Variable response to radioactive iodine treatment in poorly differentiated thyroid carcinoma

Underwood, Hunter J.; Shaha, Ashok R.; Patel, Kepal N.

doi:10.21037/gs.2019.10.14

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…PDTC is thought to arise from either de-differentiation of a well-differentiated thyroid cancer or a de novo mutation of benign thyroid follicular cells with both early and late driver mutations [ 9 ]. In a publication by Patel et al, it was noted that PDTC has the potential to concentrate iodine as they arise from follicular epithelium.…”

Section: Discussionmentioning

confidence: 99%

An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule

Yuang,

Al-Bahadili,

Chang

2023

JCEM Case Reports

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Poorly differentiated thyroid carcinoma (PDTC) is a rare entity of thyroid cancer with an intermediate clinical behavior between differentiated and anaplastic thyroid cancer. Here we present a patient who was referred to the endocrinology clinic for evaluation of hyperthyroidism and multinodular goiter. Due to presence of right toxic thyroid nodules and compressive symptoms, the patient underwent right lobectomy and isthmectomy, where surgical pathology revealed PDTC in the right thyroid lobe. Based on this unusual case of malignancy within a toxic nodule, we propose further evaluation of hot nodules with concerning features such as growth rate. Furthermore, exploration of relative sodium iodine symporter (NIS) expression in PDTC may help us better understand how iodine uptake changes as PDTC develops, which may impact our approach to assessing and treating PDTC in the future.

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Section: Discussionmentioning

confidence: 99%

An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule

Yuang,

Al-Bahadili,

Chang

2023

JCEM Case Reports

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“… 9 However, it seems that the standard treatment for DTCs is surgical resection followed by radioactive iodine (RAI) in moderate to high‐risk patients. 10 According to the statement of the American Head and Neck Society, EBRT is recommended for patients who are older than 45 years and have gross residual or unresectable locoregional disease or patients with greater probability of microscopic residual disease and lower response to RAI. EBRT is not indicated as an adjuvant therapy following total reaction of the gross disease.…”

Section: Introductionmentioning

confidence: 99%

The role of external beam radiation therapy in the management of thyroid carcinomas: A retrospective study in Iran Cancer Institute

et al. 2022

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Background Thyroid cancers are histologically classified into three types; differentiated thyroid carcinoma (DTC), medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). Among the several therapeutic strategies for treatment and management of thyroid cancer, surgical resection in combination with radioactive iodine therapy (RAI) is indicated for moderate to high‐risk differentiated thyroid cancer (DTC) patients‐ according to current guidelines. However, external radiation therapy (EBRT) can be a viable alternative treatment option for these patients and scarce evidence is available regarding the efficacy and effectiveness of EBRT on thyroid cancer. Aim This study aims at evaluating the role of EBRT in the management of thyroid carcinomas. Methods and Results In this retrospective cohort study, the records of 59 patients with thyroid cancer were accessed who were treated by EBRT from 2008 to 2016. The indications for EBRT included unresectable primary (definitive) or loco‐regional recurrences (salvage) not suitable for RAI, palliation for local disease or metastatic foci (palliative), and the adjuvant treatment for suspected residual disease following resection. Progression‐free survival (PFS) and overall survival (OS) were calculated for different types of cancer. PFS was measured from the start of EBRT to the last uneventful follow‐up, recurrence, or death. Kaplan–Meier model was used for the survival analysis. Fifty‐nine patients were evaluated. The histopathology of the tumors was differentiated and poorly‐differentiated, medullary and anaplastic thyroid carcinomas in 22 and 6, 15 and 16 patients, respectively. Twenty‐seven patients received external beam radiotherapy (EBRT) as adjuvant therapy and 18 of the cases as palliative therapy while the remaining received salvage or definitive primary EBRT. The stage of patients' cancer was as follows: stage II in 3 and III in 1, IVA in 18 and IVB in 18 and IVC in 19. Stage‐based median overall survival was 26 months for IVA, 44 for IVB, and 29 for IVC. The median PFS was 18, 22 and 21 months for stages IVA, IVB and IVC, respectively. Conclusion Based on our findings, EBRT may still play a role in the management of patients with thyroid carcinoma and should be considered in the armamentarium against thyroid cancers.

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“…Five-year survival rates range from approximately 65 to 85% and can vary substantially [ 2 , 3 , 4 ]. PDTC lesions are at an increased risk of being radioiodine refractory (RAI-R) at initial diagnosis or becoming so in the course of disease [ 5 , 6 ]. Subsequently, the benefit of radioactive iodine therapy (RAIT) in these patients is variable and the routine treatment with RAIT is therefore largely controversial.…”

Section: Introductionmentioning

confidence: 99%

Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC

Kersting

Seifert

Kessler

et al. 2021

Cancers

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Background: The clinical phenotype of poorly differentiated thyroid cancer (PDTC) can vary substantially. We aim to evaluate risk factors for radioiodine refractory (RAI-R) disease and reduced overall survival (OS). Methods: We retrospectively screened our institutional database for PDTC patients. For the assessment of RAI-R disease, we included patients who underwent dual imaging with 18F-FDG-PET and 124I-PET/131I scintigraphy that met the internal standard of care. We tested primary size, extrathyroidal extension (ETE), and age >55 years as risk factors for RAI-R disease at initial diagnosis and during the disease course using uni- and multivariate analyses. We tested metabolic tumor volume (MTV), total lesion glycolysis (TLG) on 18F-FDG-PET, and the progression of stimulated thyroglobulin within 4–6 months of initial radioiodine therapy as prognostic markers for OS. Results: Size of primary >40 mm and ETE were significant predictors of RAI-R disease in the course of disease in univariate (81% vs. 27%, p = 0.001; 89% vs. 33%, p < 0.001) and multivariate analyses. Primary tumor size was an excellent predictor of RAI-R disease (AUC = 0.90). TLG/MTV > upper quartile and early thyroglobulin progression were significantly associated with shorter median OS (29.0 months vs. 56.9 months, p < 0.05; 57.8 months vs. not reached p < 0.005, respectively). Discussion: PDTC patients, especially those with additional risk factors, should be assessed for RAI-R disease at initial diagnosis and in the course of disease, allowing for early implementation of multimodal treatment. Primary tumor size >40 mm, ETE, and age >55 are significant risk factors for RAI-R disease. High MTV/TLG is a significant risk factor for premature death and can help identify patients requiring intervention.

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Variable response to radioactive iodine treatment in poorly differentiated thyroid carcinoma

Cited by 4 publications

References 7 publications

An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule

An Unexpected Finding of Poorly Differentiated Thyroid Carcinoma in a Toxic Thyroid Nodule

The role of external beam radiation therapy in the management of thyroid carcinomas: A retrospective study in Iran Cancer Institute

Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC

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