Abstract
ObjectivePulmonary function test (PFT) is a useful tool for an objective assessment of respiratory function. Impaired pulmonary function is critical for the survival and quality of life in patients with pulmonary metastases of solid cancers including thyroid cancer. This study aimed to evaluate clinical factors associated with severely impaired pulmonary function by serial assessment with PFT in patients with pulmonary metastasis of differentiated thyroid cancer (DTC) who received radioactive iodine treatment (RAIT).PatientsThis retrospective study enrolled 31 patients who underwent serial PFTs before and after RAIT for pulmonary metastasis of DTC. We evaluated the risk factors for severe impairment of pulmonary function.ResultsThe median age of the patients was 44.1 years and 18 of them were female patients. Severe impairment of pulmonary function was observed in five patients (16%) after a median of three RAITs (cumulative I-131 activity = 20.4 GBq). These patients were older and more frequently had mild impairment of baseline pulmonary function, respiratory symptoms, or progressive disease compared with patients with stable pulmonary function. Neither cumulative dose nor number of RAIT was associated with decreased pulmonary function. Coexisting pulmonary diseases, presence of respiratory symptoms, and metastatic disease progression were significantly associated with severe decrease in forced vital capacity during follow-up (p =.047, p =.011, and p =.021, respectively).ConclusionsPulmonary function was severely impaired during follow-up in some patients with pulmonary metastasis of DTC after a high-dose RAITs. Neither the number of RAIT nor the cumulative I-131 activity was associated with decreased pulmonary function. Serial PFT might be considered for some high-risk patients during follow-up.
Highlights
Pulmonary function test (PFT) is a useful tool for objective assessment of respiratory impairment [1, 2]
Neither cumulative dose nor number of Radioactive iodine treatment (RAIT) was associated with decreased pulmonary function
Pulmonary function was severely impaired during follow-up in some patients with pulmonary metastasis of differentiated thyroid cancer (DTC) after a high-dose RAITs
Summary
Pulmonary function test (PFT) is a useful tool for objective assessment of respiratory impairment [1, 2]. Cardiopulmonary function is an important predictor of survival in patients with metastatic breast cancer [3]. Impairment of pulmonary function could be more important for quality of life in patients with pulmonary metastases of differentiated thyroid cancer (DTC) due to its relatively longer survival period compared with other cancers. It is important to know the risk factors for worsening pulmonary function in patients with pulmonary metastases of DTC. Radioactive iodine treatment (RAIT) is an effective therapeutic modality for DTC patients with distant metastases [4, 5]. Radioactive iodine refractoriness is an important prognostic factor in patients with metastatic DTC. About 70% of pulmonary metastases of DTC are radioactive iodine-avid, and their 10-year survival rates are about 60%. Those with radioactive iodine refractory metastases of DTC have only 10% of 10-year survival rate [6,7,8,9]
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