Cargando…

Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment

BACKGROUND: Repeated radioiodine ((131)I) treatment (RT) are commonly performed in patients with (131)I-avid distant metastatic differentiated thyroid cancer (DM-DTC), but more precise indications remain indeterminate. This prospective study was conducted to explore predictors for biochemical respon...

Descripción completa

Detalles Bibliográficos
Autores principales: Sa, Ri, Cheng, Lin, Jin, Yuchen, Fu, Hao, Shen, Yan, Chen, Libo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701118/
https://www.ncbi.nlm.nih.gov/pubmed/33304320
http://dx.doi.org/10.3389/fendo.2020.587315
_version_ 1783616426768072704
author Sa, Ri
Cheng, Lin
Jin, Yuchen
Fu, Hao
Shen, Yan
Chen, Libo
author_facet Sa, Ri
Cheng, Lin
Jin, Yuchen
Fu, Hao
Shen, Yan
Chen, Libo
author_sort Sa, Ri
collection PubMed
description BACKGROUND: Repeated radioiodine ((131)I) treatment (RT) are commonly performed in patients with (131)I-avid distant metastatic differentiated thyroid cancer (DM-DTC), but more precise indications remain indeterminate. This prospective study was conducted to explore predictors for biochemical response (BR) to next RT. METHODS: Totally thyroidectomized patients with (131)I-avid DM-DTC demonstrated by initial post-therapeutic whole body scan (Rx-WBS) were consecutively recruited. Repeated RTs were performed at a fixed dose and a fixed interval, which was terminated once a decline in thyroid stimulating hormone-suppressed thyroglobulin (Tg(on)) could not be achieved or Rx-WBS was negative. BR was evaluated by change rate of Tg(on) level (ΔTg(on)%). RESULTS: After exclusion of 27 ineligible courses, a total of 166 neighboring course pairs from 77 patients were established and utilized. Univariate and multivariate analyses showed that the maximum target/background ratio (T/B(max)) on the whole body scan and ΔTg(on)% derived from the former RT were independently associated to the latter one. In predicting biochemical remission, the positive predictive value (PPV) and negative predictive value (NPV) of T/B(max) at the cut-off value of 8.1 were 79.1% and 84.0%, respectively; whereas the PPV and NPV of ΔTg(on)% at the cut-off value of 25.3% were 70.8% and 77.1%, respectively. Notably, the PPV of combined T/B(max) ≥ 8.1 and ΔTg(on)% ≥ 25.3% increased to 87.7%; while the NPV of T/B(max) ≥ 8.1 or ΔTg(on)% ≥ 25.3% reached as high as 97.7%. CONCLUSIONS: This study revealed that combined use of the latest RT-derived T/B(max) and ΔTg(on)% may efficiently identify biochemical responders/non-responders to next RT, warranting management optimization of patients with (131)I-avid DM-DTC.
format Online
Article
Text
id pubmed-7701118
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-77011182020-12-09 Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment Sa, Ri Cheng, Lin Jin, Yuchen Fu, Hao Shen, Yan Chen, Libo Front Endocrinol (Lausanne) Endocrinology BACKGROUND: Repeated radioiodine ((131)I) treatment (RT) are commonly performed in patients with (131)I-avid distant metastatic differentiated thyroid cancer (DM-DTC), but more precise indications remain indeterminate. This prospective study was conducted to explore predictors for biochemical response (BR) to next RT. METHODS: Totally thyroidectomized patients with (131)I-avid DM-DTC demonstrated by initial post-therapeutic whole body scan (Rx-WBS) were consecutively recruited. Repeated RTs were performed at a fixed dose and a fixed interval, which was terminated once a decline in thyroid stimulating hormone-suppressed thyroglobulin (Tg(on)) could not be achieved or Rx-WBS was negative. BR was evaluated by change rate of Tg(on) level (ΔTg(on)%). RESULTS: After exclusion of 27 ineligible courses, a total of 166 neighboring course pairs from 77 patients were established and utilized. Univariate and multivariate analyses showed that the maximum target/background ratio (T/B(max)) on the whole body scan and ΔTg(on)% derived from the former RT were independently associated to the latter one. In predicting biochemical remission, the positive predictive value (PPV) and negative predictive value (NPV) of T/B(max) at the cut-off value of 8.1 were 79.1% and 84.0%, respectively; whereas the PPV and NPV of ΔTg(on)% at the cut-off value of 25.3% were 70.8% and 77.1%, respectively. Notably, the PPV of combined T/B(max) ≥ 8.1 and ΔTg(on)% ≥ 25.3% increased to 87.7%; while the NPV of T/B(max) ≥ 8.1 or ΔTg(on)% ≥ 25.3% reached as high as 97.7%. CONCLUSIONS: This study revealed that combined use of the latest RT-derived T/B(max) and ΔTg(on)% may efficiently identify biochemical responders/non-responders to next RT, warranting management optimization of patients with (131)I-avid DM-DTC. Frontiers Media S.A. 2020-11-16 /pmc/articles/PMC7701118/ /pubmed/33304320 http://dx.doi.org/10.3389/fendo.2020.587315 Text en Copyright © 2020 Sa, Cheng, Jin, Fu, Shen and Chen http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Sa, Ri
Cheng, Lin
Jin, Yuchen
Fu, Hao
Shen, Yan
Chen, Libo
Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title_full Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title_fullStr Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title_full_unstemmed Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title_short Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment
title_sort distinguishing patients with distant metastatic differentiated thyroid cancer who biochemically benefit from next radioiodine treatment
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701118/
https://www.ncbi.nlm.nih.gov/pubmed/33304320
http://dx.doi.org/10.3389/fendo.2020.587315
work_keys_str_mv AT sari distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment
AT chenglin distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment
AT jinyuchen distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment
AT fuhao distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment
AT shenyan distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment
AT chenlibo distinguishingpatientswithdistantmetastaticdifferentiatedthyroidcancerwhobiochemicallybenefitfromnextradioiodinetreatment