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Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid: a comparison of ablation success with different activities of radioiodine (I-131)

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Abstract

Objective

To assess efficiency of various I-131 activities on thyroid remnant ablation in thyroid cancer patients. The significance of patients’ characteristics, pathologic features and levels of Tg were analyzed.

Patients and methods

This study included 259 consecutive differentiated thyroid cancer patients, with disease confined to the thyroid, treated with I-131 after total thyroidectomy. Patients were divided into the three groups: 80 patients receiving low [1110–1850 MBq (30–50 mCi)], 121 intermediate [2775 MBq (75 mCi)] and 58 high [3700 MBq (100 mCi)] postoperative I-131 activities. Six to eight months after the application of radioiodine, measurements of TSH, Tg, anti-Tg antibodies (in hypothyroid state) together with ultrasound exam and whole-body scintigraphy were performed.

Results

The ablation was significantly more effective (after the first application) in patients receiving 100 mCi of I-131—89.7 % than in patients receiving lower activities (P = 0.016). There was no significant difference in ablation rate between the 30–50 mCi (77.5 %) and 75 mCi (70.2 %) groups. In the group receiving 30–50 mCi, patients with solitary tumors had significantly higher ablation rate (P = 0.038). In patients receiving 75 mCi ablation rates were higher among older patients (P = 0.005), with infiltration of the single lobe (P = 0.005), and with solitary tumor (P = 0.012). The rates of successful ablation after the second application of I-131 (after 12–16 months) amounted to 96, 97 and 96 % in the 30–50, 75 and 100 mCi groups, respectively. The activity of I-131 and age were independent factors for thyroid ablation failure after the first application of I-131 (model of binary logistic regression).

Conclusion

The results of remnant ablation were satisfactory with all activities applied. Although after the first application of I-131 the activity of 100 mCi is significantly more effective in thyroid ablation than the administration of 30–50 mCi and 75 mCi, the ablation rates between all the three groups are similar (almost equal) after the second application. Thus, the activity to be administered may depend on patients’ characteristics and a detailed consideration of the merits and demerits of each I-131 activity.

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References

  1. Biersack H-J, Grűnwald F, editors. Thyroid cancer. Berlin: Springer; 2005.

    Google Scholar 

  2. Mazzaferri E. A randomized trial of remnant ablation—in search of an impossible dream? J Clin Endocrinol Metab. 2004;89:3662–4.

    Article  PubMed  CAS  Google Scholar 

  3. Sawka AM, Thephamongkhol K, Brouwers M, Thabane L, Browman G, Gerstein HC. Clinical review 170: a systematic review and metaanalysis of the effectiveness of radioactive iodine remnant ablation for well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2004;89:3668–76.

    Article  PubMed  CAS  Google Scholar 

  4. Robbins RJ, Schlumberger MJ. The evolving role of (131)I for the treatment of differentiated thyroid carcinoma. J Nucl Med. 2005;46(Suppl 1):28S–37S.

    PubMed  CAS  Google Scholar 

  5. Rosario PW, Reis JS, Barroso AL, Rezende LL, Padrao EL, Fagundes TA. Efficacy of low and high 131I doses for thyroid remnant ablation in patients with differentiated thyroid carcinoma based on post-operative cervical uptake. Nucl Med Commun. 2004;25:1077–81.

    Article  PubMed  Google Scholar 

  6. Hay ID. Selective use of radioactive iodine in the postoperative management of patients with papillary and follicular thyroid carcinoma. J Surg Oncol. 2006;94:692–700.

    Article  PubMed  Google Scholar 

  7. Verburg FA, Dietlein M, Lassmann M, Luster M, Reiners C. Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2009;36:343–6.

    Article  PubMed  Google Scholar 

  8. Rosario PW, Borges MA, Valadao MM, Vasconcelos FP, Rezende LL, Padrao EL, et al. Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm? Thyroid. 2007;17:1225–8.

    Article  PubMed  Google Scholar 

  9. Reiners C, Dietlein M, Luster M. Radio-iodine therapy in differentiated thyroid cancer: indications and procedures. Best Pract Res Clin Endocrinol Metab. 2008;22:989–1007.

    Article  PubMed  CAS  Google Scholar 

  10. Sawka AM, Rotstein L, Brierley JD, Tsang RW, Thabane L, Gafni A, et al. Regional differences in opinions on adjuvant radioactive iodine treatment of thyroid carcinoma within Canada and the United States. Thyroid. 2007;17:1235–42.

    Article  PubMed  Google Scholar 

  11. Hackshaw A, Harmer C, Mallick U, Haq M, Franklyn JA. 131I activity for remnant ablation in patients with differentiated thyroid cancer: a systematic review. J Clin Endocrinol Metab. 2007;92:28–38.

    Article  PubMed  CAS  Google Scholar 

  12. Bal C, Padhy AK, Jana S, Pant GS, Basu AK. Prospective randomized clinical trial to evaluate the optimal dose of 131 I for remnant ablation in patients with differentiated thyroid carcinoma. Cancer. 1996;77:2574–80.

    Article  PubMed  CAS  Google Scholar 

  13. Bal CS, Kumar A, Pant GS. Radioiodine dose for remnant ablation in differentiated thyroid carcinoma: a randomized clinical trial in 509 patients. J Clin Endocrinol Metab. 2004;89:1666–73.

    Article  PubMed  CAS  Google Scholar 

  14. Johansen K, Woodhouse NJ, Odugbesan O. Comparison of 1073 MBq and 3700 MBq iodine-131 in postoperative ablation of residual thyroid tissue in patients with differentiated thyroid cancer. J Nucl Med. 1991;32:252–4.

    PubMed  CAS  Google Scholar 

  15. Creutzig H. High or low dose radioiodine ablation of thyroid remnants? Eur J Nucl Med. 1987;12:500–2.

    Article  PubMed  CAS  Google Scholar 

  16. Maenpaa HO, Heikkonen J, Vaalavirta L, Tenhunen M, Joensuu H. Low vs. high radioiodine activity to ablate the thyroid after thyroidectomy for cancer: a randomized study. PLoS One. 2008;3(4):e1885.

    Article  PubMed  Google Scholar 

  17. Doi SA, Woodhouse NJ, Thalib L, Onitilo A. Ablation of the thyroid remnant and I-131 dose in differentiated thyroid cancer: a meta-analysis revisited. Clin Med Res. 2007;5:87–90.

    Article  PubMed  Google Scholar 

  18. Zidan J, Hefer E, Iosilevski G, Drumea K, Stein ME, Kuten A, et al. Efficacy of I131 ablation therapy using different doses as determined by postoperative thyroid scan uptake in patients with differentiated thyroid cancer. Int J Radiat Oncol Biol Phys. 2004;59:1330–6.

    Article  PubMed  CAS  Google Scholar 

  19. Lin JD, Kao PF, Chao TC. The effects of radioactive iodine in thyroid remnant ablation and treatment of well differentiated thyroid carcinoma. Br J Radiol. 1998;71:307–13.

    PubMed  CAS  Google Scholar 

  20. Beierwaltes WH, Rabbani R, Dmuchowski C, Lloyd RV, Eyre P, Mallette S. An analysis of “ablation of thyroid remnants” with I-131 in 511 patients from 1947–1984: experience at University of Michigan. J Nucl Med. 1984;25:1287–93.

    PubMed  CAS  Google Scholar 

  21. Verkooijen RB, Stokkel MP, Smit JW, Pauwels EK. Radioiodine-131 in differentiated thyroid cancer: a retrospective analysis of an uptake-related ablation strategy. Eur J Nucl Med Mol Imaging. 2004;31:499–506.

    Article  PubMed  CAS  Google Scholar 

  22. Silberstein EB. Comparison of outcomes after (123)I versus (131)I pre-ablation imaging before radioiodine ablation in differentiated thyroid carcinoma. J Nucl Med. 2007;48:1043–6.

    Article  PubMed  CAS  Google Scholar 

  23. Dutch Endocrine Society and Society of Nuclear Medicine. Nationwide Guideline Thyroid Carcinoma. 2008. http://oncoline.nl/index.php?pagina=/richtlijn/item/pagina.php%20h&richtlijn_id=554. Updated 2008, cited 6.9.2011.

  24. Hay ID, Thompson GB, Grant CS, Bergstralh EJ, Dvorak CE, Gorman CA, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002;26:879–85.

    Article  PubMed  Google Scholar 

  25. Sherman SI, Brierley JD, Sperling M, Ain KB, Bigos ST, Cooper DS, et al. Prospective multicenter study of thyroid carcinoma treatment: initial analysis of staging and outcome. National Thyroid Cancer Treatment Cooperative Study Registry Group. Cancer. 1998;83:1012–21.

    Article  PubMed  CAS  Google Scholar 

  26. Wittekind C, Compton CC, Greene FL, Sobin LH. TNM residual tumor classification revisited. Cancer. 2002;94:2511–6.

    Article  PubMed  Google Scholar 

  27. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  28. Francis Z, Schlumberger M. Serum thyroglobulin determination in thyroid cancer patients. Best Pract Res Clin Endocrinol Metab. 2008;22:1039–46.

    Article  PubMed  CAS  Google Scholar 

  29. Taylor T, Specker B, Robbins J, Sperling M, Ho M, Ain K, et al. Outcome after treatment of high-risk papillary and non-Hurthle-cell follicular thyroid carcinoma. Ann Intern Med. 1998;129:622–7.

    PubMed  CAS  Google Scholar 

  30. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892–9.

    Article  PubMed  CAS  Google Scholar 

  31. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006;16:1229–42.

    Article  PubMed  Google Scholar 

  32. Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787–803.

    Article  PubMed  CAS  Google Scholar 

  33. BTA, RCP. British Thyroid Association Royal College of Physicians. Guidelines for the management of thyroid cancer 2007, 2nd edn.; 2007. http://www.british-thyroid-association.org. Updated 2007, cited 6.9.2011

  34. Kusic Z, Jukic T, Dabelic N, Franceschi M. Croatian Thyroid Society guidelines for the management of patients with differentiated thyroid cancer. Lijec Vjesn. 2008;130:213–27.

    PubMed  Google Scholar 

  35. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.

    Article  PubMed  Google Scholar 

  36. Kulkarni K, Van Nostrand D, Atkins F, Aiken M, Burman K, Wartofsky L. The relative frequency in which empiric dosages of radioiodine would potentially overtreat or undertreat patients who have metastatic well-differentiated thyroid cancer. Thyroid. 2006;16:1019–23.

    Article  PubMed  CAS  Google Scholar 

  37. Tuttle RM, Leboeuf R, Robbins RJ, Qualey R, Pentlow K, Larson SM, et al. Empiric radioactive iodine dosing regimens frequently exceed maximum tolerated activity levels in elderly patients with thyroid cancer. J Nucl Med. 2006;47:1587–91.

    PubMed  Google Scholar 

  38. Sgouros G, Hobbs RF, Atkins FB, Van Nostrand D, Ladenson PW, Wahl RL. Three-dimensional radiobiological dosimetry (3D-RD) with 124I PET for 131I therapy of thyroid cancer. Eur J Nucl Med Mol Imaging. 2011;38(Suppl 1):S41–7.

    Article  PubMed  Google Scholar 

  39. Lassmann M, Reiners C, Luster M. Dosimetry and thyroid cancer: the individual dosage of radioiodine. Endocr Relat Cancer 2010 3;17(3): R161–72.

    Google Scholar 

  40. de Klerk JM. 131I therapy: inpatient or outpatient? J Nucl Med. 2000;41:1876–8.

    PubMed  Google Scholar 

  41. Nakada K, Ishibashi T, Takei T, Hirata K, Shinohara K, Katoh S, et al. Does lemon candy decrease salivary gland damage after radioiodine therapy for thyroid cancer? J Nucl Med. 2005;46(2):261–6.

    PubMed  Google Scholar 

  42. Van Nostrand D. The benefits and risks of I-131 therapy in patients with well-differentiated thyroid cancer. Thyroid. 2009;19(12):1381–91.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Oncology and Nuclear Medicine, University Hospital Center “Sisters of Charity”, Vinogradska cesta 29, 10 000, Zagreb, Croatia

    Marin Prpic, Nina Dabelic, Josip Stanicic, Tomislav Jukic & Zvonko Kusic

  2. School of Public Health “Andrija Štampar”, School of Medicine, University of Zagreb, Zagreb, Croatia

    Milan Milosevic

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  1. Marin Prpic
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  2. Nina Dabelic
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Correspondence to Marin Prpic.

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Prpic, M., Dabelic, N., Stanicic, J. et al. Adjuvant thyroid remnant ablation in patients with differentiated thyroid carcinoma confined to the thyroid: a comparison of ablation success with different activities of radioiodine (I-131). Ann Nucl Med 26, 744–751 (2012). https://doi.org/10.1007/s12149-012-0637-9

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  • DOI: https://doi.org/10.1007/s12149-012-0637-9

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