Recombinant human thyroid stimulating hormone-assisted radioactive iodine remnant ablation in thyroid cancer patients at intermediate to high risk of recurrence Journal Article
| Authors: | Hugo, J.; Robenshtok, E.; Grewal, R.; Larson, S.; Tuttle, R. M. |
| Article Title: | Recombinant human thyroid stimulating hormone-assisted radioactive iodine remnant ablation in thyroid cancer patients at intermediate to high risk of recurrence |
| Abstract: | Background: Multiple studies have demonstrated successful radioactive iodine remnant ablation (RRA) following preparation with recombinant human thyroid stimulating hormone (rhTSH). Short-term studies in relatively low-risk patients have also suggested that rhTSH-stimulated RRA can have an effective adjuvant therapy function in destroying residual microscopic thyroid cancer cells. However, very few of these studies have included a significant number of intermediate or high-risk patients. The goal of this study was to examine clinical outcomes after rhTSH stimulated RRA in a larger cohort of thyroid cancer patients at higher risk of recurrence and disease-specific mortality. Methods: A retrospective chart review identified 586 thyroid cancer patients prepared for RRA with either a thyroid hormone withdrawal (THW) (n=321) or rhTSH preparation (n=265). The primary end points included both the best response to initial therapy and the clinical status at final follow-up. Clinical outcomes were compared within each of the American Thyroid Association (ATA) risk groups (low, intermediate, and high) and American Joint Committee on Cancer (AJCC) stages (I-IV) based on the method of preparation for RRA (THW vs. rhTSH). Results: Preparation with rhTSH was more likely to be associated with an excellent response to therapy (39.4% for rhTSH vs. 30% for TWH, p=0.03) and fewer additional therapies (29% for rhTSH vs. 37% for TWH, p=0.05) than THW. However, after a median follow-up period of 9 years, the final clinical outcomes were not significantly different with respect to recurrence rates (1.5% for rhTSH vs. 1.2% for TWH), likelihood of having persistent disease (46% for rhTSH vs. 48% for THW) or likelihood of having no evidence of disease (53% for rhTSH vs. 52% for TWH). Furthermore, clinical outcomes were similar between rhTSH and THW preparation across all ATA risk groups and AJCC stages. Conclusions: rhTSH preparation for RRA is associated with a small, but statistically significant improvement in an initial response to therapy and similar final clinical outcomes across a wide range of risk of recurrence and risk of disease-specific mortality. These data suggest that rhTSH preparation for RRA can be effectively used in intermediate and high-risk patients without known distant metastases. © 2012, Mary Ann Liebert, Inc. |
| Keywords: | adult; controlled study; treatment outcome; treatment response; middle aged; cancer surgery; retrospective studies; major clinical study; review; cancer recurrence; cancer risk; multimodality cancer therapy; combined modality therapy; outcome assessment; recurrence risk; follow up; cohort studies; neoplasm recurrence, local; cohort analysis; medical record review; retrospective study; oncocytoma; cancer mortality; risk assessment; risk; cancer hormone therapy; disease severity; iodine 131; iodine radioisotopes; neoplasm, residual; recombinant proteins; ablation techniques; thyroidectomy; thyroid carcinoma; thyroid neoplasms; thyroid papillary carcinoma; recombinant thyrotropin; thyrotropin; thyroid follicular carcinoma; tumor ablation; iodine 123; poorly differentiated thyroid cancer; radioactive iodine remnant ablation |
| Journal Title: | Thyroid |
| Volume: | 22 |
| Issue: | 10 |
| ISSN: | 1050-7256 |
| Publisher: | Mary Ann Liebert, Inc |
| Date Published: | 2012-10-01 |
| Start Page: | 1007 |
| End Page: | 1015 |
| Language: | English |
| DOI: | 10.1089/thy.2012.0183 |
| PROVIDER: | scopus |
| PUBMED: | 22873801 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 2 November 2012" - "CODEN: THYRE" - "Source: Scopus" |
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