RESUMO
Background: Radioiodine (RAI) therapy plays a vital role in the postoperative treatment of differentiated thyroid cancer (DTC) patients underwent total thyroidectomy (TT). However, even in the presence of capsular invasion and lymph node metastasis prognosis can be excellent and a postoperative RAI treatment might not be necessary for all patients. Therefore, this study explored the criteria for avoiding unnecessary RAI therapy in these patients. Method: We applied response to therapy assessment immediately after surgery and prospectively recruited 179 excellent or indeterminate response DTC patients with capsular invasion and/or LNM who underwent TT without RAI therapy. During the follow-up, thyroglobulin (Tg), thyroglobulin antibody (TgAb) levels, and cervical ultrasonography were collected and analyzed. Disease-free survival (DFS) was calculated using the Kaplan-Meier method. In addition, response to therapy assessments was performed on patients during each follow-up. Results: The mean follow-up period was 29.85 ± 17.44 months, and the 3- and 5-year DFS for all the patients was 99.3% in each. At the last follow-up, 165 (92.2%) patients had excellent responses, while 12 (6.7%) had an indeterminate response, and one (0.6%) each had biochemical and incomplete responses. No significant difference was observed in response to therapy between the subgroups of LNM and tumor invasion (P>0.05). For patients with capsular invasion and a number of metastatic lymph nodes ≤5 and >5, the proportions of recorded excellent responses were 95.9%, 91.0%, and 85.7%, respectively. Better responses were observed in females (excellent response: 95.5%, P=0.023), patients with stimulated Tg (s-Tg) ≤1ng/ml (excellent response: 100%, P<0.001), s-Tg ≤ 2ng/ml (excellent response: 98.4%, P<0.001), and excellent response for the immediate postoperative assessment (excellent response: 98.5%, P=0.004). Conclusions: The current study suggested that the response to therapy assessment immediately applied postoperatively could help avoid unnecessary RAI therapy among DTC patients with capsular invasion and/or LNM. Moreover, excellent response patients and patients with indeterminate response and s-Tg ≤ 2ng/ml could be managed without RAI therapy.
RESUMO
BACKGROUND & OBJECTIVE: One of the major limitations of curative resection in the patients with pancreatic cancer is local tumor extension to the major vessels surrounding pancreas. Therefore the assessment of the involvement of major arteries surrounding pancreas by tumor before operation is very important for the judgement of respectability of pancreatic carcinoma. This study was designed to assess the clinical value of contrast-enhanced CT(CECT) and selective angiography (SAG) in predicting the unresectability of patients with pancreatic cancer. METHODS: From Aug 7, 1996 to Aug 12, 2000, 67 patients with pancreatic ductal adenocarcinoma proved pathologically were retrospectively analyzed. Of these patients, 31 and 54 patients were treated with CECT and SAG, respectively. The involvement of major vessels surrounding pancreas in CECT and SAG were assessed by operator according to specific criterias, which were compared with finding in operation. Finally, the accuracy of the method was assessed. RESULT: Among 31 cases who were treated with CECT, 13 were judged unresectable by CECT; and 12 were found unresectable during operation, with predict value of 91%. Among 54 cases who were treated with SAG, 28 were judged unresectable by SAG; and 23 were found unresectable during operation, with predict value of 82%. The sensitivity, specificity, and predict value of CECT and SAG were 60%, 91%, 92%, and 77%, 79%, 82%, respectively. The sensitivity, specificity, and predict value of CECT combined with SAG were 91%, 100%, 100%, respectively. CONCLUSION: Enhanced CT and SAG are useful in assessing the unresectability of pancreatic carcinoma, the combination of two ways can improve the sensitivity, specificity and predict value.