Subscribe to RSS
DOI: 10.1055/a-2077-7246
Factors Affecting Ablation Success After I-131 Radioactive Iodine Therapy in Low and Intermediate Risk Papillary Thyroid Cancer
Abstract
The study was to evaluate the effect of radioactive iodine (RAI) treatment application time and clinical, histopathological factors on ablation success in patients with operated papillary thyroid cancer (PTC) in low and intermediate-risk. One hundred sixty-one patients with PTC in the low and intermediate-risk were evaluated. Most patients (89.4%) were in the low-risk, and 10.6% were in the intermediate-risk. When the patients were divided into two groups according to the date of receiving RAI treatment after surgery, those who received early treatment (≤3 months) constituted the majority of the patients (72.7%). Seventeen patients received 1.85 Gigabecquerel (GBq), 119 3.7 GBq, 25 5.55 GBq RAI. Most patients (82%) achieved ablation success after the first RAI treatment. The time interval between surgery and RAI treatment did not affect ablation success. Stimulated Tg level measured on the RAI treatment day was an independent predictive factor for successful ablation (p<0.001). The cut-off value of Tg found to predict ablation failure was 5.86 ng/ml. It was concluded that 5.55 GBq RAI treatment could predict ablation success compared to 1.85 GBq dose (p=0.017). It was concluded that having a T1 tumor may predict treatment success compared to a T2 or T3 tumor (p=0.001, p<0.001, retrospectively). The time interval does not affect ablation success in low and intermediate-risk PTC. The ablation success rate may decrease in patients who receive low-dose RAI and have high Tg levels before treatment. The most crucial factor in achieving ablation success is giving enough doses of RAI to ablate the residual tissue.
Key words
intermediate risk - low risk - papillary thyroid cancer - radioiodine ablation - successful ablationPublication History
Received: 26 February 2023
Accepted after revision: 12 April 2023
Article published online:
02 June 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 James DL, Ryan ÉJ, Davey MG. et al. Radioiodine remnant ablation for differentiated thyroid cancer: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147: 544-552
- 2 Harris PE. The management of thyroid cancer in adults: a review of new guidelines. Clin Med 2002; 2: 144-146
- 3 Haymart M, Banerjee M, Stewart AK. et al. Use of radioactive iodine for thyroid cancer. JAMA 2011; 306: 721-728
- 4 Segal K, Shpitzer T, Hazan A. et al. Invasive well differentiated thyroid carcinoma: effect of treatment modalities on outcome. Otolaryngol Head Neck Surg 2006; 134: 819-822
- 5 Siegel R, Ma J, Zou Z. et al. Cancer statistics, 2014. CA Cancer J Clin 2014; 64: 9-29
- 6 Rosario PW, Ward LS, Carvalho GA. et al. Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus. Arq Bras Endocrinol Metabol 2013; 57: 240-264
- 7 Cooper DS, Doherty GM, Haugen BR. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214
- 8 Haugen BR, Alexander EK, Bible KC. et al. American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and ifferentiated thyroid cancer. Thyroid 2015; 2016: 1-133
- 9 Pacini F, Schlumberger M, Dralle H. et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803
- 10 Tuttle RM, Ahuja S, Avram AM. et al. Controversies, consensus, and collaboration in the Use of 131I therapy in diferentiated thyroid cancer: a joint statement from the American thyroid association, the European association of nuclear medicine, the society of nuclear medicine and molecular imaging, and the European thyroid association. Thyroid 2019; 29: 461-470
- 11 Hackshaw A, Harmer C, Mallick U. et al. 131I activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J Clin Endocrinol Metab 2007; 92: 28-38
- 12 Albano D, Bonacina M, Durmo R. et al. Efficacy of low radioiodine activity versus intermediate-high activity in the ablation of low-risk differentiated thyroid cancer. Endocrine 2020; 68: 124-131
- 13 Özdoğan Ö, Aksu A, Doğan E. et al. Applying postoperative radioiodine therapy before 3 months seems to decrease ablation success in patients with differentiated thyroid carcinoma. Ann Nucl Med 2021; 35: 223-231
- 14 Li H, ZhangY-Q WC, Zhang X. et al. Delayed initial radioiodine therapy related to incomplete response in low- to intermediate-risk diferentiated thyroid carcinoma. Clin Endocrinol 2018; 88: 601-606
- 15 Lamartina L, Cooper DS. Radioiodine remnant ablation in low-risk differentiated thyroid cancer: the “con” point of view. Endocrine 2015; 50: 67-71
- 16 Higashi T, Nishii R, Yamada S. et al. Delayed initial radioactive iodine therapy resulted in poor survival in patients with metastatic differentiated thyroid carcinoma: a retrospective statistical analysis of 198 cases. J Nucl Med 2011; 52: 683-689
- 17 Tsirona S, Vlassopoulou V, Tzanela M. et al. Impact of early vs late postoperative radioiodine remnant ablation on final outcome in patients with low-risk well-differentiated thyroid cancer. Clin Endocrinol 2011; 80: 459-463
- 18 Krajewska J, Jarzab M, Kukulska A. et al. Postoperative radioiodine treatment within 9 months from diagnosis significantly reduces the risk of relapse in low-risk differentiated thyroid carcinoma. Nucl Med Mol Imaging 2019; 53: 320-327
- 19 Scheffel RS, Zanella AB, Dora JM. et al. Timing of radioactive iodine administration does not influence outcomes in patients with differentiated thyroid carcinoma. Thyroid 2016; 26: 1623-1629
- 20 Suman P, Wang CH, Moo-Young TA. et al. Timing of adjuvant radioactive iodine therapy does not affect overall survival in low-and intermediate-risk papillary thyroid carcinoma. Am Surg 2016; 82: 807-814
- 21 Schneider DF, Ojomo KA, Chen H. et al. Remnant uptake as a postoperative oncologic quality indicator. Thyroid 2013; 23: 1269-1276
- 22 Araz M, Küçük NÖ. Should the place of radioactive iodine whole body scintigraphy in follow-up of ifferentiated thyroid cancer reevaluated in the era of SPECT/CT?. Nucl Med Semin 2021; 7: 70-79
- 23 Abe K, Ishizaki U, Ono T. et al. Low-dose radioiodine therapy for patients with intermediate- to high-risk differentiated thyroid cancer. Ann Nucl Med 2020; 34: 144-151
- 24 Dong P, Wang L, Qu Y. et al. Low- and high-dose radioiodine ablation for low-/intermediate-risk differentiated thyroid cancer in China: Large randomized clinical trial. Head Neck 2021; 43: 1311-1320
- 25 Iizuka Y, Katagiri T, Ogura K. et al. Comparison between the different doses of radioactive iodine ablation prescribed in patients with intermediate-to-high-risk differentiated thyroid cancer. Ann Nucl Med 2019; 33: 495-501
- 26 Mallick U, Harmer C, Yap B. et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 2012; 366: 1674-1685