy in 38.3% of patients. One year after initial therapy, 45.7% showed excellent response, 8.6% acceptable response, and 45.7% incomplete response. A statistically significant relationship was found between negative 18F-FDG PET/CT and excellent response (80 vs. 12.2%, p < 0.001; OR 52.8). 18F-FDG PET/CT scan performed early in surveillance of patients with high/intermediate-risk thyroid carcinoma provides important additional information not available with conventional follow-up methods and had a high impact on therapy. A negative 18F-FDG PET/CT predicts an excellent response to therapy in the new ongoing risk stratification.
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Affiliation(s)
- E M Triviño Ibáñez
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Granada, Spain.
| | - M A Muros
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - E Torres Vela
- Department of Endocrinology and Metabolism, San Cecilio University Hospital, Granada, Spain
| | - J M Llamas Elvira
- Department of Nuclear Medicine, Virgen de las Nieves University Hospital, Granada, Spain
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Abstract
The incidence of thyroid cancer has been increasing. After total thyroidectomy of well-differentiated thyroid tumors with intermediate- or high-risk features on pathology, radioiodine remains one of the mainstays of therapy for both thyroid remnant ablation as well as for treatment of metastatic disease. SPECT/CT, a relatively new modality, has been shown to play a pivotal role predominantly in the post-therapy setting by changing the risk stratification of patients with thyroid cancer. In the case of radioiodine treatment failure, FDG-PET/CT may provide prognostic information based on extent and intensity of metabolically active metastatic sites as well as serve as an important imaging test for response assessment in patients treated with chemotherapy, targeted therapies, or radiotherapy, thereby affecting patient management in multiple ways. The role of newer redifferentiation drugs has been evaluated with the use of I-124 PET/CT.
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Affiliation(s)
- Ravinder K Grewal
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Alan Ho
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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35
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Mauri G, Cova L, Ierace T, Baroli A, Di Mauro E, Pacella CM, Goldberg SN, Solbiati L. Treatment of Metastatic Lymph Nodes in the Neck from Papillary Thyroid Carcinoma with Percutaneous Laser Ablation. Cardiovasc Intervent Radiol 2016; 39:1023-30. [PMID: 26911732 DOI: 10.1007/s00270-016-1313-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the effectiveness of percutaneous laser ablation (PLA) of cervical lymph node metastases from papillary thyroid carcinoma. MATERIALS AND METHODS 24 patients (62.3 ± 13.2 year; range 32-80) previously treated with thyroidectomy, neck dissection, and radioiodine ablation underwent ultrasound-guided PLA of 46 (18)FDG-PET/CT-positive metachronous nodal metastases. All patients were at high surgical risk or refused surgery and were unsuitable for additional radioiodine ablation. A 300 µm quartz fiber and a continuous-wave Nd-YAG laser operating at 1.064 mm were used. Technical success, rate of complications, rate of serological conversion, and local control at follow-up were derived. Fisher's exact test and Mann-Whitney U test were used and Kaplan-Meier curve calculated. RESULTS Technical success was obtained in all 46 lymph nodes (100 %). There were no major complications. Thyroglobulin levels decreased from 8.40 ± 9.25 ng/ml before treatment to 2.73 ± 4.0 ng/ml after treatment (p = 0.011), with serological conversion in 11/24 (45.8 %) patients. Overall, local control was obtained in 40/46 (86.9 %) lymph nodes over 30 ± 11 month follow-up, with no residual disease seen at imaging in 19/24 (79.1 %) patients. Local control was achieved in 40/46 (86.9 %) lymph nodes at 1 year and in all of the 25 nodes (100 %) followed for 3 years. Estimated mean time to progression was 38.6 ± 2.7 m. CONCLUSION Ultrasound-guided PLA is a feasible, safe, and effective therapy for the treatment of cervical lymph node metastases from papillary thyroid carcinoma.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, Milan, Italy. .,Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Milano, Italy.
| | - Luca Cova
- Unit of Interventional Oncology, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | - Tiziana Ierace
- Unit of Interventional Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Alberto Baroli
- Department of Nuclear Medicine, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | - Enzo Di Mauro
- Department of Nuclear Medicine, General Hospital of Busto Arsizio, Busto Arsizio, Italy
| | | | - Shraga Nahum Goldberg
- Image-guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Luigi Solbiati
- Unit of Interventional Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.,Humanitas Research Hospital, Humanitas University, Milan, Italy
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8327] [Impact Index Per Article: 1040.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Kiess AP, Agrawal N, Brierley JD, Duvvuri U, Ferris RL, Genden E, Wong RJ, Tuttle RM, Lee NY, Randolph GW. External-beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society. Head Neck 2015; 38:493-8. [PMID: 26716601 DOI: 10.1002/hed.24357] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/04/2015] [Indexed: 01/03/2023] Open
Abstract
The use of external-beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) is debated because of a lack of prospective clinical data, but recent retrospective studies have reported benefits in selected patients. The Endocrine Surgery Committee of the American Head and Neck Society provides 4 recommendations regarding EBRT for locoregional control in DTC, based on review of literature and expert opinion of the authors. (1) EBRT is recommended for patients with gross residual or unresectable locoregional disease, except for patients <45 years old with limited gross disease that is radioactive iodine (RAI)-avid. (2) EBRT should not be routinely used as adjuvant therapy after complete resection of gross disease. (3) After complete resection, EBRT may be considered in select patients >45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. (4) Cervical lymph node involvement alone should not be an indication for adjuvant EBRT.
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Affiliation(s)
- Ana P Kiess
- Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Nishant Agrawal
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - James D Brierley
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric Genden
- Department of Otolaryngology, Mount Sinai Hospital, New York, New York
| | - Richard J Wong
- Department of Surgery - Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Department of Medicine - Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory W Randolph
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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Vaisman F, Carvalho DP, Vaisman M. A new appraisal of iodine refractory thyroid cancer. Endocr Relat Cancer 2015; 22:R301-10. [PMID: 26307020 DOI: 10.1530/erc-15-0300] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/12/2022]
Abstract
Thyroid cancer incidence is increasing all over the world - mostly due to an increase in the detection of small tumors that were previously undetected. A small percentage of these tumors lose the ability to uptake and/or to respond to radioiodine (RAI) therapy, especially in metastatic patients. There are several new therapeutic options that have emerged in the last 5 years to treat RAI refractory thyroid cancer patients, however, it is very important to properly identify RAI refractory patients and to clarify those appropriate for these treatments. In this review, we discuss the RAI refractory definitions and the criteria that have been suggested based on RAI uptake in the post therapy scan, as well as the response after RAI therapy and the possible molecular mechanisms involved in this process. We offer a review of the therapeutic options available at the moment and the therapeutic considerations based on a patient's individualized personal characteristics, primary tumor histology, tumor burden and location and velocity of lesion growth.
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Affiliation(s)
- Fernanda Vaisman
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Denise P Carvalho
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Mario Vaisman
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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Daignault CP, Palmer EL, Scott JA, Swan JS, Daniels GH. Papillary Thyroid Carcinoma Metastasis to the Lumbar Spine Masquerading as a Schmorl's Node. Nucl Med Mol Imaging 2015; 49:217-22. [PMID: 26279695 DOI: 10.1007/s13139-015-0320-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 11/26/2022] Open
Abstract
A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.
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Affiliation(s)
- Cory P Daignault
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA ; Department of Radiology, Division of Nuclear Medicine, UMass Memorial Medical Center, 55 Lake Ave N, Worcester, MA 01655 USA
| | - Edwin L Palmer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - James A Scott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - John S Swan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Gilbert H Daniels
- Thyroid Unit and Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
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Traub-Weidinger T, Putzer D, von Guggenberg E, Dobrozemsky G, Nilica B, Kendler D, Bale R, Virgolini IJ. Multiparametric PET imaging in thyroid malignancy characterizing tumour heterogeneity: somatostatin receptors and glucose metabolism. Eur J Nucl Med Mol Imaging 2015; 42:1995-2001. [DOI: 10.1007/s00259-015-3114-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 06/10/2015] [Indexed: 01/22/2023]
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Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015; 25:716-59. [PMID: 25900731 PMCID: PMC4854274 DOI: 10.1089/thy.2014.0460] [Citation(s) in RCA: 687] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Affiliation(s)
- Gary L. Francis
- Division of Pediatric Endocrinology, Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, Virginia
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Salvatore Benvenga
- University of Messina, Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Janete M. Cerutti
- Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Catherine A. Dinauer
- Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Hamilton
- Division of Endocrinology, University of Toronto, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian D. Hay
- Division of Endocrinology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Markus Luster
- University of Marburg, Marburg, Germany
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Department of Radiology, Seattle, Washington
| | - Marianna Rachmiel
- Pediatric Division, Assaf Haroffeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geoffrey B. Thompson
- Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic, Rochester, Minnesota
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Shinto AS, Kamaleshwaran KK, Mallia M, Korde A, Samuel G, Banerjee S, Velayutham P, Damodharan S, Sairam M. Utility of (99m)Tc-Hynic-TOC in 131I Whole-Body Scan Negative Thyroid Cancer Patients with Elevated Serum Thyroglobulin Levels. World J Nucl Med 2015; 14:101-8. [PMID: 26097420 PMCID: PMC4455165 DOI: 10.4103/1450-1147.154229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several studies have reported on the expression of somatostatin receptors (SSTRs) in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate the imaging abilities of a recently developed Technetium-99m labeled somatostatin analog, (99m)Tc-Hynic-TOC, in terms of precise localization of the disease. The study population consisted of 28 patients (16 men, 12 women; age range: 39-72 years) with histologically confirmed DTC, who presented with recurrent or persistent disease as indicated by elevated serum thyroglobulin (Tg) levels after initial treatment (serum Tg > 10 ng/ml off T4 suppression for 4-6 weeks). All patients were negative on the Iodine-131 posttherapy whole-body scans. Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) was performed in all patients. SSTR scintigraphy was true positive in 23 cases (82.1%), true negative in two cases (7.1%) and false negative in three cases (10.7%) which resulted in a sensitivity of 88.46%, specificity of 100% and an accuracy of 89.2%. Sensitivity of (99m)Tc-Hynic-TOC scan was higher (93.7%) for patients with advanced stages, that is stages III and IV. (18)F-FDG showed a sensitivity of 93.7%, a specificity of 50% and an accuracy of 89.3%. (18)F-FDG PET was found to be more sensitive, with lower specificity due to false positive results in 2 patients. Analysis on a lesion basis demonstrated substantial agreement between the two imaging techniques with a Cohen's kappa of 0.66. Scintigraphy with (99m)Tc-Hynic-TOC might be a promising tool for treatment planning; it is easy to perform and showed sufficient accuracy for localization diagnostics in thyroid cancer patients with recurrent or metastatic disease.
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Affiliation(s)
- Ajit S Shinto
- Department of Nuclear Medicine, KMCH, Coimbatore, Tamil Nadu, India
| | | | - Madhav Mallia
- Isotope Application and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
| | - Aruna Korde
- Isotope Application and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
| | - Grace Samuel
- Isotope Application and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
| | - Sharmila Banerjee
- Isotope Application and Radiopharmaceuticals Division, BARC, Mumbai, Maharashtra, India
| | | | | | - Madhu Sairam
- Department of Nuclear Medicine, KMCH, Coimbatore, Tamil Nadu, India
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Kim H, Na KJ, Choi JH, Ahn BC, Ahn D, Sohn JH. Feasibility of FDG-PET/CT for the initial diagnosis of papillary thyroid cancer. Eur Arch Otorhinolaryngol 2015; 273:1569-76. [PMID: 25971994 DOI: 10.1007/s00405-015-3640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/26/2015] [Indexed: 12/26/2022]
Abstract
To assess the role of [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) as a preoperative diagnostic tool in papillary thyroid carcinoma (PTC). From 2011 to 2014, 197 patients with PTC (246 tumor foci in all) underwent FDG-PET. Among these patients, 46 underwent neck dissection for lateral neck metastasis. According to the FDG avidity of the tumor foci or lateral neck metastasis, factors associated with the prognostic value were evaluated by univariate and multivariate logistic regression analyses. Among the 197 patients, 7 (3.6 %) were incidentally found to have non-thyroid origin malignancy. Additionally, 63.0 % (155/246) of PTC foci showed FDG uptake on PET/CT. Univariate analysis showed that the tumor size, the presence of extrathyroidal extension, BRAF mutation, and Hashimoto thyroiditis were associated with FDG avidity. However, except for pathological extrathyroidal extension, the other factors showed statistically significant correlations with FDG avidity (p < 0.001, p = 0.008, and p = 0.009, respectively). FDG uptake in lateral neck node metastasis showed high specificity and negative predictive value (NPV). In four cases of nonspecific findings on ultrasonography (USG)/CT, FDG avidity was helpful to diagnose the presence of lateral neck metastasis. The maximum standardized uptake value (SUVmax) of PET/CT was correlated with the maximum diameter of the involved lateral node. FDG avidity did not show any significance in the recurrence-free survival of both the thyroid tumor and lateral neck metastasis. The FDG avidity of PTC did not show prognostic predictive meaning. However, in the case of lateral neck metastasis, FDG avidity showed high sensitivity and NPV, and could provide better information in cases of nonspecific findings on USG and CT.
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Affiliation(s)
- Heejin Kim
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Kyung Jin Na
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jae Hyuk Choi
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Dongbin Ahn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea
| | - Jin Ho Sohn
- Department of Otorhinolaryngology, Kyungpook National University College of Medicine, 200 Dongdukro, Junggu, Daegu, Republic of Korea.
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Worden F. Treatment strategies for radioactive iodine-refractory differentiated thyroid cancer. Ther Adv Med Oncol 2014; 6:267-79. [PMID: 25364392 PMCID: PMC4206652 DOI: 10.1177/1758834014548188] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Until recently, no truly effective treatment options have existed for patients with radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC), a serious disease with poor prognosis. In November 2013, the targeted multikinase inhibitor, sorafenib, was approved for use in these patients based on substantially improved progression-free survival compared with placebo. A number of other targeted agents, including lenvatinib, are being investigated in phase II and phase III trials. With the advent of these new treatment options, practitioners are faced with making important decisions in determining which patients are candidates for systemic treatment and the optimal timing for treatment initiation. Since patients may remain asymptomatic for a protracted period of time, tumor size and growth rate are the primary considerations for making these choices. Proactive management of side effects is also critical in optimizing the effectiveness of treatment. Here we review targeted systemic agents that are either in use or are under investigation for RAI-refractory DTC and provide recommendations on the rationale for initiating systemic treatment and on managing adverse events. Four illustrative case studies are provided.
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Affiliation(s)
- Francis Worden
- University of Michigan Health System, Departments of Internal Medicine and Oncology, 1500 E Medical Center Dr SPC 5912, Ann Arbor, MI 48109, USA
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The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level. Ann Nucl Med 2014; 28:970-9. [PMID: 25120245 DOI: 10.1007/s12149-014-0897-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
Abstract
AIM In the follow-up of differentiated thyroid cancer (DTC) after a successful total-near total thyroidectomy and I-131 ablation therapy, anti-thyroglobulin antibodies (anti-Tg) may be persistently or progressively increased in the patients with an undetectable serum thyroglobulin (Tg) level. In these cases, further investigation was performed to search for recurrence/metastases. The aim of our study was clarifying the role of FDG-PET/CT in detecting recurrence/metastasis in patients with DTC with negative serum Tg and elevated anti-Tg level. MATERIALS AND METHODS A total of 40 patients (32 female, 8 male; mean age: 43.15 years (22-65); mean age at diagnosis: 39.08 (16-64)) with DTC who had undetectable serum Tg and elevated anti-Tg level after a successful initial therapy were included in the study. All of the patients had serum anti-Tg of >40 IU/ml and underwent FDG-PET/CT to search for recurrence/metastasis. RESULTS Twenty patients (50 %) had recurrence/metastasis on FDG-PET/CT while the other 20 had no pathologic findings. Of the 20 patients who had positive FDG-PET/CT, 12 had a histopathological final diagnosis of which 11 were true positive (TP) and 1 was false positive (FP). On the other hand, 16 of the 40 patients had a histopathological final diagnosis of which 11/16 had TP, 1/16 FP, 3/16 false negative (FN) and 1/16 true negative (TN) findings by PET/CT. The final diagnosis was made by clinical follow-up in the remaining 24 patients. Of these, 8 patients were PET positive, and in 1 (12.5 %) of 8 patients a decrease in serum anti-Tg level, in 2 (25 %) patients a saw-toothed pattern and in 5 (62.5 %) a progressive increase in the serum anti-Tg level were noted during the follow-up. Of the 16 of 24 patients who were diagnosed by clinical follow-up, in 8 a (50 %) decrease in serum anti-Tg level, in 6 (37.5 %) a saw-toothed pattern, and in 2 (12.5 %) a progressively increased anti-Tg level was seen. Of the 40 patients, 14 (35 %) had a diagnosis of recurrence/metastasis finally, with PET/CT detecting 11 (78.6 %) of them. CONCLUSION The value of a persistently or progressively increased serum anti-Tg level in the follow-up of DTC in the prediction of recurrence/metastasis is controversial. However, it is reported that FDG-PET can be useful in the detection of recurrence/metastasis. We conclude from the available data that PET/CT can be effectively used in the detection of recurrence/metastasis in the follow-up of patients with DTC and negative serum Tg and a persistently/progressively increased anti-Tg level. Besides, one half of the patients were FDG negative, meaning that further studies are needed to assess the prognostic-clinical value of PET negativity.
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Papini E, Pacella CM, Misischi I, Guglielmi R, Bizzarri G, Døssing H, Hegedus L. The advent of ultrasound-guided ablation techniques in nodular thyroid disease: towards a patient-tailored approach. Best Pract Res Clin Endocrinol Metab 2014; 28:601-18. [PMID: 25047209 DOI: 10.1016/j.beem.2014.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Surgery is the long-established therapeutic option for benign thyroid nodules, which steadily grow and become symptomatic. The cost of thyroid surgery, the risk of temporary or permanent complications, and the effect on quality of life, however, remain relevant concerns. Therefore, various minimally invasive treatments, directed towards office-based management of symptomatic nodules, without requiring general anaesthesia, and with negligible damage to the skin and cervical tissues, have been proposed during the past two decades. Today, ultrasound-guided percutaneous ethanol injection and thermal ablation with laser or radiofrequency have been thoroughly evaluated, and are accessible procedures in specialized centres. In clinical practice, relapsing thyroid cysts are effectively managed with percutaneous ethanol injection treatment, which should be considered therapy of choice. In solid non-functioning thyroid nodules that grow or become symptomatic, trained operators may safely induce, with a single session of laser ablation treatment or radiofrequency ablation, a 50% volume decrease and, in parallel, improve local symptoms. In contrast, hyperfunctioning nodules remain best treated with radioactive iodine, which results in a better control of hyperthyroidism, also in the long-term, and fewer side-effects. Currently, minimally invasive treatment is also investigated for achieving local control of small size neck recurrences of papillary thyroid carcinoma in patients who are poor candidates for repeat cervical lymph node dissection. This particular use should still be considered experimental.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy.
| | - Claudio M Pacella
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Giancarlo Bizzarri
- Department of Diagnostic Imaging, Ospedale Regina Apostolorum, Albano, Rome, Italy
| | - Helle Døssing
- Department of ENT Surgery, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedus
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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Romesser PB, Sherman EJ, Shaha AR, Lian M, Wong RJ, Sabra M, Rao SS, Fagin JA, Tuttle RM, Lee NY. External beam radiotherapy with or without concurrent chemotherapy in advanced or recurrent non-anaplastic non-medullary thyroid cancer. J Surg Oncol 2014; 110:375-82. [PMID: 24961938 PMCID: PMC10152973 DOI: 10.1002/jso.23656] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/26/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To review clinical outcomes and toxicities in locally advanced differentiated thyroid cancer patients treated with external beam radiotherapy (EBRT) with or without concurrent chemotherapy (CCRT). METHODS Between 1990 and 2012, 66 patients with gross residual/unresectable non-anaplastic non-medullary thyroid cancer were treated with EBRT. RESULTS The median overall survival was 42.0 months. The overall locoregional progression-free survival (LPFS) at 3 years was 77.3%. CCRT resulted in a non-significant improvement in LPFS (90.0% vs. 73.0%, P = 0.347). Poorly differentiated histology had significantly improved LPFS (89.4% vs. 66.1%, P = 0.020), despite a significantly worse distant metastasis-free survival (43.9% vs. 82.5%, P = 0.023). Acute treatment-related toxicity included dermatitis, mucositis, and dysphagia with grade three rates of 12.1%, 19.7%, and 16.7%, respectively. The incidence of late toxicity was low. CCRT was only associated with a significant greater rate of acute grade 3 hoarseness (10.0% vs. 0.0%, P = 0.033), but with no difference in the rate of grade 2 late toxicity. CONCLUSIONS EBRT is a safe and effective treatment modality with 90% LPFS at 3 years in patients with gross residual or unresectable non-anaplastic, non-medullary thyroid carcinoma treated with CCRT. Further incorporation of EBRT with concurrent chemotherapy may result in improved disease control.
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Affiliation(s)
- Paul B. Romesser
- Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York NY
| | - Eric J. Sherman
- Department of Medicine; Head and Neck Division; Memorial Sloan Kettering Cancer Center; New York NY
| | - Ashok R. Shaha
- Department of Surgery; Memorial Sloan Kettering Cancer Center; New York NY
| | - Ming Lian
- Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York NY
| | - Richard J. Wong
- Department of Surgery; Memorial Sloan Kettering Cancer Center; New York NY
| | - Mona Sabra
- Department of Medicine, Endocrine Service; Memorial Sloan Kettering Cancer Center; New York NY
| | - Shyam S. Rao
- Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York NY
| | - James A. Fagin
- Department of Medicine, Endocrine Service; Memorial Sloan Kettering Cancer Center; New York NY
| | - R. Michael Tuttle
- Department of Medicine, Endocrine Service; Memorial Sloan Kettering Cancer Center; New York NY
| | - Nancy Y. Lee
- Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York NY
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Farwell MD, Pryma DA, Mankoff DA. PET/CT imaging in cancer: current applications and future directions. Cancer 2014; 120:3433-45. [PMID: 24947987 DOI: 10.1002/cncr.28860] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 12/22/2022]
Abstract
Positron emission tomography (PET) is a radiotracer imaging method that yields quantitative images of regional in vivo biology and biochemistry. PET, now used in conjunction with computed tomography (CT) in PET/CT devices, has had its greatest impact to date on cancer and is now an important part of oncologic clinical practice and translational cancer research. In this review of current applications and future directions for PET/CT in cancer, the authors first highlight the basic principles of PET followed by a discussion of the biochemistry and current clinical applications of the most commonly used PET imaging agent, (18) F-fluorodeoxyglucose (FDG). Then, emerging methods for PET imaging of other biologic processes relevant to cancer are reviewed, including cellular proliferation, tumor hypoxia, apoptosis, amino acid and cell membrane metabolism, and imaging of tumor receptors and other tumor-specific gene products. The focus of the review is on methods in current clinical practice as well as those that have been translated to patients and are currently in clinical trials.
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Affiliation(s)
- Michael D Farwell
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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