scholarly journals Dynamic Risk Stratification in Patients with Differentiated Thyroid Cancer Treated Without Radioactive Iodine

2016 ◽  
Vol 101 (7) ◽  
pp. 2692-2700 ◽  
Author(s):  
Denise P. Momesso ◽  
Fernanda Vaisman ◽  
Samantha P. Yang ◽  
Daniel A. Bulzico ◽  
Rossana Corbo ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Response To Therapy ◽  
Therapy Assessment ◽  
Dynamic Risk ◽  
Incomplete Response ◽  
Risk Estimates ◽  
Negative Imaging

Context: Although response to therapy assessment is a validated tool for dynamic risk stratification in patients with differentiated thyroid cancer (DTC) treated with total thyroidectomy (TT) and radioactive iodine therapy (RAI), it has not been well studied in patients treated with lobectomy or TT without RAI. Because these responses to therapy definitions are heavily dependent on serum thyroglobulin (Tg) levels, modifications of the original definitions were needed to appropriately classify patients treated without RAI. Objective: This study aimed to validate the response to therapy assessment in patients with DTC treated with lobectomy or TT without RAI. Design and Setting: This was a retrospective study, which took place at a referral center. Patients: A total of 507 adults with DTC were treated with lobectomy (n = 187) or TT (n = 320) without RAI. They had a median age of 43.7 y, 88% were female, 85.4% had low risk, and 14.6% intermediate risk. Main Outcome Measure: Main outcome measured was recurrent/persistent structural evidence of disease (SED) during a median followup period of 100.5 months (24–510). Results: Recurrent/persistent SED was observed in 0% of the patients with excellent response to therapy (nonstimulated Tg for TT < 0.2 ng/mL and for lobectomy < 30 ng/mL, undetectable Tg antibodies [TgAb] and negative imaging; n = 326); 1.3% with indeterminate response (nonstimulated Tg for TT 0.2–5 ng/mL, stable or declining TgAb and/or nonspecific imaging findings; n = 2/152); 31.6% of the patients with biochemical incomplete response (nonstimulated Tg for TT > 5 ng/mL and for lobectomy > 30 ng/mL and/or increasing Tg with similar TSH levels and/or increasing TgAb and negative imaging; n = 6/19) and all (100%) patients with structural incomplete response (n = 10/10) (P < .0001). Initial American Thyroid Association risk estimates were significantly modified based on response to therapy assessment. Conclusions: Our data validate the newly proposed response to therapy assessment in patients with DTC treated with lobectomy or TT without RAI as an effective tool to modify initial risk estimates of recurrent/persistent SED and better tailor followup and future therapeutic approaches. This study provides further evidence to support a selective use of RAI in DTC.

scholarly journals A New Dynamic Response to Therapy Assessment in Postoperative Patients With Low-Risk Differentiated Thyroid Cancer Treated Without Radioactive Iodine

2021 ◽  
Vol 11 ◽  
Author(s):  
Ping Dong ◽  
Li Wang ◽  
Liu Xiao ◽  
Liu Yang ◽  
Rui Huang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Dynamic Response ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Response To Therapy ◽  
Low Risk ◽  
Therapy Assessment ◽  
Incomplete Response ◽  
Increasing Trend

BackgroundTotal thyroidectomy (TT) or lobectomy without radioactive iodine (RAI) is becoming a common management for patients with low-risk differentiated thyroid cancer (DTC). However, the assessment of response to therapy for these patients remains controversial. The aim of this study was to propose and validate a new dynamic evaluation strategy to assess the response to therapy in patients with low-risk DTC treated with TT or lobectomy but without RAI.MethodsWe performed a retrospective analysis of 543 adult patients with low-risk DTC who underwent TT or lobectomy without RAI therapy. Follow-up consisted of trends of serum thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb) levels and neck ultrasonography (US) were conducted every 6–24 months. Response to therapy assessments were defined as excellent response, biochemical incomplete response, structural incomplete response, and indeterminate response according to the follow-up findings.ResultsAt a median follow-up of 51 months (range 33–66 months), 517 (95%) had excellent response, while the other 26 had either biochemical incomplete response (an increasing trend of suppressed serum Tg levels, n=9; an increasing trend of TgAb levels, n=3) or indeterminate response (a stable or decreasing trend of suppressed serum Tg levels, but a stable positive trend of TgAb levels, n=14). No patients had structural incomplete response or no deaths related to thyroid cancer. The risk of incomplete response was significantly higher in lobectomy than in TT (p<0.001).ConclusionOur study proposed and validated a new dynamic response to therapy assessment depending on trends of suppressed serum Tg, TgAb levels, and neck US findings which could be an appropriate tool for postoperative follow-up in low-risk DTC patients without RAI therapy. Our findings provided further evidence to support no routine recommendation of RAI after surgery in low-risk DTC.

scholarly journals Natural Course of the American Thyroid Association Response to Therapy Statuses (Dynamic Risk Stratification) in Differentiated Thyroid Cancer

2020 ◽  
pp. 1-10
Author(s):  
Noha Mukhtar ◽  
Hadeel Aljamei ◽  
Abeer Aljomaiah ◽  
Yosra Moria ◽  
Ali S. Alzahrani
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Response To Therapy ◽  
Natural Course ◽  
Initial Management ◽  
Excellent Response ◽  
Dynamic Risk ◽  
The Status

The concept of response to therapy in differentiated thyroid cancer (DTC) was introduced as a dynamic risk stratification used to assess the status of the disease at the time of the evaluation during the follow-up and the risk of recurrence in the future. Our aim in this study was to evaluate the natural course over time of different response to therapy statuses. <b><i>Methods:</i></b> We studied 501 nonselected DTC patients (102 males and 399 females) with a median age of 37 years (interquartile range [IQR] 29–48). All patients underwent near-total or total thyroidectomy followed by I-131 ablation (initial management). <b><i>Results:</i></b> Of the 501 patients, 387 patients (77.2%) did not have any additional therapuetic interventions after the initial management. In this group, the response to therapy status at the time of the first evaluation after I-131 (median 17 months, IQR 14–22) was an excellent response in 258 (66.7%), an indeterminate response in 101 (26.1%), biochemically incomplete in 17 (4.4%), and structurally incomplete in 11 patients (2.8%). The status changed spontaneously without any intervention in many of them. At the last follow-up visit (median duration 101 months, IQR 71–126), 357 patients (92.2%) achieved an excellent response, 4 (1%) an indeterminate response, 8 (2.1%) a biochemically incomplete status, 16 (4.1%) a structurally incomplete status, and 2 (0.5%) died secondary to DTC with a structurally incomplete status. The response to therapy in the other 114 patients who underwent additional interventions changed from before intervention to the last evaluation as follows: excellent response, 0 to 60 patients (52.6%), indeterminate response, 20 (17.5%) to 1 patient (0.9%), biochemically incomplete 25 (21.9%) to 10 patients (9%), and structurally incomplete 69 (60.5%) to 43 patients (37.7%). Overall, at the last evaluation, 417 (83.2%) were in an excellent response, 5 (1%) in an indeterminate response, 18 (3.6%) in a biochemically incomplete status, 50 (10.2%) in a structurally incomplete status, and 11 (2.2%) died secondary to DTC with a structurally incomplete status. <b><i>Conclusions:</i></b> The response to therapy at the initial evaluation is predictive of the long-term outcome. Most patients with the indeterminate response and some in the biochemically incomplete statuses spontaneously regress to an excellent status. Mortality and progression of DTC occur mostly in the structurally incomplete status.

scholarly journals Thyroglobulin levels before radioactive iodine therapy and dynamic risk stratification after 1 year in patients with differentiated thyroid cancer

2017 ◽  
Vol 61 (6) ◽  
pp. 590-599 ◽  
Author(s):  
Leonardo Bandeira ◽  
Rosália do Prado Padovani ◽  
Ana Luiza Ticly ◽  
Adriano Namo Cury ◽  
Nilza Maria Scalissi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Differentiated Thyroid Cancer ◽  
Radioactive Iodine ◽  
Radioactive Iodine Therapy ◽  
Dynamic Risk
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