Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid: a comparison of ablation success with different activities of radioiodine (I-131)

Prpić, Marin; Dabelić, Nina; Staničić, Josip; Jukić, Tomislav; Milošević, Milan; Kusić, Zvonko

doi:10.1007/s12149-012-0637-9

Cited by 25 publications

(15 citation statements)

References 31 publications

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“…Our results are in accordance with a study by El-Refaei et al, which investigated treatment outcome after re-ablation using both low-and high I-131activities, and found no difference in overall treatment success between these two study groups [9]. Similarly, another study, concluded that although high I-131 activities used in the first application are significantly more effective in thyroid ablation than low-and intermediate activities, it is not the case in re-ablation [14]. Long-term side effects, including the possibility for secondary malignancies, as well as increased radiation exposure to medical staff, must be taken into consideration when using high activities [17,18].…”

Section: Discussionsupporting

confidence: 91%

“…The most effective cost-benefit strategy, the rationale for re-ablation, as well as the reablation I-131 activity in these patients is still a subject of an ongoing debate [8][9]14]. Malick and colleagues concluded that low activity I-131 in post-thyroidectomy ablation using 1110 MBq (30 mCi) was effective [8].…”

Section: Discussionmentioning

confidence: 99%

“…While most studies have shown that I-131 activity is not correlated with ablation success, some authors still recommend higher I-131 activities, while others recommend lower activities for effective ablation [10][11][12][13][14]. Similarly, in patients with ablation failure, additional uncertainties pertain to the optimal second ablation activity and the optimal combination of activities used for the first and second ablation, especially when the potential risks of treatment must be balanced against treatment success [9,[11][12] .…”

Section: Introductionmentioning

confidence: 99%

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Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma

Prpić¹,

Kruljac

Kust³

et al. 2016

Endocrine

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Results: Re-ablation was successful in 113 out of 128 patients (88.3%). Mean first I-131 activity was 2868 ± 914 MBq (77.5 ± 24.7 mCi), and mean second I-131 activity 3004 ± 699 MBq (81.2 ± 18.9 mCi). There was no association between the first, second, and cumulative activity with reablation treatment outcome. Treatment failure was associated with higher Tg levels prior to reablation (Tg2) (OR 1.16, 95% CI 1.05 -1.29, P=0.003) and N1a status (OR 3.89, P=0.032). After excluding patients with positive-to-negative TgAb conversion, Tg2 level of 3.7 ng/mL predicted treatment failure with a sensitivity of 75.0 %, specificity of 80.5%, and a negative predictive value of 97.1%. Patients with positive-to-negative TgAb conversion had higher failure rates (OR=2.96, 95% CI 0.94 -9.29).3 Conclusions: Re-ablation success was high in all subgroups of patients and I-131 activity did not influence treatment outcome. Tg may serve as a good predictor of re-ablation failure. Patients with positive-to-negative TgAb conversion represent a specific group, in whom Tg level should not be used as a predictive marker of treatment outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma

Prpić¹,

Kruljac

Kust³

et al. 2016

Endocrine

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“…The second, third and fourth 131 I treatments were administered orally, with 120, 150 and 150 mCi, respectively. The rate of successful ablation was in agreement with results from a previous study, which stated that 30-50 mCi, 75 mCi or 100 mCi as a second 131 I treatment achieved successful ablation in patients with DTC confined to the thyroid (27). This may be partially explained by the change in size of remnant thyroid tissue, which is expected to become significantly smaller following a high initial dose of 131 I.…”

Section: Characteristicssupporting

confidence: 90%

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

et al. 2018

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Abstract. Cervical lymph node metastasis (CLNM) is common in differentiated thyroid cancer (DTC). Radioiodine-131 ( 131 I) treatment is recommended for the removal of residual thyroid tissue following thyroidectomy. To date, the effect of 131 I therapy on the outcomes of patients with DTC with CLNM is unclear. The aim of the present study was to evaluate the final outcome of patients with DTC with CLNM according to 131 I administration, and to analyze the factors that may affect clinical outcomes. A total of 357 patients with DTC with CLNM were recruited and divided into three groups: Those who received 2, 3 or 4 doses of 131 I therapy, respectively. Successful ablation was defined as levels of stimulated serum thyroglobulin <2 ng/ml in the absence of CLNM. The rates of successful ablation were 80.35 (229/285), 76.36 (42/55) and 70.59% (12/17) for patients who received 2, 3 and 4 doses, respectively. The patients with DTC with CLNM who were <45 years old, with tumor sizes <2 cm, solitary nodules and TNM stage I-II disease exhibited significantly higher rates of successful ablation compared with the patients who were ≥45 years old, with tumor size ≥2 cm, multiple nodules and stage III-IV disease. Multivariate analyses revealed that tumor size, number of nodules and TNM stage were independent risk factors associated with successful ablation in patients with DTC with CLNM who received 2 doses of 131 I therapy. 131 I administration is a useful therapy to eradicate cervical lymph node metastasis in patients with DTC, and may be preferentially indicated in patients with DTC with CLNM who are aged <45 years, with tumor sizes <2 cm, solitary nodules and lower TNM stages, in order to control and prevent recurrence and/or metastases.

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“…A recent study on 259 DTC patients confined to the thyroid has reported that 100 mCi of RAI was significantly more effective in thyroid ablation than 30-50 mCi and also superior to 75 mCi (Prpic et al 2012). However, ablation rates were nearly similar after a second RAI dose.…”

Section: Recent Reviews Of New England Journal Of Medicine Articles Bmentioning

confidence: 96%

Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

Blumhardt¹,

Wolin²,

Phillips³

et al. 2014

Endocrine-Related Cancer

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Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the postoperative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.

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Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid: a comparison of ablation success with different activities of radioiodine (I-131)

Cited by 25 publications

References 31 publications

Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma

Re-ablation I-131 activity does not predict treatment success in low- and intermediate-risk patients with differentiated thyroid carcinoma

Clinical outcomes and associated factors of radioiodine-131 treatment in differentiated thyroid cancer with cervical lymph node metastasis

Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

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