scholarly journals Clinical outcomes of low-dose and high-dose postoperative radioiodine therapy in intermediate-risk papillary thyroid carcinoma patients with low postoperative stimulated thyroglobulin (1-20 ng/ml) and non-structural or functional metastasis: study protocol for a randomized-controlled trial

2021 ◽  
Author(s):  
Pan Chen ◽  
Jia-Xin Luo ◽  
Wei Ouyang ◽  
Hui-Juan Feng ◽  
Ju-Qing Wu ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Dose Group ◽  
Low Dose ◽  
Disease Free Survival ◽  
High Dose Group ◽  
High Dose ◽  
Intermediate Risk ◽  
Papillary Thyroid ◽  
Free Survival

Abstract Background: For some intermediate risk papillary thyroid carcinoma patients, if there are structural metastases, reoperation is preferred. If there are functional metastases (131I avidity), they can be treated with high-dose radioactive iodine (131I). However, it is still controversial whether 131I ablation should be used and the determination of 131I dosage for another part of intermediate risk patients with non-structural or functional metastases, especially those with postoperative stimulated thyroglobulin (ps-Tg) 1-20 ng/ml. The aim of the present study is mainly to compare the 3-years disease-free survival between low-dose group (1.1 GBq) and high-dose group (3.7 GBq) in intermediate risk papillary thyroid carcinoma patients with non-structural or functional metastases and ps-Tg 1-20 ng/ml.Methods: A single-center, randomized, double-blind parallel controlled study is designed at the Zhujiang Hospital of Southern Medical University. Participants will be randomized to low-dose group (1.1 GBq) or high-dose group (3.7 GBq) in a 1:1 ratio. After orally receiving different dosage of 131I once on an empty stomach, all patients will return to our hospital every 3-12 months to be performed related inspection items. Discussion: We believe that the 3-year disease-free survival of low-dose group (1.1 GBq) may not be lower than that of high-dose group (3.7 GBq) in intermediate-risk thyroid papillary carcinoma patients with no structural or functional metastases and ps-Tg 1-20 ng/ml. Besides we expect to clarify whether there are apparent differences in successful remnant ablation, efficacy, progression-free survival, safety, and health economics evaluation between the two groups.Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov/), ID: NCT04354324. Registered on 16 April, 2020.

scholarly journals Ablation therapy using a low dose of radioiodine may be sufficient in low- to intermediate-risk patients with follicular variant papillary thyroid carcinoma

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096649
Author(s):  
Fuxin Li ◽  
Wei Li ◽  
Katherine D. Gray ◽  
Rasa Zarnegar ◽  
Dan Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Local Recurrence ◽  
Thyroid Carcinoma ◽  
Low Dose ◽  
High Dose ◽  
Intermediate Risk ◽  
Papillary Thyroid ◽  
Follicular Variant ◽  
Remnant Ablation

Objectives Follicular variant papillary thyroid carcinoma (FVPTC) is treated similarly to classical variant papillary thyroid carcinoma (cPTC). However, FVPTC has unique tumour features and behaviours. We investigated whether a low dose of radioiodine was as effective as a high dose for remnant ablation in patients with FVPTC and evaluated the recurrence of low-intermediate risk FVPTC. Methods Data from cPTC and FVPTC patients treated with I-131 from 2004 to 2014 were reviewed. Demographics, tumour behaviour, lymph node metastasis, and local recurrence data were compared between FVPTC and cPTC patients. Then, low-intermediate risk FVPTC patients were divided into low, intermediate, and high I-131 dose groups, and postoperative I-131 activities were analysed to evaluate the effectiveness of I-131 therapy for thyroid remnant ablation. Results In total, 799 cases of FVPTC (n = 168) and cPTC (n = 631) treated with I-131 were identified. Patients with FVPTC had a larger primary nodule size than cPTC, but lymph node metastases and local recurrence were more prevalent in cPTC than in FVPTC. For the low-, intermediate-, and high-dose groups, success rates of ablation did not differ (82.0%, 80%, and 81.3%, respectively). Conclusion FVPTC differs from cPTC in behaviour. Low-dose ablation may be sufficient in FVPTC patients with low-intermediate disease risk.

scholarly journals Is Completion Thyroidectomy Necessary in Patients with Papillary Thyroid Carcinoma who Underwent Lobectomy?

2021 ◽  
Vol 37 (2) ◽  
pp. 25-31
Author(s):  
Il Ku Kang ◽  
Kwangsoon Kim ◽  
Ja Seong Bae ◽  
Jeong Soo Kim
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Lymph Nodes ◽  
Disease Free Survival ◽  
Completion Thyroidectomy ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Disease Free ◽  
Positive Lymph Nodes

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC.Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months.Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092)Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

scholarly journals BRAF V600E mutation in papillary thyroid carcinoma: it’s relation to clinical features and oncologic outcomes in a single cancer centre experience

2021 ◽  
Author(s):  
Mahmoud Al-Masri ◽  
Tawfiq Al-Shobaki ◽  
Hani Al-Najjar ◽  
Rafal Iskanderian ◽  
Enas Younis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Disease Free Survival ◽  
Braf V600e Mutation ◽  
Braf V600e ◽  
Cancer Center ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Disease Free

Purpose: This study focuses on the oncologic influence of BRAF V600E mutations in a cohort of Middle Eastern PTC patients treated at a single centre. We test the association of BRAFV600E mutation with papillary thyroid carcinoma at King Hussein Cancer Center. Methods: Patients with histologically confirmed PTC who underwent surgical treatment between 2006 and 2015 were included in this study. Oncological outcomes, both short and long termed were collected. Results: A total of 128 patients (68% females) were included in this study with a mean age of 38 years (±13.8). The median follow-up period was 50 months. The BRAF V600E mutation was found in 71% of patients. The tumor size for patients with a negative BRAF V600E mutation were significantly larger in comparison to patients who tested positive for the mutation (3.47 cm versus 2.31 cm, respectively, P = 0.009). The two groups showed similar disease-free survival (DFS) rates; positive = 75% (median 43 months (0-168)) compared to 78% for the negative BRAF V600E mutation (median 38 months (3-142)) (P= 0.162, HR=0.731) Furthermore, both groups showed similar overall survival rates: positive = 94.5% (median 56 months (0-228)) compared to 94.6% for the negative BRAF V600E mutation (median 43 months (3-157)) (P = 0.941, HR= 0.940). Conclusion: BRAF V600E mutation had no effect on loco-regional recurrence, distant metastasis, overall survival or disease-free survival. These findings may be attributed to geographic variations or reflect that BRAF V600E may only serve as an indicator of poor prognosis in high risk groups.

scholarly journals Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

2021 ◽  
Vol 10 (21) ◽  
pp. 5144
Author(s):  
Joohyun Woo ◽  
Hyeonkyeong Kim ◽  
Hyungju Kwon
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Cox Regression ◽  
Medical Center ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Cox Regression Analysis

The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality can predict the recurrence of PTC. A total of 1249 patients who underwent total thyroidectomy for PTC at the Ewha Medical Center between March 2012 and December 2019 were reviewed. In this study, multifocality was found in 487 patients (39.0%) and the mean follow-up period was 5.5 ± 2.7 years. Multifocality was associated with high-risk features for recurrence, including extrathyroidal extension, lymph node metastasis, and margin involvement. After adjustment of those clinicopathological features, 10-year disease-free survival was 93.3% in patients with multifocal tumors, whereas those with unifocal disease showed 97.6% (p = 0.011). Multivariate Cox regression analysis indicated that male sex (HR 2.185, 95% CI 1.047–4.559), tumor size (HR 1.806, 95% CI 1.337–2.441), N1b LN metastasis (HR 3.603, 95% CI 1.207–10.757), and multifocality (HR 1.986, 95% CI 1.015–3.888) were independent predictors of recurrence. In conclusion, multifocality increased the risk of recurrence in patients with PTC. Patients with multifocal PTCs may need judicious treatment and follow-up approaches.

scholarly journals Do aggressive variants of papillary thyroid carcinoma have worse clinical outcome than classic papillary thyroid carcinoma?

2018 ◽  
Vol 179 (3) ◽  
pp. 135-142 ◽  
Author(s):  
Eyun Song ◽  
Min Ji Jeon ◽  
Hye-Seon Oh ◽  
Minkyu Han ◽  
Yu-Mi Lee ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Clinical Outcome ◽  
Thyroid Carcinoma ◽  
Disease Free Survival ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Unfavorable Clinical Outcome ◽  
Tall Cell ◽  
Cell Variant ◽  
Columnar Cell Variant

Objective Evidence for unfavorable outcomes of each type of aggressive variant papillary thyroid carcinoma (AV-PTC) is not clear because most previous studies are focused on tall cell variant (TCV) and did not control for other major confounding factors contributing to clinical outcomes. Design Retrospective cohort study. Methods This study included 763 patients with classical PTC (cPTC) and 144 with AV-PTC, including TCV, columnar cell variant (CCV) and hobnail variants. Disease-free survival (DFS) and dynamic risk stratification (DRS) were compared after two-to-one propensity score matching by age, sex, tumor size, lymph node metastasis and extrathyroidal extension. Results The AV-PTC group had significantly lower DFS rates than its matched cPTC group (HR = 2.16, 95% CI: 1.12–4.16, P = 0.018). When TCV and CCV were evaluated separately, there was no significant differences in DFS and DRS between patients with TCV (n = 121) and matched cPTC. However, CCV group (n = 18) had significantly poorer DFS than matched cPTC group (HR = 12.19, 95% CI: 2.11–70.33, P = 0.005). In DRS, there were significantly more patients with structural incomplete responses in CCV group compared by matched cPTC group (P = 0.047). CCV was an independent risk factor for structural persistent/recurrent disease in multivariate analysis (HR = 4.28; 95% CI: 1.66–11.00, P = 0.001). Conclusions When other clinicopathological factors were similar, patients with TCV did not exhibit unfavorable clinical outcome, whereas those with CCV had significantly poorer clinical outcome. Individualized therapeutic approach might be necessary for each type of AV-PTCs.

scholarly journals Radioactive iodine ablation may not decrease the risk of recurrence in intermediate-risk papillary thyroid carcinoma

2016 ◽  
Vol 23 (5) ◽  
pp. 367-376 ◽  
Author(s):  
Seo Ki Kim ◽  
Jung-Woo Woo ◽  
Jun Ho Lee ◽  
Inhye Park ◽  
Jun-Ho Choe ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Radioactive Iodine ◽  
Regional Lymph Node ◽  
Medical Center ◽  
Clinicopathological Characteristics ◽  
Cancer Center ◽  
High Dose ◽  
Intermediate Risk ◽  
Papillary Thyroid

The use of radioactive iodine (RAI) ablation in patients with intermediate-risk papillary thyroid carcinoma (PTC) who show microscopic extrathyroidal extension (ETE), regional lymph node (LN) metastasis, tumors with aggressive histology, or vascular invasion has been debated due to the lack of data regarding long-term prognosis in this risk group. Therefore, the purpose of this study was to resolve the controversy surrounding the prognostic benefit of RAI ablation, especially in intermediate-risk PTC patients. We retrospectively reviewed the medical records of 8297 intermediate-risk PTC patients who underwent primary total thyroidectomy with or without neck dissection at the Thyroid Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, between January 1997 and June 2015. Of these 8297 patients, 7483 (90.2%) received RAI ablation. After adjusting for clinicopathological characteristics, RAI ablation did not significantly decrease the risk of loco-regional recurrence (LRR) (adjusted hazard ratio (HR) 0.852, P 0.413). Moreover, RAI ablation did not decrease the risk of LRR even in intermediate-risk PTC patients with aggressive features such as BRAF positivity (adjusted HR 0.729, P 0.137), tumor size >1 cm (adjusted HR 0.762, P 0.228), multifocality (adjusted HR 1.032, P 0.926), ETE (adjusted HR 0.870, P 0.541), and regional LN metastasis (adjusted HR 0.804, P 0.349). Furthermore, high-dose RAI ablation (>100 mCi) did not significantly decrease the risk of LRR (adjusted HR 0.942, P 0.843). Therefore, RAI ablation in intermediate-risk PTC patients should be considered on the basis of tailored risk restratification.

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