Abstract
Background: In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and 131I remnant ablation an empiric 131I therapy may be considered. However, outcome data after empiric therapy in did not show a clear evidence of improved survival. We assessed the efficacy of such empiric 131I therapy in patients with DTC and evaluated the long-term outcome.Methods: A total of 100 patients with DTC showing raised Tg level during follow-up after thyroidectomy and 131I ablation were treated with a further 131I therapy (6.1 ± 1.7 GBq). Whole-body scan (WBS) was performed 5–7 days after therapy. Tg value at 12 months after 131I therapy was considered as an indicator of treatment response: ≤1.5 ng/ml complete remission (CR), >50% decrease partial remission (PR), higher than pre-therapy progression disease (PD), all other cases stable disease (SD). Patients were followed-up for 96 ± 75 months.Results: After 12 months, 62% of patients were in CR, 16% in PR, 8% in SD, and 14% in PD. WBS was positive in 41% of patients and negative in 59% (P = NS). Among patients with local recurrences at WBS 89% showed either CR or PR, while 71% of patients with distant metastases were in SD or PD (P < 0.001). Distant metastases at WBS (P < 0.05), CR (P < 0.0001), and CR + PR (P < 0.0001) were predictors of both progression free survival and overall survival.Conclusion: There is a beneficial effect of 131I therapy on outcome of patients with DTC treated on the basis of elevated Tg value. In these patients, survival is affected by achievement of CR or PR at 12 months evaluation after 131I therapy and by the presence of distant metastases at WBS.
Highlights
Follow-up of patients with differentiated thyroid cancer (DTC) after total or near-total thyroidectomy and 131I remnant ablation is performed by assessment of thyroglobulin (Tg) levels, ultrasonography, and 131I diagnostic whole-body scan
complete remission (CR) was evident in 67% of papillary DTC and in 37% of follicular DTC, partial remission (PR) in 17% of papillary DTC and in 13% of follicular DTC, stable disease (SD) in 7% of papillary DTC and in 13% of follicular DTC, progression disease (PD) in 10% of papillary DTC, and in 37% of follicular DTC (P < 0.01)
When positive therapy 131I wholebody scan (t-WBS) were subdivided according to site of uptake, 89% of those with local recurrences showed either CR or PR, while 71% of patients with distant metastases at t-WBS were in SD
Summary
Follow-up of patients with differentiated thyroid cancer (DTC) after total or near-total thyroidectomy and 131I remnant ablation is performed by assessment of thyroglobulin (Tg) levels, ultrasonography, and 131I diagnostic whole-body scan (dWBS). The most reliable parameter for the detection of tumor recurrence is a raised Tg level, which suggests persistence or recurrence of viable tumor tissue [1,2,3,4,5] In these patients an empiric 131I therapy may be considered [6], there is still no agreement on the cutoff value of serum Tg above which a patient should be treated with an empiric 131I dose. In patients with differentiated thyroid cancer (DTC) and raising serum thyroglobulin (Tg) after total or near-total thyroidectomy and 131I remnant ablation an empiric 131I therapy may be considered. We assessed the efficacy of such empiric 131I therapy in patients with DTC and evaluated the long-term outcome
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