Efficacy of low-dose iodine-131 ablation of post-operative thyroid remnants: a study of 69 cases

Leung, S. F.; Law, Martin Wm; Ho, Stephen

doi:10.1259/0007-1285-65-778-905

Cited by 37 publications

(18 citation statements)

References 17 publications

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“…For remnant ablation in adults, most centers use 3.7 GBq (100 mCi), many decide on 1.1 GBq (30 mCi), which has been suggested to be the lowest effective activity in this setting (Bal et al 2004b), while others, including ours, chose intermediate activities like 2.2 GBq (60 mCi) (Leung et al 1992, Reynolds & Robbins 1997, Mazzaferri & Massoll 2002, Pacini et al 2002, Zidan et al 2004.…”

Section: Dosimetric Considerationsmentioning

confidence: 92%

“…'Successful ablation' usually is defined using relatively short-term 'surrogate markers', namely, absent or <0.1-1.0% uptake on a diagnostic WBS performed 6-12 months after the procedure (Leung et al 1992, van Wyngaarden & McDougall 1996, Pacini et al …”

Section: Primary Treatment Of Juvenile Dtc Overviewmentioning

confidence: 99%

“…Typically, one course of radioiodine therapy achieves successful ablation defined in this manner (Zidan et al 2004), however, the procedure sometimes must be repeated, usually after 6-12 months (Leung et al 1992, van Wyngaarden & McDougall 1996, Pacini et al 2002. Approaches for choosing an ablative activity are discussed in detail in the Dosimetric Considerations section below.…”

Section: Goal Of Ablation Rationalementioning

confidence: 99%

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Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

169

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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Section: Dosimetric Considerationsmentioning

confidence: 92%

Section: Primary Treatment Of Juvenile Dtc Overviewmentioning

confidence: 99%

Section: Goal Of Ablation Rationalementioning

confidence: 99%

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Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

169

160

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“…Often surgeons will leave some thyroid tissue near the upper parathyroid and the insertion of the recurrent laryngeal nerve to protect these structures, and this is termed ''near-total thyroidectomy.'' In this scenario, the remnant is often ablated with RAI (24). Total thyroidectomy, on the other hand, eliminates the need to administer an ablative RAI dose to destroy the thyroid remnant, and any RAI that is given is more effective in destroying metastatic disease (22,25).…”

Section: Introductionmentioning

confidence: 99%

Remnant Uptake as a Postoperative Oncologic Quality Indicator

Schneider

Ojomo

Chen

et al. 2013

Thyroid

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Background: The purpose of this study was to examine the utility of remnant uptake on postoperative radioiodine scans as an oncologic indicator after thyroidectomy for differentiated thyroid cancer (DTC). Methods: We conducted a retrospective review of patients undergoing total thyroidectomy for DTC and subsequent radioactive iodine (RAI) treatment. Of the eight surgeons included, three were considered high volume, performing at least 20 thyroidectomies per year. Patients with distant metastases at diagnosis or poorly differentiated variants were excluded. To control for the effect of varying RAI doses, the remnant uptake was analyzed as a ratio of the percentage uptake to the dose received (uptake to dose ratio [UDR]). Multivariate logistic regression was used to determine the influence of UDR on recurrence. Results: Of the 223 patients who met inclusion criteria, 21 patients (9.42%) experienced a recurrence. Those with a recurrence had a 10-fold higher UDR compared with those who did not (0.030 vs. 0.003, p = 0.001). Similarly, patients with increasing postoperative thyroglobulin measurements (0.339 vs. 0.003, p < 0.001) also had significantly greater UDRs compared with those with stable thyroglobulin. The UDRs of high-volume surgeons were significantly smaller than low-volume surgeons (0.003 vs. 0.025, p = 0.002). When combined with other known predictors for recurrence, UDR .10], p = 0.041) was significantly associated with recurrence. High-volume surgeons maintained a low level of permanent complications across all UDRs, whereas low-volume surgeons had greater permanent complications associated with higher uptake. Conclusions: Remnant uptake is a useful postoperative oncologic quality indicator that can predict a patient's risk of disease recurrence and indicate the completeness of resection.

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“…However, due to cumbersomeness of dosimetry method, majority of treating physicians have adopted fixed empiric activity of RAI (30-200mCi or 1110-7400MBq) with no consensus about adequate ablative dose in low risk patients. Some are proponents of low dose like 30-50mCi (1110-1850MBq) of RAI (Leung et al, 1992;Bal et al, 1996) while others believe that a higher dose like 100-150mCi (3700-5550MBq) is more effective in ablating the remnant thyroid tissue (Doi et al, 2000;Doi and Woodhouse 2000;Sawka et al, 2004). The basic reason of this disagreement is due to lack of reliable evidence from retrospective and non-randomized nature of most of studies, different selection criteria, variation in adequacy of surgery and different criteria used for successful remnant ablation.…”

Section: Low or High Dose Of Rai For Remnant Ablation?mentioning

confidence: 99%

Controversies about Radioactive Iodine-131 Remnant Ablation in Low Risk Thyroid Cancers: Are We Near A Consensus?

Zaman¹,

Fatima²,

Padhy³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review is an attempt to update readers about the previous and existing practice based on results of nonrandomized trials and evolving trends fueled by recently published randomized studies.

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Efficacy of low-dose iodine-131 ablation of post-operative thyroid remnants: a study of 69 cases

Cited by 37 publications

References 17 publications

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Remnant Uptake as a Postoperative Oncologic Quality Indicator

Controversies about Radioactive Iodine-131 Remnant Ablation in Low Risk Thyroid Cancers: Are We Near A Consensus?

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