Low versus high radioiodine dose in postoperative ablation of residual thyroid tissue in patients with differentiated thyroid carcinoma

Fallahi, Babak; Beiki, Davood; Takavar, Abbas; Fard-Esfahani, Armaghan; Gilani, Kambiz; Saghari, Mohsen; Eftekhari, Mohammad

doi:10.1097/mnm.0b013e32834e306a

Cited by 80 publications

(54 citation statements)

References 29 publications

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“…Particularly, 2 large multicentre randomised trials [3,4] and 1 meta-analysis [5] have shown that low-dose radioiodine (1.1 GBq) is as effective as a high-dose (3.7 GBq) in ablating thyroid remnant in the low and intermediate risk patients. However, some series [3,4,8,9] have reported variable success rates (ranging between 39 and 98%) using a low-dose radioiodine in low/intermediate risk. This can be explained by the variability of inclusion criteria and of success ablation definition.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

et al. 2018

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Aim: Based on the response criteria of the 2015 American Thyroid Associations guidelines, our objectives were to determine the response rate when using a low dose of 131-I GBq in patients with low-risk differentiated thyroid cancer (LRDTC) and the influence of clinical and analytical variables on the prediction of complete response. Methods: We performed a multicentre and longitudinal study, including patients who were operated for LRDTC and who underwent radioiodine remnant ablation with a low-dose of 131-I. All patients were assessed at 6–12 months, and their status was classified as complete (excellent response) or incomplete response (structural incomplete, biochemical incomplete or indeterminate response). Various factors including age, gender, histology, tumour focality and size, stage, time from surgery to treatment, type of thyroid-stimulating hormone (TSH) stimulation, preablation serum thyroglobulin (pTg), antiTg antibodies (pAntiTgAb) and TSH (pTSH) levels were also analysed in order to predict the complete response rate. Results: Of 108 patients, 79.6% achieved complete response and the remaining showed incomplete response (2.9, 5.5 and 12% due to biochemical incomplete, structural incomplete and indeterminate response respectively). Six patients received a new dose of 131-I. Tumour size and pAntiTgAb were the only factors related to therapeutic response (p = 0.03 and p < 0.01, respectively). However, pAntiTgAb was the only independent factor related to complete response. Patients with complete response showed lower pTg than those with incomplete response (5.1 ± 12.9 vs. 11.2 ± 25 ng/mL) although without statistical significance (p = 0.14). There was no significant difference in the response rate depending on the thyrotropin stimulation methods. Conclusions: A low dose of 131-I was sufficient for reaching a complete response at 6–12 months of follow-up in the majority of patients with LRDTC. Tumour size and pAntiTgAb variables were related to therapeutic response.

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Section: Discussionmentioning

confidence: 99%

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

et al. 2018

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“…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%

“…Following a single application of I-131, approximately 8-40% of patients require an additional application (re-ablation) due to ablation failure. Ablation activities for first and second ablation range from low (1110 MBq [30mCi]) to high (≥3700 MBq [100mCi]) [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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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“…In clinical studies, expression of TSHR has been shown to correlate with the degree of iodine trapping (Edmonds et al 1977), and with efficacy of ablation (Fallahi et al et al 2012). Further, both positive and negative regulation of NIS mRNA in response to TSHR stimulation has been demonstrated in human thyroid cells (Saito et al 1997, Bruno et al 2005.…”

Section: Current Therapeutic Targeting Of Tshr In Dtcmentioning

confidence: 98%

Targeting the TSH receptor in thyroid cancer

Rowe¹,

Paul²,

Gedye³

et al. 2017

Endocrine-Related Cancer

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Recent advances in the arena of theranostics have necessitated a re-examining of previously established fields. The existing paradigm of therapeutic thyroid-stimulating hormone receptor (TSHR) targeting in the post-surgical management of differentiated thyroid cancer using levothyroxine and recombinant human thyroid-stimulating hormone (TSH) is well understood. However, in an era of personalized medicine, and with an increasing awareness of the risk profile of longstanding pharmacological hyperthyroidism, it is imperative clinicians understand the molecular basis and magnitude of benefit for individual patients. Furthermore, TSHR has been recently re-conceived as a selective target for residual metastatic thyroid cancer, with pilot data demonstrating effective targeting of nanoparticles to thyroid cancers using this receptor as a target. This review examines the evidence for TSHR signaling as an oncogenic pathway and assesses the evidence for ongoing TSHR expression in thyroid cancer metastases. Priorities for further research are highlighted.

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Low versus high radioiodine dose in postoperative ablation of residual thyroid tissue in patients with differentiated thyroid carcinoma

Abstract: The higher dose of I-131 (3700 MBq) resulted in successful ablation more often than the low dose (1110 MBq).

Cited by 80 publications

References 29 publications

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

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

Targeting the TSH receptor in thyroid cancer

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