Radioactive iodine administered for thyroid remnant ablation following recombinant human thyroid stimulating hormone preparation also has an important adjuvant therapy function Journal Article
| Authors: | Tuttle, R. M.; Lopez, N.; Leboeuf, R.; Minkowitz, S. M.; Grewal, R.; Brokhin, M.; Omry, G.; Larson, S. |
| Article Title: | Radioactive iodine administered for thyroid remnant ablation following recombinant human thyroid stimulating hormone preparation also has an important adjuvant therapy function |
| Abstract: | Background: In December 2007, the USFDA approved recombinant human thyroid stimulating hormone (rhTSH) for radioiodine remnant ablation after total thyroidectomy in patients with well-differentiated thyroid cancer without evidence of metastatic disease. Because previously undetected radioactive iodine (RAI)-avid metastatic lesions can be identified during remnant ablation, we sought to determine if rhTSH-stimulated uptake of RAI into these incidentally discovered metastases is associated with a significant therapeutic (tumoricidal) effect. Methods: This retrospective review describes the clinical outcome of 84 well-differentiated thyroid cancer patients in whom RAI-avid lesions outside the thyroid bed were first identified at the time of RAI remnant ablation (64 rhTSH stimulated, 20 thyroid hormone withdrawal [THW]) on either the diagnostic (63/84, 75%) or posttherapy (21/84, 25%) whole body scan (76 with locoregional metastasis only and 8 with pulmonary uptake). Following ablation, patients were classified as having either no evidence of disease or persistent disease on the basis of subsequent diagnostic whole body RAI scans, stimulated thyroglobulin, and cross-sectional imaging studies. Results: Despite having RAI-avid metastatic disease identified outside the thyroid bed at the time of initial ablation, 70% (45/64) of rhTSH-assisted patients and 55% (11/20) of the THW group had no evidence of disease at a median of 2.7 years following the initial RAI ablation ( p=0.159). THW and rhTSH-stimulated RAI ablation had similar efficacy in eliminating RAI-avid locoregional metastases (42/60, 70% of rhTSH and 10/16, 63% of THW, p=0.65) and pulmonary metastases (3/4, 75% of rhTSH and 1/4, 25% of THW, p=0.41). Conclusions: Preparation with either rhTSH or THWin this retrospective study appears to have similar therapeutic (tumoricidal) effects on small volume RAI-avid metastatic disease incidentally discovered at the time of ablation in both locoregional lymph nodes and pulmonary parenchyma. Copyright 2010, Mary Ann Liebert, Inc. |
| Keywords: | adult; treatment outcome; middle aged; retrospective studies; major clinical study; cancer adjuvant therapy; cancer patient; combined modality therapy; outcome assessment; follow up; retrospective study; lung metastasis; iodine 131; iodine radioisotopes; whole body imaging; recombinant proteins; ablation techniques; thyroidectomy; thyroid cancer; thyroid neoplasms; thyroglobulin; electrosurgery; adenocarcinoma, follicular; adenocarcinoma, papillary; recombinant thyrotropin; thyrotropin; whole body scintiscanning; remnant ablation |
| Journal Title: | Thyroid |
| Volume: | 20 |
| Issue: | 3 |
| ISSN: | 1050-7256 |
| Publisher: | Mary Ann Liebert, Inc |
| Date Published: | 2010-03-01 |
| Start Page: | 257 |
| End Page: | 263 |
| Language: | English |
| DOI: | 10.1089/thy.2009.0401 |
| PUBMED: | 20187781 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 4" - "Export Date: 20 April 2011" - "CODEN: THYRE" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work