Clinical outcomes following empiric radioiodine therapy in patients with structurally identifiable metastatic follicular cell-derived thyroid carcinoma with negative diagnostic but positive post-therapy (131)I whole-body scans Journal Article
| Authors: | Sabra, M. M.; Grewal, R. K.; Tala, H.; Larson, S. M.; Tuttle, R. M. |
| Article Title: | Clinical outcomes following empiric radioiodine therapy in patients with structurally identifiable metastatic follicular cell-derived thyroid carcinoma with negative diagnostic but positive post-therapy (131)I whole-body scans |
| Abstract: | Background: While radioiodine (RAI) therapy remains the most effective treatment modality for RAI-avid distant metastatic follicular cell-derived thyroid cancer, the therapeutic utility of empiric RAI therapy in patients with structurally identifiable distant metastases that demonstrate RAI avidity only on the post-therapy scan (negative diagnostic whole-body scan [DxWBS]) remains uncertain. Methods: We report a retrospective assessment of the structural response to RAI therapy in 27 patients (median age 54 years, 59% male) with metastatic thyroid cancer (45% classical papillary thyroid cancer, 21% poorly differentiated, 15% tall-cell variant, 15% follicular variant, and 4% Hurthle cell carcinoma) with structurally identifiable distant metastases (86% pulmonary metastases) in whom a properly conducted DxWBS was negative, and the post-therapy scan showed RAI-avid metastatic lesions at the time of RAI remnant ablation. Results: In response to the initial RAI ablation, none of the selected patients demonstrated structural disease regression, and no patient was rendered free of disease. However, 12 patients (44%) demonstrated stable lesions on serial structural imaging after an RAI ablation. Structural disease progression was seen in the remaining 56% (15/27), a median of 6 months after ablation. Unfortunately, additional RAI therapies given to 12/15 patients with progressive disease and 5/12 patients with stable lesions failed to cause structural disease regression, cure, or conversion from progressive to stable disease in any patient. All of the disease-specific deaths (7/27) were in patients who had structural disease progression (n=15) in response to RAI ablation. None of the patients with persistent but stable lesions on structural imaging (n=12) have died of thyroid cancer over a median follow-up period of 3.7 years. Conclusions: While 44% of patients with the DxWBS-negative/post-therapy scan-positive macroscopic distant metastasis will have stable cross-sectional imaging after RAI remnant ablation, the other 56% will demonstrate structural disease progression that cannot be effectively treated with repeated empiric RAI activities. Furthermore, the high disease-specific mortality rate seen within the first few years of remnant ablation in this small subset of patients with persistent progressive disease despite a positive post-therapy RAI scan argues that treatments other than repeated empiric RAI dosing be strongly considered. © Copyright 2012, Mary Ann Liebert, Inc. 2012. |
| Keywords: | adult; clinical article; treatment outcome; cancer growth; bone metastasis; positron emission tomography; follow up; retrospective study; cancer mortality; distant metastasis; lung metastasis; iodine 131; radioactive iodine; dosimetry; thyroid carcinoma; thyroid hormone; whole body scintiscanning |
| Journal Title: | Thyroid |
| Volume: | 22 |
| Issue: | 9 |
| ISSN: | 1050-7256 |
| Publisher: | Mary Ann Liebert, Inc |
| Date Published: | 2012-09-01 |
| Start Page: | 877 |
| End Page: | 883 |
| Language: | English |
| DOI: | 10.1089/thy.2011.0429 |
| PROVIDER: | scopus |
| PUBMED: | 22827641 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 October 2012" - "CODEN: THYRE" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work