Dynamic risk allows us to adequately select patients with differentiated thyroid cancer who do not require radioiodine treatment

Abelleira, Erika; Peñaloza, Mirna Angela; Jerkovich, Fernando; Bueno, Fernanda; Pitoia, Fabián

doi:10.20945/2359-3997000000374

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…Based on these premises, evidence from the literature advocates more and more a wait-and-see attitude in low and lower-intermediate-risks DTC, where delayed treatment does not seem to affect the final outcome, while effectively stratifying the recurrence risk and thus reducing the rate of unnecessary RAI [ 50 , 51 , 68 , 69 ]. Conversely, emerging structural or biochemical incomplete responses might arouse suspicions even in formerly low-risk patients, supporting additional adjuvant treatment in these selected cases [ 51 , 70 , 71 ]. The results of the available studies are summarized in Table 3 .…”

Section: Radioiodine Treatment Goalsmentioning

confidence: 99%

Strategies for Radioiodine Treatment: What’s New

Sparano

Moog

Hadoux

et al. 2022

Cancers

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Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.

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Section: Radioiodine Treatment Goalsmentioning

confidence: 99%

Strategies for Radioiodine Treatment: What’s New

Sparano

Moog

Hadoux

et al. 2022

Cancers

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“…In Abelleira et al, the results of a dynamic risk assessment during a postoperative follow-up of DTC patients for at least 12 months showed no recurrence in any of the patients with excellent response to treatment. In patients with indeterminate initial response at the end of the follow-up period, however, disease progress was observed in 33.4% of the cases ( 27 ). These results were consistent with the findings of the present study, suggesting that the risk of recurrence varied based on response to treatment during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Risk Reassessment of Differentiated Thyroid Cancer in Ahvaz, Iran: A Cross-sectional Retrospective Study

Jahanshahi¹,

Sarshoori²,

Rashidi³

et al. 2023

Int J Endocrinol Metab

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Background: Accurate evaluation of response to treatment in differentiated thyroid cancer (DTC) is the sine qua non of preventing over-treatment in low-risk patients and implementing appropriate interventions in high-risk individuals. Objectives: This study aimed to assess the response to therapy in DTC patients based on dynamic stratification method. Methods: In this cross-sectional study, 154 medical records of subjects with DTC (with at least 6 months after total thyroidectomy) and referred to endocrinology clinics in Ahvaz, Iran, from April 2020 to May 2021 were examined. Patients were stratified according to a dynamic risk stratification system (informed by their specific clinical, histopathological, and ultrasonography findings, and other diagnostic imagines) into four groups: Excellent response (ER), indeterminate response (IR), biochemical incomplete response (BIR), and structural incomplete response (SIR). Results: For a mean follow-up period of 28.59 months, excellent response to treatment was observed in 92 patients (59.7%), indeterminate response to treatment was found in 32 patients (20.8%), biochemical incomplete response was detected in 2 patients (1.3%), and structural incomplete response was seen in 28 patients (18.2%). In the group with low risk of recurrence, ER and IR were observed in 79.2% and 15.6% of the patients, respectively (P < 0.0001). In the group with an intermediate risk of recurrence, ER was found in 32% of the patients, while IR and SIR + BIR were seen in 34% and 34% of the patients, respectively (P < 0.0001). No cases of ER or IR were observed in the group with high risk (P = 0.001). Conclusions: In sum, response to treatment significantly varied based on dynamic risk stratification, with ER being highest in the low-risk group, less likely in moderate risk group, and undetected in the high-risk group.

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“…Al final del seguimiento se encontró que la respuesta bioquímica incompleta y estructural incompleta se mantuvieron igual, no así la respuesta indeterminada que disminuyó y se incrementó la respuesta excelente. Estos hallazgos son similares a dos estudios publicados por Abelleira y colaboradores (2017 y 2019) [2] aunque ellos encontraron una mayor respuesta estructural incompleta relacionada por la inclusión de pacientes con una mayor probabilidad de recurrencia. En el estudio la mayor respuesta indeterminada estuvo relacionada con la alta tasa de anticuerpos antitiroglobulina (TgAb) que se mantuvo estable en la mayoría de los pacientes hasta el final del seguimiento.…”

Section: Discussionunclassified

“…Dynamic risk of recurrence in patients with thyroid microcarcinoma with and without iodine-131 ablation Mónica Guisellaa Mejía Naranjo 1 * , José Camilo López Estrella 2 1. Servicio de Endocrinología, Hospital General Enrique Ortega Moreira, Ministerio de Salud Pública, Durán-Ecuador.…”

Section: Riesgo De Recurrencia Dinámico En Pacientes Con Microcarcino...mentioning

confidence: 99%

“…Se considera que dicho incremento en la incidencia se debe al diagnóstico temprano de tumores pequeños o Micro carcinomas (entendiéndose por microcarcinoma aquellos tumores menores de 1 cm). La tendencia actual a nivel mundial, en el manejo de estos tumores, es conservadora tanto para el tratamiento quirúrgico como el tratamiento ablativo con el Iodo 131, siendo éstos indicados en casos seleccionados que reúnan ciertos criterios de inclusión [2][3][4].…”

Section: Introductionunclassified

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Riesgo de recurrencia dinámico en pacientes con microcarcinoma de tiroides con y sin ablación con Yodo-131

Naranjo

Estrella

2023

Rev. Oncol. Ecu.

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Introducción: El cáncer diferenciado de tiroides ha incrementado su incidencia en las últimas 3 décadas debido al sobrediagnóstico de tumores pequeños o microcarcinomas, las nuevas tendencias en su manejo hacen de la cirugía y la terapia con iodo radioactivo el tratamiento de elección para casos seleccionados. El manejo actual de microcarcinoma de tiroides se basa en el riesgo de recurrencia inicial y su seguimiento en el tiempo con el riesgo de recurrencia dinámico. Objetivo: El presente trabajo se enfocó en analizar el riesgo de recurrencia dinámico en pacientes con microcarcinoma de tiroides que recibieron o no terapia ablativa con Iodo 131 posterior a tratamiento quirúrgico en el Hospital Teodoro Maldonado Carbo durante los años 2016 – 2018. Métodos: Se realizó un estudio ambispectivo, no experimental, descriptivo, analítico, transversal y correlacional. Se analizaron 51 pacientes atendidos en la unidad técnica de endocrinología. Resultados: De un total de 51 casos de microcarcinoma, el 60% fue tratado con terapia ablativa, la respuesta inicial fue excelente en el 53.3% de pacientes ablacionados y en el 66.7% de los casos no ablacionados. El riesgo de recurrencia inicial fue significativamente más bajo en el grupo no tratado mediante ablación (100%), mientras que en el tratado con ablación fue bajo, intermedio y alto en 16 (53.3%), 7 (23.3) y 7 (23.3), respectivamente. Conclusiones: Existe un riesgo bajo de recurrencia dinámico, independientemente de la indicación de terapia ablativa con I131, la estratificación del riesgo de recurrencia constituye una herramienta útil para seleccionar aquellos pacientes que deben recibir iodo radioactivo.

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Dynamic risk allows us to adequately select patients with differentiated thyroid cancer who do not require radioiodine treatment

Cited by 7 publications

References 26 publications

Strategies for Radioiodine Treatment: What’s New

Strategies for Radioiodine Treatment: What’s New

Risk Reassessment of Differentiated Thyroid Cancer in Ahvaz, Iran: A Cross-sectional Retrospective Study

Riesgo de recurrencia dinámico en pacientes con microcarcinoma de tiroides con y sin ablación con Yodo-131

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