Evaluation of the effectiveness of radioiodine ablation for differentiated thyroid carcinoma at low-risk patients
Authors:
Vladimír Dedek 1,2; Hana Materová 1,3
Authors‘ workplace:
Klinika nukleární medicíny, FN Ostrava, ČR
1; Ústav zobrazovacích metod, 3 Katedra biomedicínských oborů, Lékařská fakulta, Ostravská univerzita v Ostravě, ČR
2
Published in:
NuklMed 2018;7:22-31
Category:
Original Article
Overview
Introduction:
Postoperative radioiodine (RJ) ablation (TERJ) with a preferred use of low dose can be indicated also at low-risk patients with a differentiated thyroid carcinoma (DTC) according to current guidelines.
Aim:
Assessment of TERJ effectivity used in low-risk patients with DTC after applying of 1.1 GBq of 131I.
Material:
61 pts (53 females) with a DTC after declared total thyroidectomy due to a papillary or papillary-follicular cancer (60 pts) and follicular cancer (1 pt). Classification according to the tumor volume was as follows: T1a 45 pts, T1b 10 pts, and T2 6 pts.
Methods:
Pts were admitted to our department at hypothyroidism; neck scintigraphy with the detection of residual thyroid tissue after surgery was assessed. Initial level of thyroglobulin (Tg) ranges from < 0.1 to 9.0 µg/l. Blood content of antibody against Tg (anti-Tg) was increased in 18 cases (0.9–333 U/ml). Radioiodine ablation dose of 1.1 GBq was applied in all pts. Rehospitalization again at hypothyroidism was performed 6 months later; whole-body scan was done after a diagnostic dose of 110 MBq 131I. Negative scintigraphy at the region of the neck together with a low level of Tg below 2 µg/l or decline of anti-Tg in pts with a low Tg <0.1 µg/l was considered as an effective TERJ.
Results:
Negative follow-up scintigraphy with no detectable thyroid tissue was present in 52/61 pts. The second criterion, i.e. level of Tg below 2 µg/l or decline of anti-Tg was present in all these pts; the therapeutic effectivity of TERJ was thus 85.2 %. TERJ was not effective in 9/61 pts (14.8 %).
Conclusion:
According to our experience, the efficacy of TERJ after applying of 1.1 GBq of 131I (85.2 %) is comparable to the literature and also to our previous results with a group of 131 pts after applying of 3.7 GBq of 131I form the years 2007 to 2012, when the therapeutic effectivity was 80 %.
Key Words:
low-risk differentiated thyroid carcinoma, radioiodine ablation, whole-body scintigraphy, level of thyroglobulin
Sources
- Sherman SI, Thyroid carcinoma. Lancet 2003;361:501-511
- Davies L, Welch HG. Current thyroid cancer trends in the United States, JAMA Otolaryngol Head Neck Surg 2014;140:317–322
- Pellegriti G, Frasca F, Regalbuto C et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. [online] J Cancer Epidemiol 2013. [cit. 2018-03-15]. Dostupné na: DOI: <http://dx.doi. org/10.1155/2013/965212>.
- Aschebrook-Kilfoy B, Schechter RB, Shih YC et al. The clinical and economic burden of a sustained increase in thyroid cancer incidence. Cancer Epidemiol Biomarkers Prev 2013;22:1252–1259
- Gschwandtner E, Klatte T, Swietek N et al. Increase of papillary thyroid microcarcinoma and a plea for restrictive treatment: A retrospective study of 1391 prospective documented patients. Surgery 2016;159:503-511
- Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med 1998;338:297-306
- Cooper DS, Doherty GM, Haugen BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19:1167-1214
- Pacini F, Schlumberger M, Dralle H et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006;154:787-803
- Clement SC, Peeters RP, Ronckers CM et al. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma - a systematic review. Cancer Treat Rev 2015;41:925–934
- Ambrosetti MC, Colato C, Dardano A et al. Radioiodine ablation: when nad how. Q J Nucl Med Mol Imaging 2009;53:473-481
- Dedek V, Formánek M, Matoušek P. Hodnocení efektivity tyreoeliminace radiojódem u diferencovaného karcinomu štítné žlázy. NuklMed 2014;3:31-36
- Publikace ÚZIS, Novotvary 2000 Česká republika. [online] ISBN: 80-7280-168-6, [cit. 2018-02-10]. Dostupné na: http://www.uzis.cz/publikace/novotvary-2000
- Publikace ÚZIS, Novotvary 2015 Česká republika. [online] [cit. 2018-02-10]. Dostupné na: http://www.uzis.cz/publikace/novotvary-2015
- Haugen BR, Alexander EK, Bible KC et al., 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1–133
- Kuba S, Yamanouchi K, Hayashida N et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study. International Journal of Surgery 2017;38:143-148
- Macedo FIB, Mittal VK. Total thyroidectomy versus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: A meta-analysis. Surgical Oncolog 2015;24:117-122
- Vlček P, Nováková D, Vejvalka J a kol. Návrh optimálního léčebného postupu v léčbě nizkorizikového karcinomu štítné žlázy. Vnitřní Lékařství 2015;61:769-777
- Vlček P, Nováková D. Karcinomy štítné žlázy - současné léčebné postupy. Vnitřní Lékařství 2016;62:115-120
- Sawka AM, Goldestein DP, Thabane L et al. Basis for physician recommendations for adjuvant radioiodine therapy in early-stage thyroid carcinoma:principal findings of the Canadian-American thyroid cancer survey. Endocrine practice 2008;14:175-184
- Pellegriti G, Scollo C, Lumera G, et al. Clinical behaviour nad outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: Study of 299 cases. J Clin Endocrin Metab 2004;89:3713-3720
- Gallicchio R, Giacomobono S, Capacchione D et al. Should patients with remnants from thyroid microcarcinoma really not be treated with iodine-131 ablation? Endocrine 2013;44:426-433
- Mc Cowen KD, Adler PA, Ghaed N et al. Low dose radioiodine thyroid ablation in postsurgical patients with thyroid cancer. Am J Med 1976;61:52-55
- Comtois R, Thériault C, Del Vecchio P. Assessment of the efficacy of iodine-131 for thyroid ablation. J Nucl Med 1993;34:1927-1930
- Zidan J, Hefer E, Iosilevski G et al. Efficacy of I-131 ablation therapy using different doses as determined by postoperative thyroid scan uptake in patients with differentiated thyroid cancer. Int J Radiat Oncol Biol Phys 2004;59:1330-1336
- Bal CH, Padhy AK, Jana S et al. Prospective randomized clinical trial to evaluate the optimal dose of 131 I for remnant ablation in patients with differentiated thyroid carcinoma. Cancer 1996;77:2574-2580
- Bal CH, Ballal S, Soundararajan R et al. Radioiodine remnant ablation in low-risk differentiated thyroid cancer who had R0 dissection is an over treatment. Cancer Medicine 2015;4:1031-1038
- Schlumberger M, Catargi B, Borget I et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 2012;366:1663–1673
- Maenpaa HO, Heikkonen J, Vaalavirta L et al. Low vs. high radioiodine activity to ablate the thyroid after thyroidectomy for cancer: a randomized study. 2008, PLoS One 3:e1885
- Mallick U, Harmer C, Yap B et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 2012;366:1674–1685
- Caglar M, Bozkurt FM, Akca CK et al. Comparison of 800 and 3700 MBq iodine-131 for the postoperative ablation of thyroidremnant in patients with low-risk differentiated thyroid cancer. Nucl Med Commun 2012;33:268-274
- Fallahi B, Adabi K, Majidi M et al. Incidence of second primary malignancies during a long-term surveillance of patients with differentiated thyroid carcinoma in relation to radioiodine treatment. Clinical Nuclear Medicine 2011;36:277-282
- Gopalakrishna I, Morris L, Tuttle M et. al. Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer 2011;117:4439-4446
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Nuclear Medicine
2018 Issue 2
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