Usefulness of second 131I treatment in biochemical persistent differentiated thyroid cancer patients.
biochemical incomplete response
differentiated thyroid cancer
indeterminate response
radioiodine
thyroglobulin
thyroglobulin antibodies
Journal
European thyroid journal
ISSN: 2235-0802
Titre abrégé: Eur Thyroid J
Pays: England
ID NLM: 101604579
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
received:
05
04
2023
accepted:
28
09
2023
medline:
23
10
2023
pubmed:
19
10
2023
entrez:
19
10
2023
Statut:
epublish
Résumé
Second 131I treatment is commonly performed in clinical practice in patients with differentiated thyroid cancer and biochemical incomplete or indeterminate response (BiR/InR) after initial treatment. The objective of the is study is to evaluate the clinical impact of the second 131I treatment in BiR/InR patients and analyze the predictive factors for structural incomplete response (SiR). One hundred fifty-three BiR/InR patients after initial treatment who received a second 131I treatment were included in the study. The clinical response in a short- and medium- long-term follow-up was evaluated. After the second 131I treatment (median 8 months), 11.8% patients showed excellent response (ER), 17% SiR, while BiR/InR persisted in 71.2%. Less than half (38.5%) of SiR patients had radioiodine-avid metastases. Patients who, following the second 131I treatment, experienced SiR had larger tumor size and more frequently aggressive histology and vascular invasion than those experienced BiR/InR and ER. Also, the median values of thyroglobulin on levothyroxine therapy (LT4-Tg), Tg peak after recombinant human TSH stimulation (rhTSH-Tg) and thyroglobulin antibodies (TgAb) were significantly higher in patients who developed SiR. At last evaluation (median: 9.9 years), BiR/InR persisted in 57.5%, while 26.2% and 16.3% of the patients showed ER and SiR, respectively. About half of BiR/InR patients (71/153 (46.4%)) received further treatments after the second 131I treatment. Radioiodine-avid metastatic disease detected by the second 131I is an infrequent finding in patients with BiR/InR after initial treatment. However, specific pathologic and biochemical features allow to better identify those cases with higher probability of developing SiR, thus improving the clinical effectiveness of performing a second 131I treatment.
Sections du résumé
Background
Second 131I treatment is commonly performed in clinical practice in patients with differentiated thyroid cancer and biochemical incomplete or indeterminate response (BiR/InR) after initial treatment.
Objective
The objective of the is study is to evaluate the clinical impact of the second 131I treatment in BiR/InR patients and analyze the predictive factors for structural incomplete response (SiR).
Patients and methods
One hundred fifty-three BiR/InR patients after initial treatment who received a second 131I treatment were included in the study. The clinical response in a short- and medium- long-term follow-up was evaluated.
Results
After the second 131I treatment (median 8 months), 11.8% patients showed excellent response (ER), 17% SiR, while BiR/InR persisted in 71.2%. Less than half (38.5%) of SiR patients had radioiodine-avid metastases. Patients who, following the second 131I treatment, experienced SiR had larger tumor size and more frequently aggressive histology and vascular invasion than those experienced BiR/InR and ER. Also, the median values of thyroglobulin on levothyroxine therapy (LT4-Tg), Tg peak after recombinant human TSH stimulation (rhTSH-Tg) and thyroglobulin antibodies (TgAb) were significantly higher in patients who developed SiR. At last evaluation (median: 9.9 years), BiR/InR persisted in 57.5%, while 26.2% and 16.3% of the patients showed ER and SiR, respectively. About half of BiR/InR patients (71/153 (46.4%)) received further treatments after the second 131I treatment.
Conclusions
Radioiodine-avid metastatic disease detected by the second 131I is an infrequent finding in patients with BiR/InR after initial treatment. However, specific pathologic and biochemical features allow to better identify those cases with higher probability of developing SiR, thus improving the clinical effectiveness of performing a second 131I treatment.
Identifiants
pubmed: 37855417
doi: 10.1530/ETJ-23-0052
pii: e230052
pmc: PMC10620453
doi:
pii:
Substances chimiques
Thyroglobulin
9010-34-8
Iodine-131
0
Iodine Radioisotopes
0
Thyrotropin
9002-71-5
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Références
Head Neck. 2018 Jul;40(7):1588-1597
pubmed: 29509280
Clin Nucl Med. 2013 Jan;38(1):18-24
pubmed: 23242039
Am J Surg. 2002 Jan;183(1):80-6
pubmed: 11869709
J Clin Endocrinol Metab. 2012 Aug;97(8):2748-53
pubmed: 22679061
J Nucl Med. 2004 Jun;45(6):988-94
pubmed: 15181134
Thyroid. 2014 Oct;24(10):1501-7
pubmed: 25058708
J Clin Endocrinol Metab. 1995 May;80(5):1488-92
pubmed: 7744991
Front Endocrinol (Lausanne). 2018 Oct 09;9:590
pubmed: 30356857
Thyroid. 2016 Jan;26(1):1-133
pubmed: 26462967
J Clin Endocrinol Metab. 2020 Aug 1;105(8):
pubmed: 32453405
Clin Chem Lab Med. 2005;43(8):843-7
pubmed: 16201895
Endocrine. 2016 Nov;54(2):467-475
pubmed: 26668060
J Clin Endocrinol Metab. 2018 Feb 1;103(2):469-476
pubmed: 29126111
Thyroid. 2010 Dec;20(12):1341-9
pubmed: 21034228
Thyroid. 2012 Aug;22(8):832-8
pubmed: 22853728
Thyroid. 2017 Dec;27(12):1490-1497
pubmed: 29020892
J Clin Endocrinol Metab. 2010 Mar;95(3):1169-73
pubmed: 20080852
J Clin Endocrinol Metab. 2005 Mar;90(3):1440-5
pubmed: 15613412
Head Neck. 2010 Jun;32(6):689-98
pubmed: 20187016
Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006988
pubmed: 19160311
J Endocrinol Invest. 2019 Oct;42(10):1223-1230
pubmed: 30963467
Eur Thyroid J. 2019 Oct;8(5):227-245
pubmed: 31768334
Arch Otolaryngol Head Neck Surg. 2000 Mar;126(3):309-12
pubmed: 10722002
Endocrine. 2022 Jun;76(3):671-676
pubmed: 35347578
J Clin Endocrinol Metab. 2017 Mar 1;102(3):893-902
pubmed: 27929713
Eur Thyroid J. 2021 Jun;10(3):198-207
pubmed: 34178705
World J Nucl Med. 2021 Nov 01;20(4):361-368
pubmed: 35018151
J Clin Endocrinol Metab. 2001 Sep;86(9):4092-7
pubmed: 11549631
J Endocrinol Invest. 2018 Jul;41(7):849-876
pubmed: 29729004
Endocrinol Diabetes Nutr (Engl Ed). 2020 Oct;67(8):517-524
pubmed: 32534971
Hell J Nucl Med. 2017 May-Aug;20(2):122-127
pubmed: 28697188
Minerva Endocrinol. 2020 Dec;45(4):306-317
pubmed: 32623845
Thyroid. 2014 Mar;24(3):533-6
pubmed: 24067080
Clin Endocrinol (Oxf). 2008 Oct;69(4):659-63
pubmed: 18363882
Ann Surg. 2005 Apr;241(4):640-6
pubmed: 15798466
J Nucl Med. 1987 Dec;28(12):1888-91
pubmed: 3681445
Thyroid. 2018 Jul;28(7):871-879
pubmed: 29860933
Endokrynol Pol. 2017;68(6):623-630
pubmed: 29022644
Thyroid. 2009 Jan;19(1):1-3
pubmed: 19119978