Assessment of three different radioiodine doses for ablation therapy of thyroid remnants: Efficiency, complications and patient comfort.

I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ±â€…0.3, 2.6 ±â€…0.6, and 2.9 ±â€…0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.

Novel recombinant human thyroid-stimulating hormone in aiding postoperative assessment of patients with differentiated thyroid cancer-phase I/II study.

PURPOSE: Thyroid hormone withdrawal (THW) inevitably induced hypothyroidism in patients with differentiated thyroid cancer (DTC), and we aimed to evaluate the safety and efficacy of a novel recombinant human thyroid-stimulating hormone (rhTSH, ZGrhTSH) as an alternative of THW in China. METHODS: Totally, 64 DTC patients were enrolled with 24 in the dose-escalation cohort equally grouped into 0.9 mg × 1 day, 0.9 mg × 2 day, 1.8 mg × 1 day, and 1.8 mg × 2 day dosage, and 40 further enrolled into 0.9 mg × 2 day dose-expansion cohort. All patients underwent both ZGrhTSH phase and levothyroxine (L-T4) withdrawal phase for self-comparison in terms of TSH levels, the radioactive iodine (RAI) uptake, stimulated thyroglobulin level, and the quality of life (QoL). RESULTS: In ZGrhTSH phase, no major serious adverse events were observed, and mild symptoms of headache were observed in 6.3%, lethargy in 4.7%, and asthenia in 3.1% of the patients, and mostly resolved spontaneously within 2 days. Concordant RAI uptake was noticed in 89.1% (57/64) of the patients between ZGrhTSH and L-T4 withdrawal phases. The concordant thyroglobulin level with a cut-off of 1 µg/L was noticed in 84.7% (50/59) of the patients without the interference of anti-thyroglobulin antibody. The QoL was far better during ZGrhTSH phase than L-T4 withdrawal phase, with lower Billewicz (- 51.30 ± 4.70 vs. - 39.10 ± 16.61, P < 0.001) and POMS (91.70 ± 16.70 vs. 100.40 ± 22.11, P = 0.011) scores which indicate the lower the better. Serum TSH level rose from basal 0.11 ± 0.12 mU/L to a peak of 122.11 ± 42.44 mU/L 24 h after the last dose of ZGrhTSH. In L-T4 withdrawal phase, a median of 23 days after L-T4 withdrawal was needed, with the mean TSH level of 82.20 ± 31.37 mU/L. The half-life for ZGrhTSH clearance was about 20 h. CONCLUSION: The ZGrhTSH held the promise to be a safe and effective modality in facilitating RAI uptake and serum thyroglobulin stimulation, with better QoL of patients with DTC compared with L-T4 withdrawal.

Inhibidores multiquinasas en el tratamiento de cáncer diferenciado de tiroides refractario a tratamiento con yodo radioactivo / Multikinase inhibitors in the treatment of differentiated thyroid cancer refractory to treatment with radioactive iodine

ANTECEDENTES Solicitud presentada por el Comité Farmacoterapéutico del Instituto Nacional de Enfermedades Neoplásicas, en relación con la evaluación y aprobación de Lenvatinib y Sorafenib, en el tratamiento de cáncer diferenciado de tiroides irresecable o metastásico, refractario a tratamiento con yodo radioactivo. ESTRATEGIA DE BÚSQUEDA DE INFORMACIÓN: Pregunta Clínica: En los pacientes con cáncer diferenciado de tiroides irresecable o metastásico, refractario a tratamiento con yodo radioactivo, ¿es eficaz y seguro el tratamiento con inhibidores multiquinasas? Recolección de los Manuscritos a Revisar: Tipos de estudios: La estrategia de búsqueda sistemática de información científica para el desarrollo del presente informe se realizó siguiendo las recomendaciones de la Pirámide jerárquica de la evidencia propuesta por Haynes y se consideró los siguientes estudios: Sumarios y guías de práctica clínica. Revisiones sistemáticas y/o meta-análisis. Ensayos Controlados Aleatorizados (ECA) ● Estudios Observacionales (cohortes, caso y control, descriptivos) No hubo limitaciones acerca de la fecha de publicación o el idioma para ningún estudio. Fuentes de información: De acceso libre. Bases de datos: Pubmed, Cochrane. Fecha de búsqueda: La búsqueda sistemática incluyó a todos los estudios publicados sin límite de antigüedad. Términos de Búsqueda: Considerando la pregunta PICO se construyó dos estrategias de búsqueda, sin restricciones en el idioma ni en periodo de publicación. DISCUSIÓN: Tomando los criterios para un marco de valor de la Health Technology Assessment International (2018)28 para la toma de decisiones y formulación de la recomendación, se describe: La calidad de la evidencia es alta. La evidencia analizada ha consistido en revisiones sistemáticas tanto con meta análisis y de red, los cuales encabezan la pirámide de calidad de evidencia, así como ECA, GPC y ETS de agencias reconocidas. Los ensayos clínicos muestran que lenvatinib y sorafenib son efectivos para retrasar la progresión de la enfermedad, pero hay una tasa de respuesta más alta con lenvatinib y puede retrasar la progresión por más tiempo. Evaluación económica en la región no se tiene, sin embargo, en Reino Unido se realizó una, en la cual, las estimaciones de rentabilidad son más altas de lo que NICE normalmente considera aceptable. Pero los tratamientos aumentan la duración de la vida y no hay otros tratamientos disponibles para la afección. Además, las estimaciones de rentabilidad no capturan los beneficios de que las personas tengan una respuesta al tratamiento, es decir, una mejora de los síntomas. CONCLUSIONES: El cáncer de tiroides es una enfermedad oncológica de buen pronóstico en la mayoría de los casos. Existe un porcentaje de pacientes que desarrollará una progresión recurrencia o enfermedad metastásica refractaria a yodo radioactivo, siendo esta, de mal pronóstico. El tratamiento sistémico para los pacientes con CDT - RR se basa en inhibidores multiquinasas: Sorafenib y Lenvatinib. Sorafenib y Lenvatinib, han demostrado eficacia sobre placebo respecto a la SLP, sin embargo, también se ha demostrado la presencia de EA que han llevado a reducción de dosis y/o interrupción del tratamiento. Nuestro análisis para evaluar el beneficio neto de ambas tecnologías en base a los ECAs fase 3, demuestra una superioridad de Lenvatinib sobre Sorafenib. Las RS analizadas han demostrado la eficacia de ambos IMK versus placebo y una mayor eficacia de Lenvatinib sobre Sorafenib, a pesar de la mayor cantidad de eventos adversos. No se cuenta con evaluaciones económicas en la región, sin embargo, en la EE realizada por la NICE, se concluyó que a pesar de no ser costo - efectiva, al tratarse de una enfermedad rara, ambas drogas deben ser aprobadas para el manejo de pacientes con CDT - RR. Por lo expuesto, la UFETS en consenso con el Comité de ETS, concluye que Sorafenib y Lenvatinib, son alternativas de terapia en pacientes con CDT - RR con una preferencia de uso para Lenvatinib sobre Sorafenib.

Thyroid Dysfunction and Thyroid Cancer in Childhood Cancer Survivors: Prevalence, Surveillance and Management.

Childhood cancer survivors (CCS) are at increased risk of developing thyroid disorders during follow-up. Radiation therapy to a field that includes the thyroid gland and 131I-meta-iodobenzylguanidine (131I-MIBG) treatment are the main risk factors for thyroid sequelae, which include decreased thyroid function, hyperthyroidism, thyroid nodules, and differentiated thyroid cancer, specifically papillary thyroid carcinoma. In addition, treatment with anti-neoplastic drugs or immunotherapy may result in thyroid dysfunction. Central hypothyroidism may be seen in CCS after cranial radiotherapy, after immunotherapy, or secondary to a brain tumor that involves the hypothalamic-pituitary region and will be discussed elsewhere in this series. In this chapter, the prevalence, risk factors, surveillance, and management of primary hypothyroidism, hyperthyroidism, thyroid nodules, and differentiated thyroid carcinoma in CCS are discussed.

Assessment of Long-Term Hematologic Effects in Differentiated Thyroid Cancer Patients Treated with Radioactive Iodine

Objective: Radioactive iodine (RAI) therapy may cause hematologic abnormalities. The aim of this study is to evaluate long-term hematologic effects in differentiated thyroid cancer (DTC) patients after RAI therapy. Materials and Methods: A total of 1389 patients with DTC who were treated with RAI were retrospectively evaluated. Complete blood cell counts before RAI therapy and at last follow-up and hematologic malignancy development were obtained from the electronic records. Results: In the long-term analysis, thrombocytopenia and lymphopenia were observed significantly in patients over 60 years of age. Thrombocytopenia was observed more frequently in men. Leukopenia, thrombocytopenia, and lymphopenia were observed significantly with doses of >175 mCi. Thrombocytopenia and lymphopenia were observed significantly with multiple dose administration. Higher frequencies of anemia, thrombocytopenia, leukopenia, neutropenia, and lymphopenia were found in patients with advanced-stage disease. However, patients with advanced-stage disease had higher doses and more multiple doses than patients with early-stage disease. The rate of hematologic malignancy was found to be higher than in the general population. Conclusion: We suggest that cytopenia be surveyed more carefully in patients older than 60 years of age. The most important risk factor for lower platelets after RAI therapy is male gender. Clinically, the most important predictor for cytopenia is advanced disease stage, which is related to the combined effects of applied high dose activity, multiple dose applications, and high tumor burden.

Assessment and Care of Oral Lesions for Patients Who Undergo Radioiodine Treatment for Thyroid Cancer.

Patients with differentiated thyroid cancer who undergo radioiodine treatment often present oral complications with a significant impact on their oral cavity function. Any potential sources of systemic infections like periodontal disease, unfitted dentures, orthodontic appliances, deficient/rough fillings, or traumatic dentition must be treated by the dental practitioner, because they represent the main source of spread and dissemination. Any systemic complication of a dental foci may result from improper dental preparation of the patient before radioiodine therapy and inadequate post-radioiodine therapy oral care. Therefore, all patients proceeding into radioiodine treatment should be addressed by the oncological team to undergo thorough dental check-up and receive appropriate treatment in due time.

Uncertainties in Radiation Doses for a Case-control Study of Thyroid Cancer among Persons Exposed in Childhood to 131 I from Chernobyl Fallout.

Uncertainties in thyroid doses due to I intake were evaluated for 2,239 subjects in a case-control study of thyroid cancer following exposure to Chernobyl fallout during childhood and adolescence carried out in contaminated regions of Belarus and Russia. Using new methodological developments that became available recently, a Monte Carlo simulation procedure was applied to calculate 1,000 alternative vectors of thyroid doses due to I intake for the study population of 2,239 subjects accounting for sources of shared and unshared errors. An overall arithmetic mean of the stochastic thyroid doses in the study was estimated to be 0.43 Gy and median dose of 0.16 Gy. The arithmetic mean and median of deterministic doses estimated previously for 1,615 of 2,239 study subjects were 0.48 Gy and 0.20 Gy, respectively. The geometric standard deviation of individual stochastic doses varied from 1.59 to 3.61 with an arithmetic mean of 1.94 and a geometric mean of 1.89 over all subjects of the study. These multiple sets of thyroid doses were used to update radiation-related thyroid cancer risks in the study population exposed to I after the Chernobyl accident.

Impact on clinical practice of updated guidelines on iodinated contrast material: CINART.

OBJECTIVE: Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. METHODS: The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30-44 ml/min/1.73 m2 or eGFR 45-59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR < 30 ml/min/1.73 m2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. RESULTS: Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; - 89%), extra hospitalisations (- 93%), and costs (- 91%). CONCLUSION: Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. KEY POINTS: • Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. • Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. • The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were - 89% prophylaxis complications, - 93% hospitalisations, and - 91% costs, and similar reductions are expected for Dutch and adherent European medical centres.

Eficacia y seguridad de lenvatinib para pacientes adultos con cáncer de tiroides diferenciado, metastásico, refractario a yodo radioactivo / Efficacy and safety of lenvatinib for adult patients with radioiodine-refractory metastatic differentiated thyroid cancer

INTRODUCCIÓN: El presente dictamen expone la evaluación de la eficacia y seguridad de lenvatinib, comparado con la mejor terapia de soporte, en pacientes adultos con cáncer de tiroides diferenciado, metastásico, refractario a yodo radioactivo. El cáncer de tiroides diferenciado es el más frecuente de todos los cánceres tiroideos (90 %) con una tasa de supervivencia a los 10 años de aproximadamente 90 %. No obstante, los pacientes con cáncer de tiroides diferenciado metastásico (CTDm) tienen una tasa de supervivencia a los 10 años de alrededor del 10 %. La opción terapéutica de primera línea para el CTDm es la cirugía parcial o total de la glándula, seguida de radioterapia con yodo y supresión de la hormona estimulante de tiroides (TSH, por sus siglas en inglés) en los casos pertinentes. Por otro lado, cuando el CTDm es catalogado como refractario al yodo radioactivo, las opciones terapéuticas implican el uso de inhibidores de la tirosina kinasa (ITK). Actualmente en EsSalud, no existe una alternativa de tratamiento para los pacientes con CTDm que presentan refractariedad al yodo radioactivo. Por ello, los especialistas de la institución han enviado al IETSI la solicitud de evaluación del ITK lenvatinib para dicha población. METODOLOGÍA: Se realizó una búsqueda sistemática de literatura con el objetivo de identificar evidencia sobre la eficacia y seguridad de lenvatinib, comparadas con la mejor terapia de soporte, en pacientes adultos con cáncer de tiroides diferenciado, metastásico, refractario a terapia ablativa con yodo radioactivo. Se utilizó la base de datos The Cochrane Library, PubMed, LILACS y el metabuscador TRIP Database, priorizándose la evidencia proveniente de revisiones sistemáticas o meta-análisis de ensayos clínicos controlados y aleatorizados. Asimismo, se realizó una búsqueda dentro de bases de datos pertenecientes a grupos que realizan evaluación de tecnologías sanitarias y guías de práctica clínica, incluyendo el Scottish Medicines Consortium (SMC), el National Institute for Health and Care Excellence (NICE), la Canadian Agency for Drugs and Technologies in Health (CADTH), la Haute Autorité de Santé (HAS), el Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), además de la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Se hizo una búsqueda adicional en la página web de clinicaltrials.gov, para poder identificar ensayos clínicos en curso o que no hayan sido publicados para, de este modo, disminuir el riesgo de sesgo de publicación. La búsqueda sistemática se basó en una metodología escalonada, la cual consistió en la búsqueda inicial de estudios secundarios (tipo revisiones sistemáticas de ensayos clínicos) que respondan a la pregunta PICO, seguida de la búsqueda de estudios primarios (tipo ensayos clínicos aleatorizados). RESULTADOS: Se describe la evidencia disponible de acuerdo al tipo de publicación encontrada. CONCLUSIONES: El objetivo del presente documento fue evaluar la eficacia y seguridad de lenvatinib, comparado con la mejor terapia de soporte, en el tratamiento de pacientes adultos con diagnóstico de cáncer de tiroides diferenciado, metastásico, refractario a yodo radiactivo. La búsqueda sistemática de la literatura, realizada con fecha diciembre de 2019, permitió identificar al estudio SELECT como el único ensayo clínico controlado que evaluó la eficacia y seguridad de lenvatinib en la condición de interés de la pregunta PICO. La evidencia del estudio SELECT muestra que lenvatinib, en comparación con el placebo, aumenta la SLP y la TRO en pacientes con CTDm refractario a yodo radiactivo. Sin embargo, estos resultados no se tradujeron en una mayor SG con lenvatinib, en comparación con el placebo. Sumado a ello, el estudio reportó una mayor tasa de EA totales, EA de grado 3 o 4, EA serios, discontinuación del tratamiento debido a EA, y muertes debido a EA, con lenvatinib en comparación con el placebo. Considerando esta alta toxicidad, surge una preocupación respecto a la ausencia de información sobre la calidad de vida de lenvatinib versus el placebo. Lo anterior indica que lenvatinib es un medicamento altamente tóxico, que no ha demostrado un beneficio en términos de desenlaces finales y clínicamente relevantes para el paciente como SG o calidad de vida, sino que únicamente ha demostrado tener efectos en desenlaces intermedios que no han probado predecir los desenlaces clínicos de relevancia desde la perspectiva del paciente. De este modo, se evidencia un alto grado de incertidumbre en relación al balance riesgo-beneficio de lenvatinib versus la mejor terapia de soporte en nuestra población de interés, pues la evidencia proveniente del ensayo SELECT no permite identificar una ganancia clínica neta con lenvatinib. En consecuencia, se concluye que no existen argumentos técnicos que justifiquen la aprobación de uso de lenvatinib en la institución. Por lo expuesto, el IETSI no aprueba el uso de lenvatinib como tratamiento en pacientes adultos con diagnóstico de cáncer de tiroides diferenciado, metastásico, refractario a yodo radioactivo.

Assessment of the nuclear medicine personnel occupational exposure to radioiodine.

PURPOSE: To physically and cytogenetically screen medical personnel of Department of Endocrinology and Nuclear Medicine, Holy Cross Cancer Center, Kielce, Poland (DENM) who are occupationally exposed to 131I. MATERIALS AND METHODS: The exposure was monitored by whole-body and finger ring dosimeters. The thyroid iodine intake was measured by a whole-body spectrometer equipped with two semiconductor gamma radiation detectors. A cytokinesis-block micronucleus assay and the premature chromosome condensation technique were used to assess the aberration score. Cytogenetic analyses were carried out on a group of 29 workers and were compared to 32 controls (healthy donors), matched for gender and age. RESULTS: On average, the exposed group showed a significantly higher frequency of genetic damage and a higher proliferation index compared to the control group. Smoking status, age and duration of exposure influenced the observed effects in both groups. No differences in measured biomarkers were observed after stratification of the exposed group into two subgroups based on the measured 131I activity below and above 6 Bq. CONCLUSION: The findings suggest that radiation protection principles based on whole-body and finger ring dosimetry, supported by activity measurements with a whole-body spectrometer, may be insufficient to monitor the absorbed dose estimation of the nuclear medicine staff who are occupationally exposed to 131I. Furthermore, their future health risks are influenced by confounders. Direct assessments comparing physical and biological dose estimations on the larger group are needed to accurately monitor occupational radiation exposure.

A process to describe radiation damage at the molecular level. Application to the 125I seeds in water.

The correlation between the absorbed energy and the induced biological damage still has unclear aspects, especially in the low energy and low dose rate irradiation regimes. From the knowledge of the molecular-induced effects (dissociations), it would be possible to better understand the side effects of radiation, such as induced cancers or damage to healthy tissue. With this in view, this paper presents results of a simulation of a 125I-seed treatment with an event-by-event MC code (LEPTS) specifically designed to account for the low energy secondary particle interactions, such as electron attachment, vibro-rotational and neutral dissociation interactions. This calculation allowed us to analyze the potential radiation damage not only in connection with the energy deposition, but also in terms of induced molecular dissociations by taking into account ionizing and non-ionizing dissociative processes. We propose that this description of the molecular level damage be the basis for nanodosimetric evaluations.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

OBJECTIVES/HYPOTHESIS: The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. STUDY DESIGN: Literature review and cost-effectiveness analysis. METHODS: A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. RESULTS: The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. CONCLUSIONS: Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. LEVEL OF EVIDENCE: NA. Laryngoscope, 1822-1828, 2018.

Assessment of sexual function in Japanese men with prostate cancer undergoing permanent brachytherapy without androgen deprivation therapy: Analysis from the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation database.

OBJECTIVES: To evaluate male sexual function in Japanese prostate cancer patients undergoing permanent brachytherapy without endocrine treatment, using quality of life measures of the Expanded Prostate Cancer Index Composite. METHODS: A total of 482 patients were selected as analysis subjects from the nationwide database for the Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation. The patients were asked to complete the Expanded Prostate Cancer Index Composite questionnaires before and at 3, 12, 24, and 36 months after the permanent brachytherapy. Changes in their responses were analyzed, and any association of the outcomes was investigated. Furthermore, changes over time in their answers to Q18 (usual quality of your erections) were analyzed. RESULTS: A total of 72 patients (14.9%) had received external beam radiation. A total of 68 patients (14.1%) had taken any 5-phosphodiesterase inhibitor medications. Regarding Q18, 232 patients (48.2%) selected either "There was no sexual activity" or "There was no desire for erection" before receiving permanent brachytherapy. Of all the 482 patients, sexual function was preserved in 138 patients (28.7%) 3 years after permanent brachytherapy. Overall satisfaction has significantly improved without regard for the deterioration of sexual function. Significant factors for maintaining sexual activity were patient age and sexual activity before permanent brachytherapy. CONCLUSIONS: In Japanese patients undergoing permanent brachytherapy alone for prostate cancer, the sexual function is not well preserved. However, decreased sexual function does not seem to represent a major factor determining patients' overall satisfaction. These findings might be peculiar to Japanese patients, in whom elderly subjects account for the majority.

Persistent Elevation of Thyroglobulin in Patient Treated for Differentiated Thyroid Cancer: A Ten-Year Review.

Differentiated Thyroid Cancer (DTC) is increasing in prevalence due to better diagnostic tools and excellent long-term survival. This study is to understand the outcome of twenty-six patients with DTC over a period of 10 years after the initial treatment with surgery and radioiodine therapy. Our study analysis showed no deaths, and indicated that older men were more likely to have persistent disease. Further studies are needed to focus on cost effective long-term management of DTC.

Validez de la sobrevida libre de progresión como desenlace subrogado de la sobrevida global o calidad de vida en pacientes con carcinoma de tiroides diferenciado, metastásico, irresecable, refractario a tratamiento con yodo radioactivo / alidity of progression-free survival as a surrogate outcome of overall survival or quality of life in patients with differentiated, metastatic, unresectable thyroid carcinoma, refractory to treatment with radioactive iodine

ANTECEDENTES: El carcinoma de tiroides representa el 90 % de las neoplasias endocrinas. En EEUU, en el año 2017, se han presentado 56.870 nuevos casos, siendo tres veces más frecuente en mujeres que en hombres, con una mortalidad de 0.5 casos por 100.000 habitantes. En el Perú, en el año 2012, el cáncer de tiroides representó el 3.3 % de las neoplasias malignas, 7 casos por 100,000 habitantes, presentándose el 83.0% de estos en mujeres. El objetivo del presente dictamen metodológico fue evaluar la validez de la sobrevida libre de progresión (SLP) como desenlace subrogado de la sobrevida global (SG) o la calidad de vida en pacientes con carcinoma de tiroides diferenciado, metastásico, irresecable, refractario a tratamiento con yodo radioactivo. METODOLOGÍA: Se realizó una búsqueda sistemática de ensayos clínicos aleatorizados (ECA) y revisiones sistemáticas (RS), con o sin metaanálisis (MA) en U.S. National Library of Medicine (PubMed/MEDLINE) y una búsqueda libre en Google Scholar hasta diciembre del 2017. Se propuso como criterios de evaluación los estudios de Buyse et al., 2000, que se basan en valorar la correlación a nivel individual y a nivel de un ECA, y los puntos de corte de la metodología descrita por el Instituto de Calidad y Ciencias de la Salud (IQWiG, por sus siglas en alemán Institut für Qualitát und Wirtschaftlichkeit im Gesundheitswesen) de Alemania para determinar la validez de la SLP como un desenlace como subrogado de la SG o calidad de vida en pacientes con carcinoma de tiroides diferenciado, metastásico, irresecable, refractario a tratamiento con yodo radioactivo. RESULTADOS: Tras la búsqueda de la literatura, no se encontraron estudios que permitan evaluar la validez de la SLP como desenlace subrogado de la SG o calidad de vida en pacientes con carcinoma de tiroides diferenciado, metastásico, irresecable, refractario a tratamiento con yodo radioactivo. CONCLUSIONES: No se encontró evidencia científica que valide la capacidad predictiva de la SLP sobre SG o de calidad de vida en pacientes con carcinoma de tiroides diferenciado, metastásico, irresecable, refractario a tratamiento con yodo radioactivo. En consecuencia, no es posible establecer que la SLP sea un desenlace s Abrogado de la SG o calidad de vida en estos pacientes.(AU)

Thyroid Patient Salivary Radioiodine Transit and Dysfunction Assessment Using Chewing Gums.

Radiation-induced salivary gland dysfunction is the most frequent side-effect of I-131 thyroid therapy. Here, a novel saliva sampling method with ordinary chewing gums administered to the patients at appropriate time intervals post-treatment (TIPT) was used to relate this effect to chewing gum saliva activity (CGSA) content. Saliva samples were acquired after the oral administration of prescribed I-131 activity (radioactivity administered [RA]) to 19 differentiated thyroid cancer (DTC) and 16 hyperthyroidism patients of the radioisotope unit (RIU) during 2014 and 2015. The error of this saliva collecting process was found to be 1.2%-2.05%, and so, the method was considered satisfactory. For each patient, the CGSA was plotted against the TIPT producing a curve, R(t). On this, two functions were fitted: a linear on the first few rising data points and a gamma variate over the peak of the R(t). From these, several parameters related to the radioactivity oral transit were calculated and the total radioactivity administered (TRA) during all past treatments of each patient was obtained from RIU records. The patients were asked to report any swelling, dry mouth, taste-smell change, or pain and were graded as a morbidity score (MS) describing the quality of life of each. The peak radioactivity in the saliva samples, Rmax, was found to be proportional to RA and was plotted against the CGSA extrapolated at 24 and 36 hours. The linear fits produced were used to estimate the salivary glands' activity average effective half-life (16.3 hours). The MS of DTC patients was found to depend linearly both on Rmax and TRA (MS = 0.0032 × Rmax - 0.7107 and MS = 0.1862 × TRA +0.66, respectively). Both lines were used to extrapolate symptom thresholds. The measurement of Rmax in DTC patients proved very useful for individualized radiation protection, and the dependence of MS on TRA should be used when additional treatments are considered for repeat DTC patients.

The First Meeting of the WHO Guideline Development Group for the Revision of the WHO 1999 Guidelines for Iodine Thyroid Blocking.

The meeting held in May 2014 in Würzburg, Germany, discussed the scope of the revision of the 1999 WHO guidelines for iodine thyroid blocking (ITB) by following the WHO handbook for guideline development. This article describes the process and methods of developing the revised, evidence-based WHO guidelines for ITB following nuclear and radiological accidents, the results of the kick-off meeting as well as further steps taken to complete the revision.

Thyroid Blocking Policy in Hungary and Clarification of Terminology in the Light of Recommendations by International Organisations.

The ambiguous terminology 'Iodine Prophylaxis' used for decades to provide iodine to the population for very different purposes as well as its replacement with 'Iodine Thyroid Blocking' is discussed and argued. Recommendations of international organisations regarding the action level for Iodine Thyroid Blocking and their implementation in national regulations in a few Member States of the European Union, and particularly in Hungary, is presented and discussed.