RESUMO
AIM: The purpose of the present work was to evaluate the impact of 131I high activity therapy treatments of metastatic differentiated thyroid cancer (MDTC) in terms of feasibility, tolerance, efficacy, and the impact of dosimetry in order to optimize the process. METHODS: Seventeen MDTC patients underwent 27 treatments with 131I, with activity ranging from 6.2 GBq to 24.1 GBq. Red marrow (RM) peritherapy dosimetry was based on the Standard Operating Procedure of European Association of Nuclear Medicine (EANM SOP), while metastases dosimetry on the guidelines of Italian Association of Physicists in Medicine and Italian Association of Nuclear Medicine. In 12 cases prospective dosimetry was performed too, with the purpose of evaluating the possibility of maximizing the therapeutic activity, complying the 2 Gy red marrow (RM) dose constraint. The absorbed dose to 45 lesions was evaluated. The severity of myelotoxic effects was monitored during the follow-up. RESULTS: Treatments were generally well tolerated, also at the highest RM absorbed doses. RM absorbed doses ranged from 0.49 to 6.67 Gy, lesion doses from 1.1 Gy to 778 Gy. In case of repeated treatments on the same site, in 13 cases on a total of 15, an absorbed dose reduction was observed. RM prospective and peritherapeutic dosimetry differed somewhat: absorbed doses measured during therapy ranged from -7% to +40% with respect to provisional absorbed doses. CONCLUSION: In our experience high activity treatments were well-tolerated. Prospective dosimetry needs further investigation to become sufficiently reliable in order to comply the 2 Gy constraint. Lesions became progressively less iodine-avid in case of repeated treatments, so the "first big-shoot" treatment with the highest safe activity seems to be desirable to obtain the maximum efficacy.
Assuntos
Carga Corporal (Radioterapia) , Radioisótopos do Iodo/uso terapêutico , Dosagem Radioterapêutica , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/secundário , Contagem Corporal Total/métodos , Humanos , Radioisótopos do Iodo/análise , Compostos Radiofarmacêuticos/análise , Compostos Radiofarmacêuticos/uso terapêutico , Neoplasias da Glândula Tireoide/diagnóstico , Resultado do TratamentoRESUMO
Anaplastic thyroid carcinoma is a rare malignant neoplasia with high biological aggressiveness and rapid and lethal clinical course. In selected patients, an aggressive multimodal therapy could decrease illness progression both in the neck e in other sites. However, it is not clear if these combined treatments improve survival. In our institution, the Department of Nuclear Medicine has a 40-year experience in monitor and treatment of a group of 48 patient with ATC confirmation that clinical presentation could overlap pre-existent nodular goitre or rapid enlarging mass of recent onset. At onset, age do not change final poor prognosis and the survival seems most favorable in patients with a primary tumor size <6 cm. A better mean survival was noticed in those patients who respond to the multimodal therapy (8 months vs 4.6 months). Radioiodine (131 I) therapy is unnecessary due to the loss of NIS expression of the ATC cells. Therefore, after quick clinical and instrumental work up, our experience and the literature data suggest that the first line therapy is represented from external radiotherapy combined also with cisplatin or doxorubicin, followed by "curative" surgical procedure of the primary lesion in the neck and subsequent chemotherapy. For those patients who show distant metastasis at onset chemotherapy is the first line therapy followed by external radiotherapy and when possible subsequent surgical procedure.
Assuntos
Carcinoma/diagnóstico , Carcinoma/terapia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Carcinoma/radioterapia , Quimioterapia Adjuvante/métodos , Cisplatino/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Radioterapia Adjuvante/métodos , Projetos de Pesquisa/estatística & dados numéricos , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Resultado do TratamentoRESUMO
AIM: Elevated persistent value of antithyroglobulin antibodies (Ab-Tg) in differentiated thyroid carcinoma (DTC) patients may interfere with Tg determination. The aim of the study was to evaluate the use of Ab-Tg as tumor marker as a replacement for thyroglobulin (Tg). METHODS: From 1990 al 2004 767 patients have been treated and followed, mean follow-up years 6.9+/-2.4. Thirty-two patients Ab-Tg positive after radioiodine ablation, who had showed during the follow-up stable indosable value di Tg, have undergone analysis. RESULTS: The recurrences were statistically more significant when Ab-Tg were increased, than when Ab-Tg were stable or diminished during the time (P<0.0001). Lymphocytic thyroditis was found in thirteen patients (40.6%) at histological specimen after thyroidectomy. The persistence of lymphocytic thyroditis has not modified the value of Ab-Tg as tumor marker (P<0.001). The 10/32 (31.2%) patients Tg negative have been compared to the 61/712 patients Ab-Tg positive (8.6%) who relapse. The recurrence rate was significantly higher for the first group of patients than that for the second (P<0.0001). Multivariate analisys showed N1 (P<0.001; OR 2.51) and Ab-Tg positive (P<0.001; OR: 6.15) associated with recurrences. CONCLUSIONS: Ab-Tg must be determined, in concomitance with Tg, during the follow-up of DTC, to establish the accuracy of Tg, in order to use it as tumour marker. It must be kept in mind that the strongest indication for relapse due to Ab-Tg is an increasing of level in the same patient measured in the long time. Persistent elevated Ab-Tg levels are prognostic of future recurrences.
Assuntos
Autoanticorpos/análise , Carcinoma Papilar, Variante Folicular/terapia , Carcinoma Papilar/terapia , Tireoglobulina/imunologia , Neoplasias da Glândula Tireoide/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Papilar/radioterapia , Carcinoma Papilar/cirurgia , Carcinoma Papilar, Variante Folicular/radioterapia , Carcinoma Papilar, Variante Folicular/cirurgia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Adulto JovemRESUMO
OBJECTIVE: We evaluated the efficacy of fine needle aspiration cytology (FNAC) of the thyroid in a series of 5469 lesions with histological control and studied the causes of, and the possibility of reducing the limitations of the method. METHODS: FNAC was always performed by a pathologist under the guidance of a clinician, using a 22-gauge needle. Generally two aspirations were carried out, and usually four slides were obtained for each nodule; they were then stained with May-Grünwald-Giemsa and with Papanicolaou. The cytological diagnoses were classified in four groups: inadequate, benign, suspicious and malignant. RESULTS: We obtained a complete sensitivity of 93.4%, a positive predictive value of malignancy of 98.6%, and a specificity of 74.9%. At histological control, the cytological diagnosis of Hurthle cell neoplasm corresponded to a significantly higher incidence of malignant neoplasms than the diagnosis of non-Hurthle cell follicular neoplasm (32.1% versus 15.5%). There were 66 false-negative findings, the main cause of diagnostic error (24 cases) being failure to recognize the follicular variant of papillary carcinoma. The number of inadequate FNACs was low (4.2%). CONCLUSION: Our study confirmed the great efficacy of thyroid FNAC. A cytological diagnosis of Hurthle cell neoplasm should be considered an indicator of high risk. Awareness that failure to recognize the follicular variant of papillary carcinoma was the main problem in the interpretation of thyroid FNAC should lead to a decrease of false-negative diagnoses. The inadequate rate was very low, as it was the pathologist personally who performed the needle aspiration.
Assuntos
Biópsia por Agulha Fina , Nódulo da Glândula Tireoide/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
The differential diagnosis and the identification of the source of ACTH in occult ectopic Cushing's syndrome due to a bronchial carcinoid still represents a challenge for the endocrinologist. We report our experience in six patients with occult bronchial carcinoid in whom extensive hormonal, imaging, and scintigraphic evaluation was performed. All patients presented with hypercortisolism associated with high plasma ACTH values. The CRH test and high dose dexamethasone suppression test suggested an ectopic source of ACTH in three of six patients. During bilateral inferior petrosal sinus sampling, none of the patients showed a central to peripheral ACTH gradient. At the time of diagnosis, none of the patients had radiological evidence of the ectopic source of ACTH, whereas pentetreotide scintigraphy identified the lesion in two of four patients. Finally, a chest computed tomography scan revealed the presence of a bronchial lesion in all patients, and pentetreotide scintigraphy identified four of six lesions. In all patients a bronchial carcinoid was found and removed. In one patient with scintigraphic evidence of residual disease after two operations, radioguided surgery, using a hand-held gamma probe after iv administration of radiolabeled pentetreotide, was performed; this allowed detection and removal of residual multiple mediastinal lymph node metastases. In conclusion, our data show that there is not a single endocrine test or imaging procedure accurate enough to diagnose and localize occult ectopic ACTH-secreting bronchial carcinoids. Radioguided surgery appears to be promising in the presence of multiple tumor foci and previous incomplete removal of the tumor.
Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Neoplasias Brônquicas/metabolismo , Tumor Carcinoide/metabolismo , Somatostatina/análogos & derivados , Hormônio Adrenocorticotrópico/sangue , Adulto , Idoso , Neoplasias Brônquicas/diagnóstico , Neoplasias Brônquicas/terapia , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Hormônio Liberador da Corticotropina/farmacologia , Feminino , Humanos , Radioisótopos de Índio , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Between 1980 and 1998, 4272 thyroid surgical specimens with a preoperative fine needle aspirate were sent to our Anatomical Pathology Department. Among these cases there were 17 primary thyroid lymphomas, which constituted 0.3% of all the thyroid lesions and 2.3% of the thyroid malignancies. Seven cases were diffuse large B-cell (DLBC) lymphomas and 10 were MALT lymphomas. Of the DLBC lymphomas six were correctly diagnosed by fine needle aspiration cytology (FNAC) and one was diagnosed as positive for malignancy, and among MALT lymphomas four were diagnosed as lymphoma, four as suspicious for lymphoma, and three as Hashimoto's thyroiditis (HT). Our data indicate that the diagnosis of primary thyroid lymphoma of high grade is easy, and immunocytochemistry (ICC) can confirm suspicious cases. The diagnosis of MALT lymphoma is more difficult; ICC can confirm suspicious cases, and false-negative results seem to be caused by sampling error, because HT usually coexists with MALT lymphoma.
Assuntos
Biópsia por Agulha , Carcinoma/patologia , Citodiagnóstico , Linfoma não Hodgkin/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Linfócitos B/patologia , Carcinoma/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/diagnósticoRESUMO
UNLABELLED: This study reports on 85 differentiated thyroid carcinoma (DTC) (72 papillary, 13 follicular) patients, younger than 18 yr of age at the time of diagnosis, consecutively treated during the period 1958-1995. METHODS: Follow-up (median: 111 mo, range 1-324 mo) consisted of clinical examination, serum thyroglobulin (Tg), 131I whole-body scintigraphy (whole-body scan) and other imaging procedures. RESULTS: Forty-six patients had undergone total thyroidectomy, 38 partial thyroidectomy and 1 thyroid biopsy. In 47 patients, lymph-adenectomy was also performed. Five patients were treated after surgery by external radiotherapy, 59 by 131I therapy and 16 by both modalities. Iodine-131 therapy was successful in ablating thyroid remnants in 35/48 cases, lymph node metastases in 8/11 cases and lung metastases in 12/16 cases. Among the patients with scintigraphic-confirmed disappearance of lung metastases, serum Tg was still detectable in 10 cases, but continued to decrease spontaneously even without further therapeutic doses of 131I. All patients were still alive after a median period of 137 mo (range 5-444 mo). Six patients experienced a recurrence of the disease in the neck. Sixty-seven patients were free of disease, 3 had lymph node metastases, 4 lung metastases and 11 had detectable levels of Tg without demonstrable metastases. No impairment of female fertility or untoward genetic effects were noticed. One male patient, treated with 3.33 GBq of 131I, was infertile due to oligospermia. One case of gastric cancer and one of breast cancer occurred 8 and 19 yr, respectively, after 131I therapy. CONCLUSION: Iodine-131 therapy is highly effective in reducing lung metastases, but undetectable levels of Tg are seldom achieved. Total thyroidectomy and 131I therapy is an effective and safe treatment for the majority of patients with DTC diagnosed in childhood or adolescence.
Assuntos
Adenocarcinoma Folicular , Carcinoma Papilar , Neoplasias da Glândula Tireoide , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/epidemiologia , Adenocarcinoma Folicular/secundário , Adenocarcinoma Folicular/terapia , Adolescente , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/epidemiologia , Carcinoma Papilar/secundário , Carcinoma Papilar/terapia , Criança , Terapia Combinada , Feminino , Seguimentos , Humanos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Pulmonares/secundário , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Tireoglobulina/sangue , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Fatores de TempoRESUMO
UNLABELLED: The aim of this study was to evaluate female fertility, carcinogenic, and genetic effects after treatment with 131I of differentiated thyroid carcinoma. METHODS: A total of 814 females of child-bearing age were studied. The fertility of 627 females who received 131I therapy was compared to 187 untreated females. Birth histories of the children born from these women were registered. The carcinogenic effect was evaluated by comparing the incidence of tumors in 730 patients treated with 131I with an internal control group, as well as with local population incidence. RESULTS: There was no significant difference in the fertility rate, birth weight and prematurity between the two groups. Only one case of a ventricular septal defect was observed in a child born to a women treated with 131I. The overall standardized incidence ratio (SIR) of second tumors was 1.19 (95% CI: 0.76-1.77) in patients treated with 131I. An elevated SIR was registered for salivary gland tumors and melanoma. No case of leukemia was registered. CONCLUSION: The risk of long-term effects of 131I treatment of differentiated thyroid carcinoma is quite low. Iodine-131 may be safely used in treating cases with a high risk of recurrence.
Assuntos
Fertilidade/efeitos da radiação , Radioisótopos do Iodo/efeitos adversos , Neoplasias Induzidas por Radiação/etiologia , Segunda Neoplasia Primária/etiologia , Neoplasias da Glândula Tireoide/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Infertilidade Feminina/etiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de TempoRESUMO
The poor results of traditional therapy (for purposes of recovery or palliation) in malignant pheochromocytoma and the well proven uptake of [131I]metaiodobenzylguanidine (131I-MIBG) shown by these tumors, induced us to evaluate the clinical usefulness of radiometabolic therapy with 131I-MIBG. Four patients with malignant pheochromocytoma were subjected to 131I-MIBG therapy, between 1987 and 1991, in our department. They all were in an advanced stage of the disease and showed severe symptoms and poor reaction to traditional therapy. The cumulative activity given was 7.4-22.2 GBq. All patients demonstrated transient subjective improvement; in addition, both biochemical and haemodynamic parameters ameliorated. Two patients showed a reduction in the size and number of metastases seen on scintigraphy. One patient died due to progression of the disease. Three patients are still alive and in good condition. No remarkable early or late side-effects were reported. We suggest that 131I-MIBG radiometabolic therapy in advanced-stage malignant pheochromocytoma could be useful in reducing symptoms. Further investigation might show whether a greater reduction in the size of the tumor could be achieved using different therapeutic schedules or by treating the disease in its earlier stages.
Assuntos
Neoplasias das Glândulas Suprarrenais/terapia , Antineoplásicos/uso terapêutico , Radioisótopos do Iodo/uso terapêutico , Iodobenzenos/uso terapêutico , Feocromocitoma/secundário , 3-Iodobenzilguanidina , Neoplasias das Glândulas Suprarrenais/epidemiologia , Adulto , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Feocromocitoma/epidemiologia , Feocromocitoma/terapia , Estudos RetrospectivosRESUMO
The successful use of [131I]metaiodobenzylguanidine (131I-MIBG) in the scintigraphic localisation and treatment of several tumors deriving from neuroectoderm has led us to its application in metastatic carcinoid tumors. We selected five patients (two men and three women; age range 53-79 years) who showed progression of the disease with severe related symptoms, poor response to traditional therapy and a good uptake of 131I-MIBG in neoplastic tissue. A cumulative radioactivity of 3.7-22.2 GBq was given. All patients had a clear subjective improvement with a better quality of life for a period of 2-36 months, sometimes accompanied by decreased 5-hydroxyindoleacetic acid urinary excretion. Results concerning objective remission of the disease were unsatisfactory. No remarkable early or late side-effect was noted. We believe 131I-MIBG is useful for symptomatic treatment of metastatic carcinoid in seriously ill patients too. Different treatment schedule and recruitment of patients with less advanced disease could make pathological remission a possible goal.
Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Tumor Carcinoide/secundário , Radioisótopos do Iodo/uso terapêutico , Iodobenzenos/uso terapêutico , Neoplasias Hepáticas/secundário , 3-Iodobenzilguanidina , Idoso , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/terapia , Tumor Carcinoide/epidemiologia , Tumor Carcinoide/terapia , Terapia Combinada , Feminino , Humanos , Itália/epidemiologia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The poor results of traditional therapy in advanced carcinoid tumors and the well-proven uptake of 131I-MIBG shown by some of these tumors induced us to attempt a radiometabolic approach. We selected for the treatment 5 patients (3 men and 2 women) who showed progression of disease, a fairly good uptake of 131I-MIBG with severe related symptoms, and a poor response to traditional therapy. A cumulative radioactivity of 5.5-29.6 GBq was given. Acute side effects after 131I-MIBG administration or late radiation-induced damages were not observed. Symptoms increased during the first 2-4 weeks in 2 patients: in one of these relief was achieved with drugs. Results concerning objective remission of the disease were unsatisfactory. In contrast, definite improvement of symptoms was shown in 2 of 5 patients, resulting in a better quality of life.