High thyroglobulin and negative whole-body scan: no long-term benefit of empiric radioiodine therapy

Tramontin, Mariana Yoshii; Nobre, Gabriela Maia; Lopes, Márcia Marília Gomes Dantas; Carneiro, Michel Pontes; Junior, Paulo Alonso Garcia Alves; Andrade, Fernanda Accioly de; Vaisman, Fernanda; Corbo, Rossana; Bulzico, Daniel

doi:10.1007/s12020-021-02647-8

Cited by 11 publications

(12 citation statements)

References 22 publications

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“…Therefore, they concluded that ET was not associated with regression of stable lesions, or conversion from progressive to stable disease. Similarly, Tramontin et al [20] confirmed no significant differences during a long-term follow-up between treated and untreated patients. Likewise, Yuan et al [9] evaluated the outcome of 80 DTC patients with elevated Tg levels after surgery and RAI treatment and negative diagnostic WBS.…”

Section: Discussionmentioning

confidence: 88%

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis

Piscopo,

Zampella,

Volpe

et al. 2023

Cancers

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We assessed the outcome of administration of empiric radioactive iodine (RAI) therapy to patients with differentiated thyroid cancer (DTC), in a propensity-score-matched cohort of patients with biochemical incomplete response (BIR) and without evidence of structural disease. We retrospectively evaluated 820 DTC patients without distant metastases, who underwent total thyroidectomy followed by RAI therapy, with available BIR at 12 months and follow-up evaluations. The patients were categorized according to the administration of empiric therapy (ET). To account for differences between patients with (n = 119) and without (n = 701) ET, a propensity-score-matched cohort of 119 ET and 119 no-ET patients was created. The need for additional therapy and the occurrence of structural disease were considered as end-points. During a median follow-up of 53 months (range 3–285), 57 events occurred (24% cumulative event rate). The rate of events was significantly higher in the no-ET compared to the ET patients (30% vs. 18% p < 0.001). The multivariate Cox analysis identified age (p < 0.01), pre-therapy Tg (p < 0.05) and empiric RAI therapy (p < 0.01) as predictors of outcome. The Kaplan–Meier analysis found that progression-free survival was lower in no-ET patients compared to the ET group (p < 0.01). In patients with DTC treated with surgery and RAI, and with biochemical incomplete response at the 12-month evaluation, their prognosis seemed to be affected by Tg values and the empiric treatment. The identification of candidates for this approach may improve prognosis.

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Section: Discussionmentioning

confidence: 88%

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis

Piscopo,

Zampella,

Volpe

et al. 2023

Cancers

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“…RAI activity, acquisition time, γ-camera model and TSH stimulation play a role in D-WBS accuracy and sensibility. In particular, the low administered RAI activity for the D-WBS acquisition would not allow to detect all the RAI avid foci [29][30][31].…”

Section: Identifying Rai-rmentioning

confidence: 99%

Current Advances in Radioactive Iodine Refractory Differentiated Thyroid Cancer

Volpe,

Nappi,

Zampella

et al. 2024

Preprint

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Background: Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine therapy is a cornerstone in DTC management, but sometimes it became useless when cancer cells develop refractoriness. Radioactive Iodine Refractory DTC (RAIR-DTC) is a condition defined by ATA 2015 guidelines when DTC cannot concentrate RAI ab initio or loses RAI uptake ability after the initial therapy. RAIR condition implies that RAI cannot reveal new met-astatic foci, so RAIR-DTC metabolic imaging needs new tracers. 18F-FDG PET/CT has been widely used, it has a demonstrated prognostic value, but 18F-FDG DTC avidity may remain low. FA-Pi, PSMA, SSTR tracers have been proposed as theragnostic agents in experimental settings and Arg-Gly-Asp (RGD) peptides in diagnostic trial field. Multi-targeted tyrosine kinase inhibitors are relatively new drugs approved in RAIR-DTC therapy. Despite the promising targeted setting, they relate to frequent adverse event onset. Sorafenib and trametinib have been included in re-differentiation protocols aimed to re-induce RAI accumulation in DTC cells. Results appeared promising, despite not excellent. Conclusions: RAIR-DTC yet represent a challenging nosological entity. There are still controversies on RAIR-DTC definition and post-RAI therapy evaluation with post-therapy whole body scan (PT-WBS) is the only validated criterion of response. The recent introduction of multiple diagnostic and therapeutic agents oblige physicians to pursue a multidisciplinary approach aiming to correct drug introduction and timing choice.

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“…findings. 18,19,[29][30][31][32][33][34][35][36][37][38][39][40] The inclusion and exclusion processes are detailed in the PRISMA flow diagram provided in Figure 1. All 14 studies ultimately selected were retrospective cohort studies, among which 4 studies 18,32,36,40 were retrospective casecontrol cohort studies.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%

Efficacy of Empirical 131I Radioiodine Therapy in Well-Differentiated Thyroid Carcinoma Patients With Thyroglobulin-Elevated Negative Iodine Scintigraphy Syndrome

Kim,

Hong,

et al. 2024

Clin Nucl Med

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Objectives This study aimed to perform a systematic review and meta-analysis on the efficacy of empirical high-dose radioiodine therapy in treating differentiated thyroid cancer patients with thyroglobulin (Tg)-elevated negative iodine scintigraphy (TENIS) syndrome. Methods We searched PubMed, EMBASE, and the Cochrane Library to identify relevant studies published until April 2022. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and registered in an international prospective register of systematic reviews (PROSPERO). Meta-analyses of proportions and odds ratios were performed to assess the beneficial effect of empirical high-dose radioiodine therapy in patients with TENIS syndrome. Subgroup analysis was also performed according to the presence of micrometastasis or macrometastasis. Results We identified 14 studies including 690 patients who received empirical high-dose radioiodine therapy for TENIS syndrome. Those who had micrometastasis exhibited additional lesions not previously observed on diagnostic whole-body scan (prop = 0.64, 95% confidence interval [CI], 0.51–0.77) and had reduced serum Tg levels (prop = 0.69; 95% CI, 0.52–0.84) after empirical radioiodine treatment. No such findings were observed among patients with macrometastasis. Moreover, we found that the empirical radioiodine treatment group had lower serum Tg levels than did controls (odds ratio = 0.27; 95% CI, 0.09–0.87), which suggests a lower risk of disease progression. Conclusions Our findings indicate that empirical high-dose radioiodine therapy promoted beneficial effects and could be recommended for patients with TENIS syndrome, especially those with micrometastasis.

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High thyroglobulin and negative whole-body scan: no long-term benefit of empiric radioiodine therapy

Cited by 11 publications

References 22 publications

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis

Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis

Current Advances in Radioactive Iodine Refractory Differentiated Thyroid Cancer

Efficacy of Empirical 131I Radioiodine Therapy in Well-Differentiated Thyroid Carcinoma Patients With Thyroglobulin-Elevated Negative Iodine Scintigraphy Syndrome

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