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Malamitsi JV, Koutsikos JT, Giourgouli SI, Zachaki SF, Pipikos TA, Vlachou FJ, Prassopoulos VK. I-131 Postablation SPECT/CT Predicts Relapse of Papillary Thyroid Carcinoma more Accurately than Whole Body Scan. In Vivo 2019; 33:2255-2263. [PMID: 31662565 DOI: 10.21873/invivo.11731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the study was to prospectively compare I-131 postablation Whole Body scan (WBS) and Single Photon Emission Computerized Tomography/Computerized Tomography (SPECT/CT) scan on thyroid cancer patients. PATIENTS AND METHODS Overall, 58 patients with papillary thyroid carcinoma were submitted to total thyroidectomy and I-131 remnant ablation. Post-ablation WBS and SPECT/CT scans performed on the same day were compared. Results of SPECT/CT were confirmed by neck and upper mediastinum ultrasound scan and on specific cases by a fully diagnostic CT scan, other tests and definitive histology acting as the gold standard. A total of 36/58 patients were followed-up for 5 years to detect relapse. RESULTS Mac Nemar Chi square and Fisher's exact tests disclosed statistically significant differences between WBS and SPECT/CT scan, concerning cervical lymphadenopathy detection (p=0.031) and relapse prediction by NM stage (p=0.033), respectively; SPECT/CT was more accurate in both comparisons. CONCLUSION In papillary thyroid carcinoma I-131 post-ablation SPECT/CT scan detects cervical lymphadenopathy and predicts relapse by NM stage more accurately than WBS.
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Affiliation(s)
- Julia V Malamitsi
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John T Koutsikos
- Department of Nuclear Medicine, Army Share Fund Hospital (417 NIMTS), Athens Greece and Department of Nuclear Medicine, Henry Dunant Hospital Centre, Athens, Greece
| | - Stamatia I Giourgouli
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia F Zachaki
- Laboratory of Health Physics, Radiobiology and Cytogenetics, National Centre for Scientific Research (NCSR) "Demokritos", Athens, Greece
| | | | - Fani J Vlachou
- Nuclear Medicine Department, Hygeia Hospital, Maroussi, Greece
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Khatami F, Larijani B, Heshmat R, Nasiri S, Saffar H, Shafiee G, Mossafa A, Tavangar SM. Promoter Methylation of Four Tumor Suppressor Genes in Human Papillary Thyroid Carcinoma. IRANIAN JOURNAL OF PATHOLOGY 2019; 14:290-298. [PMID: 31754358 PMCID: PMC6824767 DOI: 10.30699/ijp.2019.94401.1922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 07/27/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND & OBJECTIVE Papillary thyroid cancer (PTC) is considered to be the most common type of thyroid malignancies. Epigenetic alteration, in which the chromatin conformation and gene expression change without changing the sequence of DNA, can occur in some tumor suppressor genes and oncogenes. Methylation is the most common type of epigenetic alterations that can be an excellent indicator of PTC invasive behavior. METHODS In this research, we determined the promoter methylation status of four tumor suppressor genes (SLC5A8, RASSF1, MGMT, and DNMT1) and compared the results of 55 PTC cases with 40 goiter patients. For methylation, we used the methylation-sensitive high resolution melting (MS-HRM) assay technique. The resulting graphs of each run were compared with those of 0%, 50%, and 100% methylated controls. RESULTS Our data showed that the promoter methylation of SLC5A8, Ras association domain family member 1(RASSF1), and MGMT were significantly different between PTC tissue and goiter with P-value less than 0.05. The most significant differences were observed in RASSF1; 77.2% of hyper-methylated PTC patients versus 15.6% hyper-methylated goiter samples (P<0.001). CONCLUSION RASSF1 promoter methylation can be a PTC genetic marker. RASSF1 promoter methylation is under the impact of the methyltransferase genes (DNMT1 and MGMT), protein expression, and promoter methylation.
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Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nasiri
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Mossafa
- Department of Surgery, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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3
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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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4
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Pacini F, Brianzoni E, Durante C, Elisei R, Ferdeghini M, Fugazzola L, Mariotti S, Pellegriti G. Recommendations for post-surgical thyroid ablation in differentiated thyroid cancer: a 2015 position statement of the Italian Society of Endocrinology. J Endocrinol Invest 2016; 39:341-7. [PMID: 26264386 PMCID: PMC4761012 DOI: 10.1007/s40618-015-0375-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/28/2015] [Indexed: 02/08/2023]
Abstract
UNLABELLED Post-surgical ablation of thyroid remnant with radioactive iodine (RAI) in differentiated thyroid cancer (DTC) is aimed to destroy any thyroid remnant in the thyroid bed (remnant ablation) and any microscopic foci of cancer cells eventually present within the thyroid remnant (adjuvant therapy). The present text is an attempt to offer practice guidelines for the indication of thyroid ablation and the preparation of DTC patients considering the latest achievement in the field and the changing epidemiology of DTC observed in the last 10 years. METHODOLOGY The executive committee of the Italian Society of Endocrinology appointed a task force of thyroid cancer expert including Nuclear Medicine Physicians and Endocrinologists to provide a consensus on the post-surgical ablation in thyroid cancer patients. The task force had no conflict of interest and had no commercial support. A number of specific topics were selected and the members selected relevant papers by searching in the Pubmed for articles published from 2000 to January 2015. Selected studies were categorized by level of evidence, and the recommendations were graded according to the level of evidence as high (A), moderate (B), or low (C).
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Affiliation(s)
- F Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.
- Department of Endocrinology, University of Siena, Via Bracci, 53100, Siena, Italy.
| | - E Brianzoni
- Nuclear Medicine Unit, Ospedale Civile di Macerata, Macerata, Italy
| | - C Durante
- Department of Internal Medicine and Medical Specialties, University of Rome Sapienza, Rome, Italy
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Ferdeghini
- Nuclear Medicine Unit, University of Verona, Verona, Italy
| | - L Fugazzola
- Endocrine Unit, Fondazione IRCCS Ca' Granda Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - S Mariotti
- Department Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - G Pellegriti
- Endocrinology Division, Garibaldi Nesima Hospital, Palermo, Italy
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5
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Ain KB. Radioiodine-remnant ablation in low-risk differentiated thyroid cancer: pros. Endocrine 2015; 50:61-6. [PMID: 26109472 DOI: 10.1007/s12020-015-0668-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/13/2015] [Indexed: 12/17/2022]
Abstract
Differentiated thyroid carcinomas are typically treated with total thyroidectomy as initial therapy. Subsequent radioactive iodine (RAI) ablation destroys post-surgical thyroid remnants, can additionally provide adjuvant therapy of residual and metastatic thyroid cancers, and enhances the sensitivity and specificity of further diagnostic studies. There is current controversy regarding whether a large number of patients, broadly considered to have "low-risk" disease, should be provided RAI ablation. This is consequent to over-reliance on short-term studies, under-appreciation of the value of RAI remnant ablation, and inflation of the side effects of RAI therapy. A balanced assessment of all of these issues provides justification to utilize post-surgical radioiodine ablation, even in cases that are considered low risk on the basis of surgical findings.
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Affiliation(s)
- Kenneth B Ain
- Thyroid Oncology Program, Markey Cancer Center, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA,
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6
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Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA. Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab 2015; 100:1529-36. [PMID: 25642591 PMCID: PMC4399282 DOI: 10.1210/jc.2014-4332] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients. OBJECTIVE The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients. DESIGN/SETTING Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study. PATIENTS Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded. MAIN OUTCOME MEASURES Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured. RESULTS A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs 128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016). CONCLUSION This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.
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Affiliation(s)
- Ewa Ruel
- Department of Medicine (E.R., J.M.P.), Division of Endocrinology, Metabolism, and Nutrition, Department of Surgery (J.A.S.), Section of Endocrine Surgery, Duke University Medical Center, and Duke Cancer Institute (J.A.S.), Durham, North Carolina 27710; Department of Biostatistics (S.T.), Duke University, Durham, North Carolina 27708; and Duke Clinical Research Institute (M.D., J.A.S.), Durham, North Carolina 27705
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Luster M, Weber T, Verburg FA. Differentiated thyroid cancer-personalized therapies to prevent overtreatment. Nat Rev Endocrinol 2014; 10:563-74. [PMID: 24981455 DOI: 10.1038/nrendo.2014.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The concept of individualized therapy is rapidly gaining recognition in the management of patients with differentiated thyroid cancer (DTC). This Review provides an overview of the most important elements of this paradigm shift in DTC management and discusses the implications for clinical practice. In the majority of patients with DTC who have an inherently good prognosis, the extent of surgery, the dosage of (131)I therapy and the use of levothyroxine therapy are all aspects suitable for individualization, on the basis of both the stage of disease and the response to treatment. In individuals with advanced disease, newer imaging techniques, advances in (131)I therapy and the use of targeted molecular therapies (such as multitargeted kinase inhibitors) have provided new options for the personalized care of patients, for whom until recently no effective therapies were available. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of (131)I treatment, and major salivary gland damage, a common and unpleasant side effect of (131)I therapy. Highly individualized interdisciplinary treatment of patients with DTC might lead to improved outcomes with reduced severity and frequency of complications and adverse effects. However, in spite of ongoing research, personalized therapies remain in their infancy.
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Affiliation(s)
- Markus Luster
- University Hospital Giessen and Marburg, Department of Nuclear Medicine, Baldingerstrasse, 35033 Marburg, Germany
| | - Theresia Weber
- University Hospital Ulm, Department of Surgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Frederik A Verburg
- University Hospital Aachen, Department of Nuclear Medicine, Paulelsstrasse 30, 52074 Aachen, Germany
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Khorjekar GR, Van Nostrand D, Garcia C, O'Neil J, Moreau S, Atkins FB, Mete M, Orquiza MH, Burman K, Wartofsky L. Do negative 124I pretherapy positron emission tomography scans in patients with elevated serum thyroglobulin levels predict negative 131I posttherapy scans? Thyroid 2014; 24:1394-9. [PMID: 24820222 PMCID: PMC4148053 DOI: 10.1089/thy.2013.0713] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The management of patients with differentiated thyroid cancer (DTC) who have elevated serum thyroglobulin (Tg) levels and negative (131)I or (123)I scans is problematic, and the decision regarding whether or not to administer (131)I therapy (a "blind" therapy) is also problematic. While (124)I positron emission tomography (PET) imaging has been shown to detect more foci of residual thyroid tissue and/or metastases secondary to DTC than planar (131)I images, the utility of a negative (124)I PET scan in deciding whether or not to consider performing blind (131)I therapy is unknown. The objective of this study was to determine whether a negative (124)I pretherapy PET scan in patients with elevated serum Tg levels and negative (131)I or (123)I scans predicts a negative (131)I posttherapy scan. METHODS Several prospective studies have been performed to compare the radiopharmacokinetics of (124)I PET versus (131)I planar imaging in patients who 1) had histologically proven DTC, 2) were suspected to have metastatic DTC (e.g., elevated Tg, positive recent fine-needle aspiration cytology, suspicious enlarging mass), and 3) had (131)I planar and (124)I PET imaging performed. Using these criteria, we retrospectively identified patients who had an elevated Tg, a negative diagnostic (131)I/(123)I scan, a negative diagnostic (124)I PET scan, therapy with (131)I, a post-therapy (131)I scan, and a prior (131)I therapy with a subsequent positive post-(131)I therapy scan. For each scan, two readers categorized every focus of (131)I and (124)I uptake as positive for thyroid tissue/metastases or physiological. RESULTS Twelve patients met the above criteria. Ten of these 12 patients (83%) had positive foci on (131)I posttherapy scan. CONCLUSION In our selected patient population, (131)I posttherapy scans are frequently positive in patients with elevated serum Tg levels, a negative diagnostic (131)I or (123)I scan, and a negative (124)I PET scan. Thus, for a patient with elevated serum Tg level, negative diagnostic (131)I planar scan, and a prior post-(131)I therapy scan that was positive, a negative (124)I PET scan will have a low predictive value for a negative post-(131)I therapy scan and should not be used to exclude the option of blind (131)I therapy.
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Affiliation(s)
- Gauri R. Khorjekar
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Douglas Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Carlos Garcia
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jeffrey O'Neil
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Shari Moreau
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Francis B. Atkins
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Mihriye Mete
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC
| | - Michael H. Orquiza
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kenneth Burman
- Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Leonard Wartofsky
- Department of Medicine at the MedStar Washington Hospital Center, Washington, DC
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Gholami S, Chen CH, Lou E, Belin LJ, Fujisawa S, Longo VA, Chen NG, Gönen M, Zanzonico PB, Szalay AA, Fong Y. Vaccinia virus GLV-1h153 in combination with 131I shows increased efficiency in treating triple-negative breast cancer. FASEB J 2013; 28:676-82. [PMID: 24186964 DOI: 10.1096/fj.13-237222] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We investigated the therapeutic efficacy of a replication-competent oncolytic vaccinia virus, GLV-1h153, carrying human sodium iodide symporter (hNIS), in combination with radioiodine in an orthotopic triple-negative breast cancer (TNBC) murine model. In vitro viral infection was confirmed by immunoblotting and radioiodine uptake assays. Orthotopic xenografts (MDA-MB-231 cells) received intratumoral injection of GLV-1h153 or PBS. One week after viral injection, xenografts were randomized into 4 treatment groups: GLV-1h153 alone, GLV-1h153 and (131)I (∼ 5 mCi), (131)I alone, or PBS, and followed for tumor growth. Kruskal-Wallis and Wilcoxon tests were performed for statistical analysis. Radiouptake assay showed a 178-fold increase of radioiodine uptake in hNIS-expressing infected cells compared with PBS control. Systemic (131)I-iodide in combination with GLV-1h153 resulted in a 6-fold increase in tumor regression (24 compared to 146 mm(3) for the virus-only treatment group; P<0.05; d 40). We demonstrated that a novel vaccinia virus, GLV-1h153, expresses hNIS, increases the expression of the symporter in TNBC cells, and serves both as a gene marker for noninvasive imaging of virus and as a vehicle for targeted radionuclide therapy with (131)I.
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Affiliation(s)
- Sepideh Gholami
- 1Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
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To treat or not to treat: the role of adjuvant radioiodine therapy in thyroid cancer patients. JOURNAL OF ONCOLOGY 2012. [PMID: 23193402 PMCID: PMC3502018 DOI: 10.1155/2012/707156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Radioactive iodine (RAI) is used in treatment of patients with differentiated papillary and follicular thyroid cancer. It is typically used after thyroidectomy, both as a means of imaging to detect residual thyroid tissue or metastatic disease, as well as a means of treatment by ablation if such tissue is found. In this paper, we discuss the indications for and the mechanisms of RAI in the treatment of patients with thyroid cancer. We discuss the attendant risks and benefits that come with its use, as well as techniques used to optimize its effectiveness as an imaging tool and a therapeutic modality.
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Creach KM, Siegel BA, Nussenbaum B, Grigsby PW. Radioactive iodine therapy decreases recurrence in thyroid papillary microcarcinoma. ISRN ENDOCRINOLOGY 2012; 2012:816386. [PMID: 22462017 PMCID: PMC3313572 DOI: 10.5402/2012/816386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 11/24/2011] [Indexed: 11/23/2022]
Abstract
Background. The most appropriate therapy for papillary microcarcinoma (PMC) is controversial. Methods. We reviewed the therapy and outcome of 407 patients with PMC. Results. Three hundred-eighty patients underwent total thyroidectomy, and 349 patients received I-131 therapy. The median followup was 5.3 years. Forty patients developed recurrent disease. On univariate analysis, development of disease recurrence was correlated with histological tumor size > 0.8 cm (P = 0.0104), age < 45 years (P = 0.043), and no I-131 therapy (P < 0.0001). On multivariate analysis, histological tumor size > 0.8 cm, positive lymph nodes, and no I-131 therapy were significant. The 5-year RFS for patients treated with I-131 was 95.0% versus 78.6% (P < 0.0001) for patients not treated with I-131. Patients with lymph node metastasis who did not receive I-131 had a 5-year RFS of 42.9% versus 93.2% (P < 0.0001) for patients who received I-131. Conclusions. Recommend I-131 remnant ablation for patients with PMC, particularly patients with lymph node metastasis.
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Affiliation(s)
- Kimberly M Creach
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Mailstop no. 90-38-635, St. Louis, MO 63110, USA
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12
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Antonelli A, Fallahi P, Grosso M, Boni G, Minuto MN, Miccoli P. Lobectomy versus total thyroidectomy in children with post-Chernobyl thyroid cancer: a 15 year follow-up. Endocrine 2011; 40:432-6. [PMID: 21698517 DOI: 10.1007/s12020-011-9500-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 06/03/2011] [Indexed: 11/25/2022]
Abstract
In 1994, 21 Belarus children presenting papillary thyroid cancer (PTC) diagnosed after the Chernobyl disaster, and already submitted to subtotal surgery, underwent thyroid re-operation and post-operative radioiodine (131(I)) therapy. All were re-evaluated after a 15-year follow-up, to evaluate the results of partial versus total thyroidectomy. Nineteen out of 21 children (mean age 9.2 years) had previously undergone a lobectomy. All cases underwent re-operation in 1994. Histology revealed a PTC in the residual lobe in three cases, three had lymph node metastases. After surgery, 20 patients underwent 131(I) therapy. The post-131(I) whole body scan was negative in seven cases, showed neck node metastases in five, lung metastases in three, multiple associated metastases in six. The follow-up was performed with rhTSH-stimulated serum thyroglobulin (Tg) evaluation and ultrasonography. Twenty patients showed Tg <1 ng/ml and negative ultrasonography; the patient who refused 131(I) therapy showed a thyroid remnant and a Tg of 32 ng/ml. Chi-square analysis showed significantly higher prevalences of residual cancer in the neck or lung, lymph node metastases, and re-operations (before completion) in patients who had undergone lobectomy than in those who had undergone completion thyroidectomy and 131(I) therapy. The surgical complications after lobectomy were similar to those after completion thyroidectomy. A less-than-total thyroidectomy should not be indicated in patients with radiation-induced PTC, due to the high risk of residual cancer in the thyroid left in situ. The results of this study favor total thyroidectomy as the initial treatment for thyroid cancer in children exposed to fallout radiation.
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O'Neill CJ, Oucharek J, Learoyd D, Sidhu SB. Standard and emerging therapies for metastatic differentiated thyroid cancer. Oncologist 2010; 15:146-56. [PMID: 20142332 DOI: 10.1634/theoncologist.2009-0190] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Differentiated thyroid cancer accounts for >90% of cases of thyroid cancer, with most patients having an excellent prognosis. Distant metastases occur in 10%-15% of patients, decreasing the overall 10-year survival rate in this group to 40%. Radioactive iodine has been the mainstay of treatment for distant metastases, with good results when lesions retain the ability to take up iodine. For patients with metastatic disease resistant to radioactive iodine, treatment options are few and survival is poor. Chemotherapy and external beam radiotherapy have been used in these patients, but with disappointing results. In recent years, our understanding of the molecular pathways involved in thyroid cancer has increased and a number of molecular targets have been identified. These targets include the proto-oncogenes BRAF and RET, known to be common mutations in thyroid cancer; vascular endothelial growth factor receptor and platelet-derived growth factor receptor, associated with angiogenesis; and the sodium-iodide symporter, with the aim of restoring its expression and hence radioactive iodine uptake. There are now multiple trials of tyrosine kinase inhibitors, angiogenesis inhibitors, and other novel agents available to patients with metastatic thyroid cancer. This review discusses both traditional and novel treatments for metastatic differentiated thyroid cancer with a particular focus on emerging treatments for patients with radioactive iodine-refractory disease.
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Affiliation(s)
- Christine J O'Neill
- University of Sydney Endocrine Surgical Unit, St. Leonards, New South Wales, Australia
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14
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Verburg FA, Dietlein M, Lassmann M, Luster M, Reiners C. Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 2009; 36:343-6. [PMID: 19050874 DOI: 10.1007/s00259-008-0997-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kohlfuerst S, Igerc I, Lobnig M, Gallowitsch HJ, Gomez-Segovia I, Matschnig S, Mayr J, Mikosch P, Beheshti M, Lind P. Posttherapeutic (131)I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. Eur J Nucl Med Mol Imaging 2009; 36:886-93. [PMID: 19169681 DOI: 10.1007/s00259-008-1044-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 12/01/2008] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this prospective study was to determine the diagnostic impact and influence on patient treatment of posttherapeutic (131)I SPECT-CT when the findings on planar posttherapeutic whole-body scintigraphy (ptWBS) were inconclusive. MATERIALS AND METHODS A total of 53 SPECT-CT scans were performed in 41 patients with thyroid cancer after high-dose (131)I therapy (2.944 to 7.526 GBq (131)I) because of diagnostic uncertainty on ptWBS. Physiological uptake in the salivary glands, gastric mucosa, gut, nasal mucosa, urinary tract and liver were considered to be normal. Any other foci of increased (131)I uptake, except iodine uptake clearly located in the thyroid bed, were considered to be abnormal. The data were evaluated on a lesion and a patient basis. RESULTS Regarding neck lesions, SPECT-CT provided a diagnostic impact in 26/90 lesions (28.9%) and confirmed the diagnosis in 64/90 lesions (71.1%). On a patient basis, SPECT-CT changed N status in 12/33 patients (36.4%), provided a diagnostic impact in 21/33 patients (63.6%) and led to a treatment change in 8/33 patients (24.2%). Regarding lesions distant from the neck, SPECT-CT confirmed the diagnosis in 62/71 lesions (87.3%) and had a diagnostic impact in 9/71 lesions (12.7%). On a patient basis, SPECT-CT changed M status in 4/19 patients (21.1%), had a diagnostic impact in 14/19 patients (73.7%) and led to a treatment change in 2/19 patients (10.5%). Considering all patients, SPECT-CT led to a treatment change in 10/41 patients (24.4%). CONCLUSION Integrated SPECT-CT is a useful tool, especially in cases of diagnostic uncertainty and helps to individualize patient management.
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Affiliation(s)
- S Kohlfuerst
- Department of Nuclear Medicine and Endocrinology, PET-CT Centre, State Hospital Klagenfurt, Klagenfurt, Austria.
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Ma C, Kuang A, Xie J. Radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. Cochrane Database Syst Rev 2009; 2009:CD006988. [PMID: 19160311 PMCID: PMC7212000 DOI: 10.1002/14651858.cd006988.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases has been observed in follow-up studies. The management of this condition remains controversial. Most studies support blind radioactive iodine treatment while others negate this approach. OBJECTIVES To assess the effects of radioiodine therapy for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases. SEARCH STRATEGY Studies were obtained from computerised searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese. SELECTION CRITERIA Randomised controlled clinical trials and prospective controlled clinical trials. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and interviewed authors of all potentially relevant studies by electronic mail to verify randomisation procedures. One author entered data into a data extraction form and the second one verified the results of this procedure. MAIN RESULTS Because of the absence of any suitable randomised or prospective controlled trial in this area, results currently cannot be presented. AUTHORS' CONCLUSIONS The currently available evidence is insufficient to reliably assess the potential of radioiodine treatment for differentiated thyroid carcinoma with thyroglobulin positive and radioactive iodine negative metastases.
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Affiliation(s)
- Chao Ma
- Department of Nuclear Medicine, Affiliated Hospital of Medical College Qingdao University, Jiangsu Road 16, Qingdao, Shandong Province, China, 266003.
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Wong K, Choi FP, Lee YY, Ahuja AT. Current role of radionuclide imaging in differentiated thyroid cancer. Cancer Imaging 2008; 8:159-62. [PMID: 18818134 PMCID: PMC2556502 DOI: 10.1102/1470-7330.2008.0024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Nuclear medicine plays an integral role in the management of differentiated thyroid cancer. This editorial aims to provide a summary of the current role of radionuclide imaging, including whole body iodine scan and fluorodeoxyglucose (FDG)-positron emission tomography (PET), in the diagnostic work-up and follow-up of patients with thyroid cancer.
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Affiliation(s)
- K.T. Wong
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Frankie P.T. Choi
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Yolanda Y.P. Lee
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
| | - Anil T. Ahuja
- Department of Diagnostic Radiology & Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Radiology, North District Hospital, Hong Kong SAR
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Urhan M, Dadparvar S, Mavi A, Houseni M, Chamroonrat W, Alavi A, Mandel SJ. Iodine-123 as a diagnostic imaging agent in differentiated thyroid carcinoma: a comparison with iodine-131 post-treatment scanning and serum thyroglobulin measurement. Eur J Nucl Med Mol Imaging 2007; 34:1012-7. [PMID: 17256140 DOI: 10.1007/s00259-006-0341-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Using 123I for diagnostic purposes avoids the risk of stunning for subsequent radioiodine treatment and affords an excellent image quality. In this study we assessed the role of 123I in comparison with 131I post-treatment imaging in patients with thyroid cancer. METHODS We compared a total of 292 123I scans with their corresponding post-treatment 131I images. Patients received a therapeutic dose of 131I following diagnostic scanning with 50-111 MBq of 123I. All patients were in a hypothyroid state (>30 microIU/l) before radioiodine administration for either diagnostic or therapeutic purposes. RESULTS In 228 out of 263 patients with a positive diagnostic scan, 123I whole-body scan findings were concordant with those of corresponding post-treatment 131I images (concordance rate 87%). However, there were 44 additional foci of abnormal uptake on post-treatment 131I scans in 22 discordant cases with no impact on therapeutic management of the patients. In 13 patients, there was at least one new site on post-treatment images that had been missed on pretreatment 123I images. Twenty-nine patients with a negative diagnostic scan were treated with 131I owing to a high serum thyroglobulin level (range 11.3-480 ng/ml). Radioiodine uptake sites were seen in eight post-treatment scans. In 21 pairs of whole-body scans, both the pre- and the post-treatment scan were negative (concordance rate 72.4%). CONCLUSION 123I scanning is comparable to high-dose 131I post-treatment imaging in thyroid carcinoma patients, and 123I offers excellent image quality as a diagnostic agent. It avoids disadvantages such as stunning before treatment and delivery of a high radiation dose to patients.
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Affiliation(s)
- Muammer Urhan
- Division of Nuclear Medicine, Department of Radiology, Department of Medicine University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
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