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The outcome of I-131 ablation therapy for intermediate and high-risk differentiated thyroid cancer using a strict definition of successful ablation

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Abstract

Purpose

This article examines the outcome of radioactive iodine ablation therapy for thyroid cancer in high-risk patients and investigates background factors influencing ablation failure.

Materials and methods

We included 91 patients in this retrospective analysis and evaluated the ablation success rate. Successful ablation was defined as the absence of visible iodine-131 (I-131) accumulation in the thyroid bed after whole-body scans and thyroglobulin levels <2 ng/ml in a TSH-stimulated state after ablation. We extracted data on patients’ age, sex, I-131 dose, pathology, resection stump findings, tumor T category and thyroglobulin levels, which could affect ablation outcome.

Results

Successful ablation was achieved in only 14 patients (15.4%). Pre-ablation serum thyroglobulin levels were significantly higher in the ablation failure group than in the success group (P < 0.001), while no significant differences were found for other factors between the groups. Furthermore, thyroglobulin levels >10 ng/ml were significantly related to ablation failure after multivariate analysis (odds ratio 27.2; 95% confidence interval 2.469–299.7; P = 0.007).

Conclusion

The ablation success rate was very low because of high thyroglobulin levels, even with high-dose I-131. High-risk patients, especially those with high thyroglobulin levels (>10 ng/ml), are unlikely to reach levels low enough to meet successful ablation criteria.

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References

  1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–28.

    Article  CAS  PubMed  Google Scholar 

  2. Mazzaferri EL, Kloos RT. Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001;86:1447–63.

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  4. 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  CAS  PubMed  Google Scholar 

  5. 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  CAS  PubMed  Google Scholar 

  6. Peizhun D, Jiao Xuelong, Zhou Yanbing, Li Y, Kang S, Zhang D, et al. Low versus high radioiodine activity to ablate the thyroidafter thyroidectomy for cancer: a meta-analysis of randomized controlled trials. Endocrine. 2015;48:96–105.

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. 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.

    CAS  PubMed  Google Scholar 

  10. Caglar M, Bozkurt FM, Akca CK, Vargol SE, Bayraktar M, Ugur O, et al. Comparison of 800 and 3700 MBq iodine-131 for the postoperative ablation of thyroid remnant in patients with low-risk differentiated thyroid cancer. Nucl Med Commun. 2012;33:268–74.

    Article  CAS  PubMed  Google Scholar 

  11. Kusacic Kuna S, Samardzic T, Tesic V, Medvedec M, Kuna K, Bracic I, et al. Thyroid remnant ablation in patients with papillary cancer: a comparison of low, moderate, and high activities of radioiodine. Nucl Med Commun. 2009;30:263–9.

    Article  PubMed  Google Scholar 

  12. Prpic M, Dabelic N, Stanicic J, Jukic T, Milosevic M, Kusic Z. 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. 2012;26:744–51.

    Article  CAS  PubMed  Google Scholar 

  13. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 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 differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Molinaro E, Giani C, Agate L, Biagini A, Pieruzzi L, Bianchi F, et al. Patients with differentiated thyroid cancer who underwent radioiodine thyroid remnant ablation with low-activity 131I after either recombinant human TSH or thyroid hormone therapy withdrawal showed the same outcome after a 10-year follow-up. J Clin Endocrinol Metab. 2013;98:2693–700.

    Article  CAS  PubMed  Google Scholar 

  15. Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:1433–41.

    Article  CAS  PubMed  Google Scholar 

  16. Takami H, Ito Y, Okamoto T, Yoshida A. Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg. 2011;35:111–21.

    Article  PubMed  Google Scholar 

  17. Tamilia M, Al-Kahtani N, Rochon L, Hier MP, Payne RJ, Holcroft CA, et al. Serum thyroglobulin predicts thyroid remnant ablation failure with 30 mCi iodine-131 treatment in patients with papillary thyroid carcinoma. Nucl Med Commun. 2011;32:212–20.

    Article  CAS  PubMed  Google Scholar 

  18. Bernier MO, Morel O, Rodien P, Muratet JP, Giraud P, Rohmer V, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2005;32:1418–21.

    Article  CAS  PubMed  Google Scholar 

  19. Mallick U, Harmer C, Yap B, Wadsley J, Clarke S, Moss L, et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med. 2012;366:1674–85.

    Article  CAS  PubMed  Google Scholar 

  20. Schlumberger M, Catargi B, Borget I, Deandreis D, Zerdoud S, Bridji B, et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med. 2012;366:1663–73.

    Article  CAS  PubMed  Google Scholar 

  21. Schvartz C, Bonnetain F, Dabakuyo S, Gauthier M, Cueff A, Fieffé S, et al. Impact on overall survival of radioactive iodine in low-risk differentiated thyroid cancer patients. J Clin Endocrinol Metab. 2012;97:1526–35.

    Article  CAS  PubMed  Google Scholar 

  22. Khan N, Oriuchi N, Higuchi T, Zhang H, Endo K. PET in the follow-up of differentiated thyroid cancer. Br J Radiol. 2003;76:690–5.

    Article  CAS  PubMed  Google Scholar 

  23. Silberstein EB. The problem of the patient with thyroglobulin elevation but negative iodine scintigraphy: the TENIS syndrome. Semin Nucl Med. 2011;41:113–20.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Ken Watanabe, Mayuki Uchiyama & Kunihiko Fukuda

Authors
  1. Ken Watanabe
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  2. Mayuki Uchiyama
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  3. Kunihiko Fukuda
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Corresponding author

Correspondence to Ken Watanabe.

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Financial support

This research was not supported by Grants from any foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

This study was approved by the Clinical Ethics Committee of Jikei University.

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Watanabe, K., Uchiyama, M. & Fukuda, K. The outcome of I-131 ablation therapy for intermediate and high-risk differentiated thyroid cancer using a strict definition of successful ablation. Jpn J Radiol 35, 505–510 (2017). https://doi.org/10.1007/s11604-017-0660-9

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  • DOI: https://doi.org/10.1007/s11604-017-0660-9

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