RESUMO
CONTEXT: Recombinant human thyrotropin (rhTSH) has been shown to be an effective stimulation method for radioactive iodine (RAI) therapy in differentiated thyroid cancer, including in those with nodal metastases (N1 DTC). OBJECTIVES: To demonstrate the noninferiority of rhTSH vs thyroid hormone withdrawal (THW) in preparation to RAI regarding disease status at the first evaluation in the real-life setting in patients with N1 DTC. DESIGN: This was a French multicenter retrospective study. Groups were matched according to age (<45/≥45 years), number of N1 nodes (≤5/>5 lymph nodes), and stage (pT1-T2/pT3). RESULTS: The cohort consisted of 404 patients pT1-T3/N1/M0 DTC treated with rhTSH (n = 205) or THW (n = 199). Pathological characteristics and initially administrated RAI activities (3.27 ± 1.00 GBq) were similar between the two groups. At first evaluation (6 to 18 months post-RAI), disease-free status was defined by thyroglobulin levels below threshold and a normal ultrasound. Disease-free rate was not inferior in the rhTSH group (75.1%) compared with the THW group (71.9%). The observed difference between the success rates was 3.3% (-6.6 to 13.0); rhTSH was therefore considered noninferior to THW because the upper limit of this interval was <15%. At the last evaluation (29.7 ± 20.7 months for rhTSH; 36.7 ± 23.8 months for THW), 83.5% (rhTSH) and 81.5% (THW) of patients achieved a complete response. This result was not influenced by any of the known prognostic factors. CONCLUSIONS: A preparation for initial RAI treatment with rhTSH was noninferior to that with THW in our series of pT1-T3/N1/M0-DTC on disease-free status outcomes at the first evaluation and after 3 years.
Assuntos
Quimiorradioterapia Adjuvante/métodos , Radioisótopos do Iodo/administração & dosagem , Neoplasias da Glândula Tireoide/terapia , Tireotropina/administração & dosagem , Tiroxina/uso terapêutico , Adulto , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Proteínas Recombinantes/administração & dosagem , Estudos Retrospectivos , Testes de Função Tireóidea , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/efeitos da radiação , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia , Suspensão de TratamentoRESUMO
PURPOSE: Single photon emission computed tomography/computed tomography (SPECT/CT) now makes it possible to use combined morphologic CT and functional scintigraphy information. It has proved useful for localization of abnormal parathyroid glands, especially in the case of an ectopic gland. We experienced that it was also beneficial for patients with a history of previous neck surgery, and we report 4 cases in this entity. MATERIALS AND METHODS: Four patients with prior neck surgery and hyperparathyroidism underwent parathyroid Tc-99m MIBI scintigraphy with SPECT/CT. Two patients had undergone surgery for hyperparathyroidism and 2 had undergone thyroidectomy, 1 for thyroid cancer and 1 for multinodular goiter. Parathyroid hormone levels were assessed during surgery, and patients were followed several months after treatment. RESULTS: SPECT/CT successfully localized the abnormal gland, including an uncommon anterior situation for which previous surgery guided by planar imagery failed to cure the hyperparathyroidism. It allowed efficient surgical treatment, as confirmed by parathyroid hormone level normalization, without complications and with a relatively short operation time in those challenging cases. CONCLUSIONS: SPECT/CT seems to be a useful tool for presurgical assessment in hyperparathyroidism, not only for ectopic glands but also for patients with previous neck surgery.