Increased thyroid uptake on 18F-FDG PET/CT is associated with the development of permanent hypothyroidism in stage IV melanoma patients treated with anti-PD-1 antibodies

Frelau, Alexandra; Palard-Novello, Xavier; Jali, E.; Boussemart, Lise; Dupuy, Alain; James, Pandora; Devillers, Anne; Jeune, Florence Le; Edeline, Julien; Lesimple, Thierry; Girard, Antoine

doi:10.1007/s00262-020-02712-7

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…Focal 18 F-FDG -avid thyroid lesions are potentially malignant, whereas lesions with diffusely increased thyroid 18 F-FDG uptake are associated with thyroid disorders, such as thyroiditis or hypothyroidism [ 21 ]. 18 F-FDG uptake has been shown to correlate with the development of hypothyroidism in patients treated with immunotherapy agents [ 11 , 12 ]; thyroid dysfunction due to immune-mediated damage is the most common immune-related endocrinological adverse event, with a reported incidence of 7–21% [ 22 , 23 ]. In patients treated with immunotherapy, the SUVmax and SUVmean of the thyroid in the end of treatment PET/CT were significantly higher in patients who developed immunotherapy-related thyroiditis than in those who did not [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Incidental diffuse 18 F-FDG uptake in the thyroid has been reported in 0.6–3.3% of the population and is mainly related to thyroiditis or hypothyroidism [ 8 ]. Interim or end-of-treatment PET/CT has been used to predict hypothyroidism in patients treated with immunotherapy [ 9 – 12 ]; however, the prediction of RIHT using PET/CT has not been previously reported. In this study, we aimed to investigate the value of early post-treatment 18 F-FDG PET/CT for predicting RIHT.…”

Section: Introductionmentioning

confidence: 99%

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Early post-treatment 18F-FDG PET/CT for predicting radiation-induced hypothyroidism in head and neck cancer

Chiu

Tsai

2022

Cancer Imaging

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Background Radiation-induced hypothyroidism (RIHT) is a common, but underestimated, late adverse effect in head and neck cancer. We investigated the value of early post-treatment 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for predicting RIHT. Methods We searched our institutional database for patients aged ≥ 20 years who had undergone definitive radiotherapy for nasopharyngeal or oropharyngeal cancer between 2005 and 2017, followed by 18F-FDG PET/CT within 180 days of radiotherapy completion. We visually assessed and compared PET/CT and baseline characteristics in patients with and without RIHT using the chi-square test for categorical variables and the t-test for continuous variables. Variable predictive ability was evaluated by measuring the area under receiver operating characteristic curves. Results Fifty-two patients were included; 22 (42%) developed RIHT and 30 (58%) did not. Two patients presented with diffuse thyroid uptake on PET/CT via visual assessment, and both developed RIHT later. Among the PET/CT variables, thyroid functioning volume was significantly higher in patients without RIHT than in patients with RIHT (16.30 ± 6.03 cm3 vs. 10.61 ± 3.81 cm3, p < 0.001). The maximum standard uptake values of the thyroid and pituitary glands did not differ significantly between the groups. Two patient characteristics, pretreatment thyroid volume and mean radiotherapy dose to the thyroid, also showed significant differences between the groups. An algorithmic approach combining visual grading of thyroid 18F-FDG uptake and thyroid functioning volume cutoff of 14.01 yielded an area under curve of 0.89 (95% confidence interval, 0.80–0.98); the sensitivity, specificity, positive predictive value, and negative predictive value were 87.0%, 82.3%, 80.0%, and 88.9%, respectively. Conclusion Early post-treatment PET/CT-derived thyroid functioning volume was a good predictor of RIHT development. Diffusely increased thyroid 18F-FDG uptake on PET/CT may indicate impending RIHT. Routine surveillance of thyroid function is warranted in patients at high risk of developing RIHT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early post-treatment 18F-FDG PET/CT for predicting radiation-induced hypothyroidism in head and neck cancer

Chiu

Tsai

2022

Cancer Imaging

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“…Raised levels of cytokines including IL-1β and IL-2 pre-treatment, as well as an early rise in thyroglobulin have been reported to predict thyroiditis ( 47 ), although the clinical utility of these markers is unclear. FDG-PET uptake in the thyroid is also associated with subsequent hypothyroidism ( 48 ).…”

Section: Thyroidmentioning

confidence: 99%

Endocrine toxicity of cancer immunotherapy: clinical challenges

Anderson

Morganstein

2021

Endocrine Connections

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Immune checkpoint inhibitors are now widely used in the treatment of multiple cancers. The major toxicities of these treatments are termed immune related adverse events and endocrine dysfunction is common. Thyroid disease, hypopituitarism and a form of diabetes resembling type 1 diabetes are now all well described, with different patterns emerging with different checkpoint inhibitors. We review the presentation and management of the common endocrine immune related adverse events, and discuss a number of recent advances in the understanding of these important, potentially life threatening toxicities. We also discuss some remaining dilemmas in management.

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“…[18F]-FDG PET/CT can reveal a wide range of irAEs [26][27][28], (e.g., sarcoidosis-like syndrome, thyroiditis, hypophysitis, enterocolitis, and pneumonitis) with an accuracy of 83% [29]. Regarding the most frequent irAEs, [18F]-FDG PET/CT has been proven to be an accurate tool forearly detection of patients that will develop permanent hypothyroïdism [30]. It has recently been reported that shared genetic factors may have an impact on the risk for irAEs and survival on ICIs in bladder cancer [31].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“Future role of [18F]-FDG PET/CT in patients with bladder cancer in the new era of neoadjuvant immunotherapy?”

Girard

Vila-Reyes

Dercle

et al. 2021

Urologic Oncology: Seminars and Original Investigations

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Increased thyroid uptake on 18F-FDG PET/CT is associated with the development of permanent hypothyroidism in stage IV melanoma patients treated with anti-PD-1 antibodies

Cited by 12 publications

References 41 publications

Early post-treatment 18F-FDG PET/CT for predicting radiation-induced hypothyroidism in head and neck cancer

Early post-treatment 18F-FDG PET/CT for predicting radiation-induced hypothyroidism in head and neck cancer

Endocrine toxicity of cancer immunotherapy: clinical challenges

“Future role of [18F]-FDG PET/CT in patients with bladder cancer in the new era of neoadjuvant immunotherapy?”

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