Abstract
BackgroundTreatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The purpose of this study was to assess the efficacy and safety of ultrasound-guided implantation of radioactive 125I-seed in radioiodine refractory differentiated thyroid carcinoma.MethodsThirty-six cervical metastatic lymph nodes (CMLNs) diagnosed with RR-DTC from 18 patients were enrolled in this retrospective study. US and contrast-enhanced ultrasound (CEUS) examinations were performed before implantation. Follow-up comprised US, CEUS, thyroglobulin (Tg) level and routine hematology at 1–3, 6, 9 and 12 months and every 6 months thereafter. The volumes of the nodules were compared before implantation and at each follow-up point. The volume reduction rate (VRR) of nodules was also recorded.ResultsThe median volume of the nodules was 523 mm3 (148, 2010mm3) initially, which decreased significantly to 53mm3 (0, 286mm3) (P < 0.01) at the follow-up point of 24 months with a median VRR as 95% (86,100%). During the follow-up period (the range was 24–50 months), 25 (69%) nodules had VRR greater than 90%, of which 12 (33%) nodules had VVR ≈ 100% with unclear structures and only 125I seed images were visible in the US. At the last follow-up visit, the serum Tg level decreased from 57.0 (8.6, 114.8) ng/ml to 4.9 (0.7, 50.3) ng/ml, (P < 0.01).ConclusionUS-guided 125I seed implantation is safety and efficacy in treating RR- DTC. It could be an effective supplement for the comprehensive treatment of thyroid cancer.
Highlights
Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-Differentiated thyroid carcinoma (DTC)) is challenging
Study subjects Inclusion criteria: (a) patients were required to be aged≥18 years; (b) patients who underwent thyroidectomy for DTC; (c) patients with measurable, pathological and/or cytologically confirmed Cervical metastatic lymph node (CMLN) from DTC, and evidence of RR according to at least one criterion used in recent clinical trials as follows (i) at least one lesion that never concentrated iodine-131; (ii) at least one lesion that progressed within 12 months after radioactive iodine (RAI) therapy despite iodine-131 avidity, or persistent disease after a cumulative dose of iodine-131 ≥ 600 mCi; (iii) partial thyroidectomy leading to thyroid tissue residue, which affects the efficacy of radioactive iodine-131 (RAI-131);and (d) patients who had inoperable CMLN or refused to undergo repeated neck surgical dissection
Locoregional recurrence and metastasis may occur in 20–30% of DTC patients within 10 years after initial treatment, which is associated with an increased mortality rate [25]
Summary
Treatment for radioiodine refractory differentiated thyroid carcinoma (RR-DTC) is challenging. The world over, cases of thyroid carcinoma have been continuously increasing in recent decades [1,2,3]. Suppression of thyroid stimulating hormone (TSH) and selective treatment of radioactive iodine-131 (RAI-131), the vast majority of DTC patients have an excellent prognosis, as reflected by 5-year relative survival rates of approximately 95% [1, 5]. RAI-131 therapy is the firstline systemic treatment in postoperative patients with progressive DTC, treatment options for radioiodine refractory differentiated thyroid carcinoma (RRDTC) have been hampered, leading to a poor overall prognosis [11]. As an emerging systemic therapy, tyrosine kinase inhibitors (TKIs) have recently shown activity in RR-DTC, the lack of long-term survival
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