Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels
Abstract Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of rec...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-09-01
|
| Series: | Thyroid Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13044-020-00089-4 |
| _version_ | 1818306998179987456 |
|---|---|
| author | Laura Iconaru Felicia Baleanu Georgiana Taujan Ruth Duttmann Linda Spinato Rafik Karmali Pierre Bergmann Anne-Sophie Hambye |
| author_facet | Laura Iconaru Felicia Baleanu Georgiana Taujan Ruth Duttmann Linda Spinato Rafik Karmali Pierre Bergmann Anne-Sophie Hambye |
| author_sort | Laura Iconaru |
| collection | DOAJ |
| description | Abstract Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk. The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence. Methods Patients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to 131I administration, cumulative administered 131I activity and response to treatment. Results In total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5 and 48.3% as intermediate risk and 19.2 and 20.7% as high risk (P = 0.38). Two patients (one in each group) with distant metastases were excluded from the analysis. Preparation to 131I administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 100% in Group 2 (p < 0.001). 131I was administered to 46/77 patients (59.7%) in Group 1 (5 at low risk of recurrence) and 38/57 patients (66.7%) in Group 2 (0 with a low risk). Among the patients treated by 131I, median cumulative activity was significantly higher in Group 1 (3.70GBq [100 mCi] range 1.11–11.1 GBq [30–300 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11–7.4 GBq [30–200 mCi], P < 0.001). Complete response was found in 90.9% in Group 1 vs. 96.5% in Group 2 (P = 0.20). Conclusions Using the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and a systematic use of rhTSH stimulation before 131I therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response. |
| first_indexed | 2024-12-13T06:51:23Z |
| format | Article |
| id | doaj.art-6aafa9c3d1ef48f48b77a1ea07c839ae |
| institution | Directory Open Access Journal |
| issn | 1756-6614 |
| language | English |
| last_indexed | 2024-12-13T06:51:23Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Thyroid Research |
| spelling | doaj.art-6aafa9c3d1ef48f48b77a1ea07c839ae2022-12-21T23:56:08ZengBMCThyroid Research1756-66142020-09-011311710.1186/s13044-020-00089-4Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in BrusselsLaura Iconaru0Felicia Baleanu1Georgiana Taujan2Ruth Duttmann3Linda Spinato4Rafik Karmali5Pierre Bergmann6Anne-Sophie Hambye7Department of Endocrinology, CHU Brugmann, Université Libre de BruxellesDepartment of Endocrinology, CHU Brugmann, Université Libre de BruxellesDepartment of Endocrinology, CHU Brugmann, Université Libre de BruxellesDepartment of Anatomopathology, CHU Brugmann, Université Libre de BruxellesDepartment of Otorhinolaryngology, CHU Brugmann, Université Libre de BruxellesDepartment of Endocrinology, CHU Brugmann, Université Libre de BruxellesDepartment of Nuclear Medicine, CHU Brugmann, Université Libre de BruxellesDepartment of Nuclear Medicine, CHU Brugmann, Université Libre de BruxellesAbstract Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk. The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence. Methods Patients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to 131I administration, cumulative administered 131I activity and response to treatment. Results In total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5 and 48.3% as intermediate risk and 19.2 and 20.7% as high risk (P = 0.38). Two patients (one in each group) with distant metastases were excluded from the analysis. Preparation to 131I administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 100% in Group 2 (p < 0.001). 131I was administered to 46/77 patients (59.7%) in Group 1 (5 at low risk of recurrence) and 38/57 patients (66.7%) in Group 2 (0 with a low risk). Among the patients treated by 131I, median cumulative activity was significantly higher in Group 1 (3.70GBq [100 mCi] range 1.11–11.1 GBq [30–300 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11–7.4 GBq [30–200 mCi], P < 0.001). Complete response was found in 90.9% in Group 1 vs. 96.5% in Group 2 (P = 0.20). Conclusions Using the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and a systematic use of rhTSH stimulation before 131I therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.http://link.springer.com/article/10.1186/s13044-020-00089-4Differentiated thyroid cancer131-iodine therapyTherapeutic response |
| spellingShingle | Laura Iconaru Felicia Baleanu Georgiana Taujan Ruth Duttmann Linda Spinato Rafik Karmali Pierre Bergmann Anne-Sophie Hambye Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels Thyroid Research Differentiated thyroid cancer 131-iodine therapy Therapeutic response |
| title | Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels |
| title_full | Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels |
| title_fullStr | Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels |
| title_full_unstemmed | Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels |
| title_short | Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels |
| title_sort | can we safely reduce the administration of 131 iodine in patients with differentiated thyroid cancer experience of the brugmann hospital in brussels |
| topic | Differentiated thyroid cancer 131-iodine therapy Therapeutic response |
| url | http://link.springer.com/article/10.1186/s13044-020-00089-4 |
| work_keys_str_mv | AT lauraiconaru canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT feliciabaleanu canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT georgianataujan canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT ruthduttmann canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT lindaspinato canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT rafikkarmali canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT pierrebergmann canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels AT annesophiehambye canwesafelyreducetheadministrationof131iodineinpatientswithdifferentiatedthyroidcancerexperienceofthebrugmannhospitalinbrussels |