Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Patients with Metastatic Differentiated Thyroid Carcinoma

Žagar, Ivana; Schwarzbartl-Pevec, Andreja A.; Vidergar-Kralj, Barbara; Horvat, R.; Bešič, Nikola

doi:10.1155/2012/670180

Cited by 7 publications

(4 citation statements)

References 26 publications

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“…Chemotherapy before surgical procedure may be effective in order to decrease the tumor size in HCTC [ 31 ]. Our group reported that RAI therapy may be effective in patients with metastatic HCTC [ 18 ] and that recombinant human thyrotropin-aided RAI therapy may be effective in patients with metastatic HCTC [ 32 ]. Since residual tumor after thyroid surgery is an independent prognostic factor for disease-specific as well as disease-free survival, an effective locoregional therapy is mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…Before 2002, the serum concentration of TSH of >30 mU/L had been achieved by a 4–6-week withdrawal of L-thyroxine suppression therapy. Since 2002, recombinant human TSH (rhTSH)-aided RAI therapy has been used in elderly patients with concomitant diseases, a history of severe hypothyroid or compressive symptoms and/or evidence of tumor progression during thyroid hormone withdrawal [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

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Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience

2014

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BackgroundHürthle cell thyroid carcinoma (HCTC) is a rare disease. It is believed that it is more aggressive than follicular thyroid carcinoma. The aim of our study was to identify factors associated with disease-specific and disease-free survival.MethodsAltogether, 108 patients with HCTC (26 male, 82 female; median age 62 years; range 19–87 years) treated at our Institute from 1972 to 2011 were included in the present retrospective study. Data on age, clinical and histopathological factors, tumor stage, recurrence, disease-free and disease-specific survival were collected. Univariate analysis was used to identify factors associated with disease-specific survival. Cox’s multivariate regression model was used to identify independent prognostic factors for disease-specific survival.ResultsThe follow-up period was 1 to 337 (median 105) months. Of 108 patients, 12 (11%) had distant and 8 (7%) had locoregional metastases before primary treatment. Recurrence was diagnosed in 26 cases (24%): locoregional, distant, and both locoregional and distant in 12, 11, and 3 cases, respectively. The 5-year, 10-year, and 20-year disease-specific survival were 96%, 88%, and 67%, respectively. Independent prognostic factors for disease-specific survival were: age of patients at diagnosis, distant metastases and residual tumor after surgery.ConclusionLong disease-specific survival was found in patients with HCTC younger than 45 years of age without distant metastases and without residual tumor after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience

2014

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“…Since 2002, recombinant human TSH (rhTSH)-aided RAI therapy has been used in altogether 13 patients who were elderly and had concomitant diseases, had a history of severe hypothyroid or compressive symptoms and/or evidence of tumor progression during thyroid hormone withdrawal. 19 …”

Section: Methodsmentioning

confidence: 99%

Locoregional disease control after external beam radiotherapy in 91 patients with differentiated thyroid carcinoma and pT4 tumor stage - a single institution experience

Bešič

Dremelj

Pilko

2018

Radiology and Oncology

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BackgroundLocoregional recurrence is common in patients with locally advanced differentiated thyroid carcinoma (DTC). Our aim was to find out the rate of locoregional control of the disease after external beam radiotherapy (EBRT) of the neck and mediastinum in patients with DTC and pT4 tumor.Patients and methodsAltogether 91 patients (47 males, 44 females, median age 61 years) with DTC had EBRT of the neck and mediastinum as part of the multimodal treatment of pT4 tumor (63 cases pT4a, 28 cases pT4b) from the year 1973 to 2015. Data on clinical factors, histopathology and recurrence were collected. Disease-free, disease-specific and overall survival was calculated.ResultsMedian tumor size was 5 cm (range 1–30 cm). Out of 91 patients, 23 had distant and 38 regional metastases. A total or near-total thyroidectomy, lobectomy, subtotal thyroidectomy and lymph node dissection was performed in 70%, 14%, 2% and 30% of cases, respectively. Thirteen percent of patients were not treated with surgery. All patients had EBRT and 39 had chemotherapy. Radioiodine (RAI) ablation of thyroid remnant and RAI therapy was applied in 90% and 40% of cases, respectively. Recurrence was diagnosed in 29/64 patients without a persistent disease: locoregional and distant in 16 and 13 cases, respectively. Five-year and ten-year disease-free survival rate was 64% and 48%, respectively.ConclusionsThe majority of patients with DTC and pT4 tumors who were treated with EBRT of the neck and mediastinum region as part of multimodal treatment have long-lasting locoregional control of the disease.

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“…However, due to the well-known drawbacks and potential health risks of THW, rhTSH has been explored as an alternative protocol for metastatic patients [ 107 ]. Some studies showed benefits and the same effectiveness of rhTSH preparation compared with THW [ 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 ]. However, most of these cohorts are small and retrospective, and the follow-up of the patients treated with rhTSH is most often significantly shorter than that of the patients treated after THW, preventing any reliable conclusions ( Table 4 ).…”

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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Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Patients with Metastatic Differentiated Thyroid Carcinoma

Cited by 7 publications

References 26 publications

Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience

Prognostic factors for disease-specific survival in 108 patients with Hürthle cell thyroid carcinoma: a single-institution experience

Locoregional disease control after external beam radiotherapy in 91 patients with differentiated thyroid carcinoma and pT4 tumor stage - a single institution experience

Strategies for Radioiodine Treatment: What’s New

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