Recombinant human thyrotropin-aided versus thyroid hormone withdrawal-aided radioiodine treatment for differentiated thyroid cancer after total thyroidectomy: A meta-analysis

Tu, Jian; Wang, Siwen; Huo, Zijun; Lin, Ying; Li, Xiaoxi; Wang, Shenming

doi:10.1016/j.radonc.2013.12.018

Cited by 34 publications

(29 citation statements)

References 28 publications

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“…Similar to our results, some authors [3,4,[33][34][35] have showed similar success ablations rate with rhTSH and THW. Based on superior short-term quality of life and similar remnant ablation efficacy found in previous studies, ATA considered the rhTSH stimulation an acceptable alternative to THW for achieving remnant ablation, particularly in patients with ATA low-risk and intermediate-risk DTC without extensive lymph node involvement [6].…”

Section: Discussionsupporting

confidence: 92%

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

et al. 2018

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Aim: Based on the response criteria of the 2015 American Thyroid Associations guidelines, our objectives were to determine the response rate when using a low dose of 131-I GBq in patients with low-risk differentiated thyroid cancer (LRDTC) and the influence of clinical and analytical variables on the prediction of complete response. Methods: We performed a multicentre and longitudinal study, including patients who were operated for LRDTC and who underwent radioiodine remnant ablation with a low-dose of 131-I. All patients were assessed at 6–12 months, and their status was classified as complete (excellent response) or incomplete response (structural incomplete, biochemical incomplete or indeterminate response). Various factors including age, gender, histology, tumour focality and size, stage, time from surgery to treatment, type of thyroid-stimulating hormone (TSH) stimulation, preablation serum thyroglobulin (pTg), antiTg antibodies (pAntiTgAb) and TSH (pTSH) levels were also analysed in order to predict the complete response rate. Results: Of 108 patients, 79.6% achieved complete response and the remaining showed incomplete response (2.9, 5.5 and 12% due to biochemical incomplete, structural incomplete and indeterminate response respectively). Six patients received a new dose of 131-I. Tumour size and pAntiTgAb were the only factors related to therapeutic response (p = 0.03 and p < 0.01, respectively). However, pAntiTgAb was the only independent factor related to complete response. Patients with complete response showed lower pTg than those with incomplete response (5.1 ± 12.9 vs. 11.2 ± 25 ng/mL) although without statistical significance (p = 0.14). There was no significant difference in the response rate depending on the thyrotropin stimulation methods. Conclusions: A low dose of 131-I was sufficient for reaching a complete response at 6–12 months of follow-up in the majority of patients with LRDTC. Tumour size and pAntiTgAb variables were related to therapeutic response.

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Section: Discussionsupporting

confidence: 92%

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

et al. 2018

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“…Based on treatment survey responses, ≈40% of patients receive 30 mCi and ≈60% patients receive 100 mCi radioiodine. Consistent with previous economic evaluations [12,13], and according to the available body of clinical evidence the model assumed successful ablation in all the patients regardless of the method of preparation and administered radioiodine activity [2,5,9,10].…”

Section: Clinical Inputsmentioning

confidence: 53%

“…Furthermore, two phase III studies (HiLo [9] and ESTIMABL [2]) have independently confirmed similar efficacy for the two methods of TSH stimulation across two 131I activity levels (30 or 100 mCi). A meta-analysis performed in 2014 that included 7 randomized controlled trials (RCTs) with a total of 1535 patients came to the same conclusion [10]. In 2012, the use of Thyrogen ® has been approved for an 131I dose range of 30-100 mCi for postoperative remnant ablation, instead of the previous approval of just 100 mCi 131I [11].…”

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confidence: 91%

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Danieli

Monari

Lazzarini

et al. 2016

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BACKGROUND: Radioiodine ablation is an adjuvant procedure used to treat patients with differentiated thyroid cancer. For ablation to be successful, patients must have elevated levels of thyroid stimulating hormone (TSH). This can be achieved by withholding thyroid hormone therapy (endogenous stimulation), or by administration of recombinant human thyroid stimulating hormone (rhTSH; Thyrogen®; exogenous stimulation) to patients in the euthyroid state.AIM: To compare the estimated health benefits, cost and cost-effectiveness of TSH stimulation with and without Thyrogen® in the Italian setting.METHODS: A cost-utility analysis was undertaken to assess the impact of exogenous vs. endogenous TSH stimulation before radioiodine remnant ablation of patients with newly diagnosed, well-differentiated papillary or follicular thyroid cancer who have undergone total or near-total thyroidectomy. A Markov model was developed to simulate treatment costs and health outcomes associated with exogenous and endogenous stimulation in four distinct health states: pre-ablation, ablation, post-ablation, and well/recovery. Treatment was stratified by patients who receive high- and low-activity (30-100 mCi, respectively) in the ablation state. The Italian National Health System perspective was adopted in the base case scenario while the impact of indirect costs was explored in a sensitivity analysis. Costs and quality-adjusted life years (QALY) specific to each health state were estimated, summarized and converted into a corresponding incremental cost-effectiveness ratio (ICER).RESULTS: We calculated a cost-effectiveness ratio of 18,357.18 €/QALY gained whereas the inclusion of indirect cost and accident cost produced reductions of the ICER to € 14,609.51 and € 15,515.26 per QALY, respectively. Finally, all results in the sensitivity analysis are below the lower bound of national and international cost- effective threshold.CONCLUSION: Thyrogen® represents a cost-effective option for patients with differentiated thyroid cancer who underwent total or near-total thyroidectomy in Italy. Our findings are consistent with other cost-utility analyses.

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“…The recent systematic review by Tu et al [19] found that the administration of rhTSH has an ablation rate similar to THW, regardless of whether low- or high-dose iodine-131 is used, and the application of rhTSH can obtain higher QoL during the early period of radioiodine treatment. The results regarding the success rates of the different therapies in the present systematic review are in agreement with those of the Cochrane review [18] and Tu et al [19]. …”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Adjuvant Interventions for Radioiodine in Patients with Thyroid Cancer

Ge³

et al. 2015

Oncol Res Treat

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Aims: The purpose of this study was to assess the effects of adjuvant interventions for radioiodine in patients with thyroid cancer. Materials and Methods: A systematic search was undertaken on July 9, 2014. RevMan 5 software was used to synthesize data. Results: 13 randomized controlled trials were included. The pooled risk ratio of 0.99 (95% confidence interval (CI): 0.96-1.02, p = 0.58) indicated no significant difference in successful thyroid remnant ablation between recombinant human thyroid-stimulating hormone (rhTSH) and thyroid hormone withdrawal in 7 trials. The percentage of patients who had successful ablation was significantly higher in the oral-lithium group than in the control group (p = 0.017). A computerized decision aid improves informed decision-making in patients with early-stage papillary thyroid cancer (PTC) who are considering adjuvant radioiodine treatment (p < 0.001). Amifostine pretreatment did not prevent parenchymal damage to the major salivary gland function after radioiodine treatment (p = 0.2461). Conclusions: The present systematic review suggests that rhTSH, lithium, and computerized decision aids maybe act as beneficial adjuvant interventions for radioiodine in patients with thyroid cancer; however, amifostine does not exhibit helpful effects in thyroid cancer patients treated with radioiodine.

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Recombinant human thyrotropin-aided versus thyroid hormone withdrawal-aided radioiodine treatment for differentiated thyroid cancer after total thyroidectomy: A meta-analysis

Cited by 34 publications

References 28 publications

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

Low-Dose Radioiodine Ablation in Patients with Low-Risk Differentiated Thyroid Cancer

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

A Systematic Review of Adjuvant Interventions for Radioiodine in Patients with Thyroid Cancer

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