When Can We Discharge Differentiated Thyroid Cancer Patients Who Present With High-Risk Disease and Subsequently Have an Excellent Response to Treatment?

2019 ◽  
Vol 31 (10) ◽  
pp. 733-734
Author(s):  
O. Mulla ◽  
K. Seejore ◽  
G.E. Gerrard ◽  
V.M. Gill ◽  
R.D. Murray
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Differentiated Thyroid Cancer ◽  
Response To Treatment ◽  
Excellent Response ◽  
High Risk Disease

scholarly journals Efficacy of Dosimetric Versus Empiric Prescribed Activity of 131I for Therapy of Differentiated Thyroid Cancer

2011 ◽  
Vol 96 (10) ◽  
pp. 3217-3225 ◽  
Author(s):  
Joanna Klubo-Gwiezdzinska ◽  
Douglas Van Nostrand ◽  
Frank Atkins ◽  
Kenneth Burman ◽  
Jacqueline Jonklaas ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Side Effects ◽  
High Risk ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Differentiated Thyroid Cancer ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background: The optimal management of high-risk patients with differentiated thyroid cancer (DTC) consists of thyroidectomy followed by radioiodine (131I) therapy. The prescribed activity of 131I can be determined using two approaches: 1) empiric prescribed activity of 131I (E-Rx); and 2) dosimetry-based prescribed activity of 131I (D-Rx). Aim: The aim of the study was to compare the relative treatment efficacy and side effects of D-Rx vs. E-Rx. Methods: A retrospective analysis was performed of patients with distant metastases and/or locoregionally advanced radioiodine-avid DTC who were treated with either D-Rx or E-Rx. Response to treatment was based on RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Results: The study group consisted of 87 patients followed for 51 ± 35 months, of whom 43 were treated with D-Rx and 44 with E-Rx. Multivariate analysis, controlling for age, gender, and status of metastases revealed that the D-Rx group tended to be 70% less likely to progress (odds ratio, 0.29; 95% confidence interval, 0.087–1.02; P = 0.052) and more likely to obtain complete response (CR) compared to the E-Rx group (odds ratio, 8.2; 95% confidence interval, 1.2–53.5; P = 0.029). There was an association in the D-Rx group between the observed CR and percentage of maximum tolerable activity given as a first treatment of 131I (P = 0.030). The advantage of D-Rx was specifically apparent in the locoregionally advanced group because CR was significantly higher in D-Rx vs. E-Rx in this group of patients (35.7 vs. 3.3%; P = 0.009). The rates of partial response, stable disease, and progression-free survival, as well as the frequency of side effects, were not significantly different between the two groups. Conclusion: Higher efficacy of D-Rx with a similar safety profile compared to E-Rx supports the rationale for employing individually prescribed activity in high-risk patients with DTC.

Role of18F-Choline Positron Emission Tomography/Computed Tomography to Detect Structural Relapse in High-Risk Differentiated Thyroid Cancer Patients

Thyroid ◽  
2019 ◽  
Vol 29 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Arnoldo Piccardo ◽  
Pierpaolo Trimboli ◽  
Matteo Puntoni ◽  
Luca Foppiani ◽  
Giorgio Treglia ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Thyroid Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Differentiated Thyroid Cancer ◽  
Emission Tomography ◽  
Positron Emission

scholarly journals Can We Safely Reduce the Administration of 131-iodine in Patients With Differentiated Thyroid Cancer? – Experience of the Brugmann Hospital in Brussels

2020 ◽  
Author(s):  
Laura Iconaru ◽  
Felicia Baleanu ◽  
Georgiana Taujan ◽  
Ruth Duttmann ◽  
Linda Spinato ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Risk Of Recurrence ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

Abstract Background131-iodine administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk.The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence.MethodsPatients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to iodine administration, cumulative administered 131I activity and response to treatment. ResultsIn total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5% and 48.3% as intermediate risk and 19.2% and 20.7% as high risk (P=0.38). Preparation to iodine administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 97.4% in Group 2 (p<0.001). 131-iodine was administered to 47/78 patients (60%) in Group 1 (5 at low risk of recurrence) and 39/58 patients (67%) in Group 2 (0 with a low risk). Among the treated patients, median 131I cumulative activity was significantly higher in Group 1 (3.70GBq [100mCi] range 1.11-20.35 GBq [30-550 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11-11.1 GBq [30-300 mCi], P<0.001. Complete response was found in 89.7% in Group 1 vs. 94.8% in Group 2 (P=0.52). ConclusionsUsing the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and an almost systematic use of rhTSH stimulation before radioiodine therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.

scholarly journals Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Laura Iconaru ◽  
Felicia Baleanu ◽  
Georgiana Taujan ◽  
Ruth Duttmann ◽  
Linda Spinato ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
High Risk ◽  
Differentiated Thyroid Cancer ◽  
Low Risk ◽  
Response To Treatment ◽  
Intermediate Risk ◽  
Risk Of Recurrence ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

Abstract Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk. The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence. Methods Patients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to 131I administration, cumulative administered 131I activity and response to treatment. Results In total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5 and 48.3% as intermediate risk and 19.2 and 20.7% as high risk (P = 0.38). Two patients (one in each group) with distant metastases were excluded from the analysis. Preparation to 131I administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 100% in Group 2 (p < 0.001). 131I was administered to 46/77 patients (59.7%) in Group 1 (5 at low risk of recurrence) and 38/57 patients (66.7%) in Group 2 (0 with a low risk). Among the patients treated by 131I, median cumulative activity was significantly higher in Group 1 (3.70GBq [100 mCi] range 1.11–11.1 GBq [30–300 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11–7.4 GBq [30–200 mCi], P < 0.001). Complete response was found in 90.9% in Group 1 vs. 96.5% in Group 2 (P = 0.20). Conclusions Using the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and a systematic use of rhTSH stimulation before 131I therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.

scholarly journals Treatment and Outcomes in Differentiated Thyroid Cancer: A Retrospective Exploration in Three UK Centres That Provide Different Advice on Low Iodine Diets

2021 ◽  
Author(s):  
Clare England ◽  
Kate Ingarfield-Herbert ◽  
Matthew Beasley ◽  
Laura Moss ◽  
Sobhan Vinjamuri ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Treatment Success ◽  
Response To Treatment ◽  
American Thyroid Association ◽  
Multi Centre Study ◽  
Remnant Ablation ◽  
Excellent Response ◽  
Ablation Success ◽  
Radioiodine Remnant Ablation

Abstract Background International guidelines on the treatment of differentiated thyroid cancers promote low iodine diets (LID) before radioiodine remnant ablation. Evidence that the LID ultimately improves treatment success is inconsistent. This study aimed to determine if there is a difference in ablation success rates according to provision of advice to follow a LID.Methods Retrospective study of patients with differentiated thyroid cancer treated with total thyroidectomy and radioiodine remnant ablation between 01/01/2015 and 31/12/2016 in 3 centres advising: no LID (C1: n=108); LID for 1-week before (C2: n=50); LID for 2-weeks before and 48 hours (C3: n=59) after RRA. Response to treatment was determined by adapted American Thyroid Association Dynamic Risk Stratification Score, stratified as excellent, indeterminate, or incomplete response.Results In total, 217 patients were included in the analysis. We found differences in preparation for radioiodine remnant ablation and in the assessment of outcomes between centres. Furthermore, although there was little difference in staging between centres there was a difference in the percentage of patients receiving 1.1GBq vs higher administered activities (15% in C1, 22% in C2 and 44% in C3, p<0.001). An excellent response was recorded for 49% in C1, 48% in C2 and 36% in C3 (p=0.61). With C1 as reference group, the odds ratios (OR) for an excellent response were C2 OR: 0.96 (95% CI 0.46,2.00) and C3 OR: 0.62 (95% CI 0.29,1.30), p=0.40.Conclusions We found no evidence that advice to follow a low iodine diet for 1 or 2 weeks before radioiodine remnant ablation impacts on ablation success but differences between centres means the results should be regarded as exploratory. There is no immediate need to change practice regarding the LID, but a prospective multi-centre study with a more homogenous approach to patient management or a randomised controlled trial will provide more definitive recommendations.

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