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30mCi radioactive iodine achieving comparative excellent response in intermediate/high-risk nonmetastatic papillary thyroid cancer: a propensity score matching study

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Abstract

Objective

To determine the efficacy of low-dose radioactive iodine (RAI) therapy (30 mCi, 1110 MBq) in Chinese patients with intermediate- to high-risk papillary thyroid cancer (PTC) without distant metastasis.

Design and methods

This large retrospective study included Chinese patients with PTC that tested negative for thyroglobulin antibodies. Patients were categorized into low-dose (30 mCi, 1110 MBq) and high-dose (>100 mCi, 3700 MBq) RAI groups. Ablation rate and long-term response were compared between groups using propensity score matching (PSM) to minimize bias and confounding.

Results

In total, we included 446 patients. No significant difference in ablation success rate was found between groups (P = 0.305) before or after PSM (N = 162; P = 0.200). Excellent response (ER) rate was not significant between groups before (P = 0.917) or after PSM (P = 0.798). Efficacy of low-dose RAI was similar to that of high-dose RAI in N0- (P = 1.000), N1a- (P = 0.981), and N1b-stage (P = 0.903) patients. Low- and high-dose RAI groups achieved similar ER rates in pre-ablative stimulated thyroglobulin level (≤1 ng/mL, P = 1.000; 1 < ps-Tg ≤ 5 ng/mL, P = 0.444; 5 < ps-Tg ≤ 10 ng/mL, P = 0.665; >10 ng/mL, P = 1.000) and BRAFV600E-positive (P = 0.324) subgroups.

Conclusions

Efficacy of low-dose RAI therapy was similar to that of high-dose for ablation and achieving ER in Chinese nonmetastatic intermediate- to high-risk PTC patients. High-dose RAI could not rectify ablation failure or non-ER rates in PTC patients with BRAFV600E, lymph node metastases, or unfavorable thyroglobulin levels.

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References

  1. R.L. Siegel, K.D. Miller, A. Jemal, Cancer statistics, 2016. CA Cancer J. Clin. 66(1), 7–30 (2016). https://doi.org/10.3322/caac.21332

    Article  PubMed  Google Scholar 

  2. A.L. Mitchell, A. Gandhi, D. Scott-Coombes, P. Perros, Management of thyroid cancer: United Kingdom national multidisciplinary guidelines. J. Laryngol. Otol. 130(S2), S150–S160 (2016). https://doi.org/10.1017/S0022215116000578

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. B.R. Haugen, E.K. Alexander, K.C. Bible, G. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G. Randolph, A. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D. Steward, R.M. Tuttle, L. Wartofsky, 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 1–133 (2015), https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  4. U. Mallick, C. Harmer, B. Yap, J. Wadsley, S. Clarke, L. Moss, A. Nicol, P.M. Clark, K. Farnell, R. McCready, J. Smellie, J.A. Franklyn, R. John, C.M. Nutting, K. Newbold, C. Lemon, G. Gerrard, A. Abdel-Hamid, J. Hardman, E. Macias, T. Roques, S. Whitaker, R. Vijayan, P. Alvarez, S. Beare, S. Forsyth, L. Kadalayil, A. Hackshaw, Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N. Engl. J. Med. 366(18), 1674–1685 (2012). https://doi.org/10.1056/NEJMoa1109589

    Article  CAS  PubMed  Google Scholar 

  5. M. Schlumberger, B. Catargi, I. Borget, D. Deandreis, S. Zerdoud, B. Bridji, S. Bardet, L. Leenhardt, D. Bastie, C. Schvartz, P. Vera, O. Morel, D. Benisvy, C. Bournaud, F. Bonichon, C. Dejax, M.E. Toubert, S. Leboulleux, M. Ricard, E. Benhamou, Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N. Engl. J. Med. 366(18), 1663–1673 (2012). https://doi.org/10.1056/NEJMoa1108586

    Article  CAS  PubMed  Google Scholar 

  6. C. Wang, T. Zhao, H. Li, W. Gao, Y. Lin, Low activity versus high activity. Nucl. Med. Commun. 38(5), 366–371 (2017). https://doi.org/10.1097/MNM.0000000000000666

    Article  CAS  PubMed  Google Scholar 

  7. M. Kim, W.G. Kim, H. Oh, S. Park, H. Kwon, D.E. Song, T.Y. Kim, Y.K. Shong, W.B. Kim, T. Sung, M.J. Jeon, Comparison of the seventh and eighth editions of the American joint committee on cancer/union for international cancer control tumor-node-metastasis staging system for differentiated thyroid cancer. Thyroid. 1149–1155 (2017). https://doi.org/10.1089/thy.2017.0050

    Article  PubMed  Google Scholar 

  8. J. Jonklaas, Nasal symptoms after radioiodine therapy: A rarely described side effect with similar frequency to lacrimal dysfunction. Thyroid 24(12), 1806–1814 (2014). https://doi.org/10.1089/thy.2014.0162

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. R. Solans, J.A. Bosch, P. Galofre, F. Porta, J. Rosello, A. Selva-O’Callagan, M. Vilardell, Salivary and lacrimal gland dysfunction (sicca syndrome) after radioiodine therapy. J. Nucl. Med. 42(5), 738–743 (2001)

    CAS  PubMed  Google Scholar 

  10. P. Zhou, Z. Tang, W. Liu, M. Tian, L. Jin, X. Jiang, H. Wang, C.Tao, Z. Ding, Y. Peng, S. Qiu, Z. Dai, J. Zhou, J. Fan, Y. Shi, Perioperative blood transfusion does not affect recurrence-free and overall survivals after curative resection for intrahepatic cholangiocarcinoma: A propensity score matching analysis. BMC Cancer 17(1), 762–772 (2017). https://doi.org/10.1186/s12885-017-3745-z

    Article  PubMed  PubMed Central  Google Scholar 

  11. X. Yang, J. Li, X. Li, Z. Liang, W. Gao, J. Liang, S. Cheng, Y. Lin, TERT promoter mutation predicts radioiodine refractory in distant metastatic differentiated thyroid cancer. J. Nucl. Med. 58, 258–265 (2016). https://doi.org/10.2967/jnumed.116.180240

    Article  CAS  PubMed  Google Scholar 

  12. J.L. Marti, L. Morris, A.S. Ho, Selective use of radioactive iodine (RAI) in thyroid cancer: No longer “one size fits all”. Eur. J. Surg. Oncol. 44, 348–356 (2017). https://doi.org/10.1016/j.ejso.2017.04.002

    Article  PubMed  Google Scholar 

  13. J.H. Jeong, E.J. Kong, S.Y. Jeong, S. Lee, I.H. Cho, K. Ah Chun, J. Lee, B. Ahn, Clinical outcomes of low-dose and high-dose postoperative radioiodine therapy in patients with intermediate-risk differentiated thyroid cancer. Nucl. Med. Commun. 38(3), 228–233 (2017). https://doi.org/10.1097/MNM.0000000000000636

    Article  CAS  PubMed  Google Scholar 

  14. J.M. Han, W.G. Kim, T.Y. Kim, M.J. Jeon, J. Ryu, D.E. Song, S.J. Hong, Y.K. Shong, W.B. Kim, Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension. Thyroid 24(5), 820–825 (2014). https://doi.org/10.1089/thy.2013.0362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. T. Zhao, J. Liang, Z. Guo, T. Li, Y. Lin, In patients with low- to intermediate-risk thyroid cancer, a preablative thyrotropin level of 30 muIU/mL is not adequate to achieve better response to 131I therapy. Clin. Nucl. Med. 41(6), 454–458 (2016). https://doi.org/10.1097/RLU.0000000000001167

    Article  PubMed  Google Scholar 

  16. I.J. Nixon, I. Ganly, S. Patel, F.L. Palmer, M.M. Whitcher, R.M. Tuttle, A.R. Shaha, J.P. Shah, The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer. Surgery 150(6), 1242–1249 (2011). https://doi.org/10.1016/j.surg.2011.09.007

    Article  PubMed  Google Scholar 

  17. I. Ganly, I.J. Nixon, L.Y. Wang, F.L. Palmer, J.C. Migliacci, A. Aniss, M. Sywak, A.E. Eskander, J.L. Freeman, M.J. Campbell, W.T. Shen, F. Vaisman, D. Momesso, R. Corbo, M. Vaisman, A. Shaha, R.M. Tuttle, J.P. Shah, S.G. Patel, Survival from differentiated thyroid cancer: what has age got to do with it? Thyroid 25(10), 1106–1114 (2015). https://doi.org/10.1089/thy.2015.0104

    Article  PubMed  PubMed Central  Google Scholar 

  18. J. Jonklaas, G. Nogueras-Gonzalez, M. Munsell, D. Litofsky, K.B. Ain, S.T. Bigos, J.D. Brierley, D.S. Cooper, B.R. Haugen, P.W. Ladenson, J. Magner, J. Robbins, D.S. Ross, M.C. Skarulis, D.L. Steward, H.R. Maxon, S.I. Sherman, The impact of age and gender on papillary thyroid cancer survival. J. Clin. Endocrinol. Metab. 97(6), E878–E887 (2012). https://doi.org/10.1210/jc.2011-2864

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. C. Wang, X. Zhang, H. Li, X. Li, Y. Lin, Quantitative thyroglobulin response to radioactive iodine treatment in predicting radioactive iodine-refractory thyroid cancer with pulmonary metastasis. PLoS ONE. 12(7), e179664 (2017). https://doi.org/10.1371/journal.pone.0179664

    Article  CAS  Google Scholar 

  20. X. Yang, J. Liang, T. Li, T. Zhao, Y. Lin, Preablative stimulated thyroglobulin correlates to new therapy response system in differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 101(3), 1307–1313 (2016). https://doi.org/10.1210/jc.2015-4016

    Article  CAS  PubMed  Google Scholar 

  21. R.C. Webb, R.S. Howard, A. Stojadinovic, D.Y. Gaitonde, M.K. Wallace, J. Ahmed, H.B. Burch, The utility of serum thyroglobulin measurement at the time of remnant ablation for predicting disease-free status in patients with differentiated thyroid cancer: a meta-analysis involving 3947 patients. J. Clin. Endocrinol. Metab. 97(8), 2754–2763 (2012). https://doi.org/10.1210/jc.2012-1533

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (Grant nos. 81571714 and 81771875) and the CSCO-Hengrui Research Foundation (No. Y-HR2016-032). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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    Authors and Affiliations

    1. Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, 100730, China

      Yingqiang Zhang, Chen Wang, Xin Zhang, Hui Li & Yansong Lin

    2. Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, 100730, China

      Yingqiang Zhang, Chen Wang, Xin Zhang, Hui Li & Yansong Lin

    3. Centre Médical Universitaire (CMU), Université de Genève, Geneva, Switzerland

      Chen Wang

    4. Department of Nuclear Medicine, Zhejiang Cancer Hospital, Hangzhou, 310022, China

      Xin Li

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    1. Yingqiang Zhang
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    3. Xin Zhang
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    Correspondence to Yansong Lin.

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    Ethical approval

    The present study was approved by the institutional review board of Peking Union Medical College Hospital (Beijing, China) Ethics Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    These authors contributed equally: Yingqiang Zhang, Chen Wang.

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    Zhang, Y., Wang, C., Zhang, X. et al. 30mCi radioactive iodine achieving comparative excellent response in intermediate/high-risk nonmetastatic papillary thyroid cancer: a propensity score matching study. Endocrine 62, 655–662 (2018). https://doi.org/10.1007/s12020-018-1724-z

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    • DOI: https://doi.org/10.1007/s12020-018-1724-z

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