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1.
Am Surg ; 86(2): 90-94, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167041

RESUMO

We aimed to evaluate the surgical margin outcomes and re-excision rates in patients undergoing bracketed seed localization of biopsy-proven breast cancer detected on screening mammogram. After approval by our Institutional Review Board, we retrospectively identified patients who had undergone iodine-125 seed localized lumpectomy at our institution from January 2010 to June 2017 by one of two fellowship-trained breast surgeons. Of those patients, a subset of 25 patients were identified who had undergone bracketed seed localization, defined as two or more seeds used to delineate the radiographic borders of the area of concern. All patients had originally presented with calcifications identified on screening mammogram that were subsequently diagnosed as ductal carcinoma in situ and/or invasive ductal carcinoma by image-guided biopsy performed at our institution. Eight patients had one positive margin on final surgical pathology and required re-excision (32%). One patient was converted to mastectomy. Of the patients requiring re-excision, the average maximum linear extent of calcifications was 3.4 cm (SD 0.97), whereas it was 3.1 cm (SD 1.2) in patients with negative surgical margins (P = 0.5). Bracketing calcifications with radioactive seeds can potentially allow more patients to undergo breast conservation surgery.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Radioisótopos do Iodo/administração & dosagem , Mastectomia Segmentar/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Mama/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Marcadores Fiduciais , Humanos , Biópsia Guiada por Imagem , Mamografia , Margens de Excisão , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
2.
J Cancer Res Clin Oncol ; 146(1): 229-236, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630263

RESUMO

OBJECTIVE: To ascertain the safety and efficacy of radioactive iodine-125 seed implantation (RISI) for the treatment of thoracic tumors. METHODS: Clinical patients with primary or metastatic tumors in the chest treated with RISI were analyzed. The RISI process included the following stages: preoperative planning, template design and 3D printing, CT-guided RISI assisted by a template, and postoperative dosimetric verification. The prescribed dose was ≥ 80 Gy. The main analytic measures were the local control (LC) rate and toxicity. RESULTS: From April 2015 to July 2018, a total of 92 patients, including 41 with lung cancer and 51 with lung metastases, were analyzed. The median lesion diameter was 5 cm. The median postoperative D90 was 142.6 Gy. The median follow-up was 10.7 months. The overall survival rates at 1 year and 3 years were 59.7% and 22.2%, respectively. The LC rates at 1 year and 3 years were 64.9% and 32.8%, respectively. The LC rates at 3 years for patients with D90 < 140 Gy and D90 > 140 Gy were 23.1% and 54.3%, respectively (P = 0.014). The LC rate of metastatic lung cancer was more favorable than that of primary lung cancer. The multivariate analyses showed that the dose and lesion type were independent factors for LC (P < 0.05). No factors were related to OS. The incidence of pneumothorax and hemoptysis was 35.8% and 3.2%, respectively. Few cases of radiotherapy-related toxicity effects were observed. CONCLUSIONS: RISI may be safe and efficacious and is associated with few complications during the treatment of thoracic tumors. If patients need local treatment and surgery or radiotherapy is not available, RISI could be considered.


Assuntos
Radioisótopos do Iodo/administração & dosagem , Impressão Tridimensional , Radioterapia Guiada por Imagem/métodos , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Radioisótopos do Iodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Radioterapia Guiada por Imagem/efeitos adversos , Adulto Jovem
3.
Surgery ; 167(1): 40-45, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31515121

RESUMO

BACKGROUND: Postoperative follow-up of papillary thyroid cancer includes serial serum thyroglobulin levels. This study aimed to determine whether stimulated thyroglobulin levels measured in the early postoperative period can accurately quantify the risk of recurrence in papillary thyroid cancer. METHODS: We undertook a cohort study of patients who underwent total thyroidectomy for papillary thyroid cancer ≥10 mm in the period 2000 to 2016 with complete biochemical data. All patients had a postoperative stimulated thyroglobulin measured within 3 months after total thyroidectomy. Structural recurrence was defined as disease detected on imaging and confirmed on histology. Biochemical disease was defined as patients with stimulated serum thyroglobulin ≥1 ng/mL with no evidence of structural disease. RESULTS: This study included 502 patients with a mean age of 50 years and median tumor diameter of 20 mm. Median follow-up was 18 months. Stimulated postoperative thyroglobulin was measured before radioiodine-ablation and was categorized into 3 groups: (1) 219 (44%) patients had thyroglobulin <1 ng/mL; (2) 55 (11%) had 1ng/mL ≤ thyroglobulin <2 ng/mL; and (3) 228 (45%) had thyroglobulin ≥2 ng/mL. The structural recurrence rate for each group was 5%, 2%, and 30%, respectively (P < .0001). CONCLUSION: In patients undergoing total thyroidectomy for papillary thyroid cancer, early postoperative stimulated thyroglobulin accurately quantifies the risk of structural disease recurrence.


Assuntos
Recidiva Local de Neoplasia/epidemiologia , Tireoglobulina/sangue , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Tomografia por Emissão de Pósitrons , Período Pós-Operatório , Estudos Retrospectivos , Medição de Risco/métodos , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/mortalidade , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/mortalidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto Jovem
4.
Surgery ; 167(1): 102-109, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31582311

RESUMO

INTRODUCTION: The relationship between treatment for differentiated thyroid cancer and patient-report of decreased energy and fatigue remains unclear. METHODS: Patients diagnosed with differentiated thyroid cancer from 2014 to 2015 included in the Georgia and Los Angeles, California cancer registries of the Surveillance, Epidemiology, and End Results program were surveyed 2 to 4 years after diagnosis, and responses were linked to data from the Surveillance, Epidemiology, and End Results registry. Multivariable logistic regression analysis determined characteristics associated with the report of worse energy level at 2 to 4 years compared to before treatment and current fatigue severity using adjusted odds ratios with 95% confidence intervals. RESULTS: Of the 2,584 respondents, 988 (38.2%) reported much worse or somewhat worse energy and 1,310 (50.7%) reported moderate to very severe fatigue. The majority of patients were treated with total thyroidectomy with or without nodal dissection (total thyroidectomy with lymph node removal [49.3%] or total thyroidectomy [38.3%]). Only 12.3% had a thyroid lobectomy. Just over half were treated with radioactive iodine therapy (56.7%) and thyroid hormone suppression (50.2%) after the thyroidectomy. Younger age, history of depression, thyroid hormone suppression (odds ratio 1.48 [confidence interval 1.21-1.82]), and receipt of radioiodine (odds ratio 1.31 [confidence interval 1.10-1.56]) correlated with worse energy. Similarly, correlates of substantial fatigue included younger age, more comorbidities, history of depression, and thyroid hormone suppression (odds ratio 1.63 [confidence interval 1.34-1.99]). The presence of low serum calcium levels for >3 months after thyroidectomy was associated with worse energy (odds ratio 1.26 [confidence interval 1.02-1.54]) and substantial fatigue (odds ratio 1.49 [confidence interval 1.21-1.84]). CONCLUSION: In addition to accepted risk factors such as depression and comorbidities, receiving radioactive iodine and reporting low calcium after thyroidectomy for differentiated thyroid cancer were associated with reports of worse energy compared to preoperative levels; thyroid hormone suppression was associated with reports of both worse energy and substantial post-treatment fatigue.


Assuntos
Fadiga/diagnóstico , Radioisótopos do Iodo/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Cálcio/sangue , California/epidemiologia , Comorbidade , Depressão/epidemiologia , Depressão/psicologia , Fadiga/sangue , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Georgia/epidemiologia , Humanos , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Índice de Gravidade de Doença , Neoplasias da Glândula Tireoide/psicologia
5.
Surgery ; 167(1): 56-63, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31585718

RESUMO

BACKGROUND: The majority of papillary thyroid cancers are driven by acquired mutations typically in the BRAF or RAS genes that aberrantly activate the mitogen-activated protein kinase pathway. This process leads to malignant transformation, dedifferentiation, and a decrease in the expression of the sodium-iodide symporter (NIS; SLC5A5), which results in resistance to radioactive iodine therapy. We sought to determine whether inhibition of aberrant mitogen-activated protein kinase-signaling can restore NIS expression. METHODS: We prospectively developed cultures of papillary thyroid cancers derived from operative specimens and applied drug treatments for 24 hours. Samples were genotyped to identify BRAF and RAS mutations. We performed quantitative PCR to measure NIS expression after treatment. RESULTS: We evaluated 24 patient papillary thyroid cancer specimens; BRAFV600E mutations were identified in 18 out of 24 (75.0%); 1 patient tumor had an HRAS mutation, and the remaining 5 were BRAF and RAS wildtype. Dual treatment with dabrafenib and trametinib increased NIS expression (mean fold change 4.01 ± 2.04, P < .001), and single treatment with dabrafenib had no effect (mean fold change 0.98 ± 0.42, P = .84). Tumor samples that had above-median NIS expression increases came from younger patients (39 vs 63 years, P < .05). CONCLUSION: Dual treatment with BRAF and MEK inhibitors upregulated NIS expression, suggesting that this treatment regimen may increase tumor iodine uptake. The effect was greatest in tumor cells from younger patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Radioisótopos do Iodo/administração & dosagem , Inibidores de Proteínas Quinases/farmacologia , Simportadores/metabolismo , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Imidazóis/farmacologia , Imidazóis/uso terapêutico , Radioisótopos do Iodo/metabolismo , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Sistema de Sinalização das MAP Quinases/genética , Masculino , Pessoa de Meia-Idade , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Mutação , Oximas/farmacologia , Oximas/uso terapêutico , Cultura Primária de Células , Estudos Prospectivos , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Piridonas , Pirimidinonas , Tolerância a Radiação/efeitos dos fármacos , Tolerância a Radiação/genética , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Células Tumorais Cultivadas , Regulação para Cima/efeitos dos fármacos
6.
Surgery ; 167(1): 19-27, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627846

RESUMO

BACKGROUND: This study compares pathologic features and overall survival of classic versus aggressive variants of papillary thyroid microcarcinoma (PMTC). METHODS: Patients ≥18 years in the National Cancer Data Base (2004-2015) with the subtypes of classic (cPTMC), tall cell (mTCV), or diffuse sclerosing (mDSV) PTC (≤1 cm) were identified. Overall survival was analyzed by Kaplan-Meier and propensity matched for clinicopathologic and treatment variables. RESULTS: There were 82,056 cPTMC patients, 923 mTCV, and 219 mDSV. Extrathyroidal extension and nodal involvement were more frequent in mTCV and mDSV versus cPTMC (P < .01). mTCV had more distant metastases than cPTMC (P = .02). On multivariable analysis, mTCV (odds ratio 4.19 [3.58-4.92], P < .001) and mDSV (odds ratio 2.76 [1.92-3.97]; P < .01) histologies were predictors of extrathyroidal extension. mTCV was an independent predictor of nodal metastases (odds ratio 1.51 [1.25-1.83], P < .01). Total thyroidectomy and radioactive iodine treatment were more commonly used in mTCV and mDSV patients when compared with cPTMC patients. Despite more aggressive features and more aggressive treatment in mTCV and mDSV patients, there was no difference in overall survival when compared with propensity-matched cPTMC patients. CONCLUSION: Although mTCV and mDSV have more aggressive pathologic features and were treated more aggressively, there were no differences in overall survival compared with propensity-matched cPTMC patients.


Assuntos
Carcinoma Papilar/mortalidade , Radioisótopos do Iodo/administração & dosagem , Metástase Linfática/diagnóstico , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/mortalidade , Tireoidectomia , Adulto , Idoso , Carcinoma Papilar/patologia , Carcinoma Papilar/terapia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Resultado do Tratamento
7.
Int J Radiat Oncol Biol Phys ; 106(1): 206-215, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627178

RESUMO

PURPOSE: The current magnetic resonance imaging-computed tomography (MRI-CT) fusion-based workflow for postimplant dosimetry of low-dose-rate (LDR) prostate brachytherapy takes advantage of the superior soft tissue contrast of MRI, but still relies on CT for seed visualization and detection. Recently an MR-only workflow has been proposed that employs standard MR sequences and visualizes conventional implanted seed with positive contrast solely through MR postprocessing. In this work, the novel MR-only based workflow is compared with the clinical CT-MRI fusion approach. METHODS AND MATERIALS: Twenty-four prostate patients with a total of 1775 implanted LDR seeds were scanned using a 3-dimensional multiecho gradient echo sequence on a 3 Tesla MR scanner within 30 days after implantation. Quantitative susceptibility mapping was used for seed visualization. Seeds were automatically segmented and localized on the quantitative susceptibility mapping using convolutional neural network and k-means clustering, respectively. To assess the MR-only seed localization error, CT and MR-derived seed positions were coregistered, and ultimately, the resulting dose-volume histograms were compared. RESULTS: The MR-based seed visualization, segmentation, and localization generated comparable results to the CT-MR registration approach. The accuracy of the MRI-only based seed identification was 99.1%. After a rigid registration between the MR and CT-derived seed centroids, the average localization error was 0.8 ± 0.8 mm. The average prostate D90, V100, V150, and V200 for MRI-only and CT-MR fusion based dosimetry were 114.3 ± 12.5% versus 113.9 ± 11.9%, 95.1 ± 3.7% versus 95.3 ± 3.8%, 54.5 ± 14.5% versus 55.0 ± 13.2% and 22.9 ± 6.8% versus 23.2 ± 6.7%, respectively. No significant differences were observed in 3-dimensional seed positions and dosimetric parameters between MR-only and CT-MR fusion-based workflows (P > 0.2). CONCLUSIONS: The MRI-only LDR postimplant dosimetry is feasible and has very good potential to eliminate the need for CT-based seed identification.


Assuntos
Braquiterapia/métodos , Imagem por Ressonância Magnética , Imagem Multimodal/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Tomografia Computadorizada por Raios X , Fluxo de Trabalho , Algoritmos , Braquiterapia/instrumentação , Estudos de Viabilidade , Gases , Humanos , Radioisótopos do Iodo/administração & dosagem , Masculino , Neoplasias da Próstata/patologia , Radiometria/métodos , Reto/diagnóstico por imagem , Fatores de Tempo
8.
Future Oncol ; 15(24s): 7-12, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31418590

RESUMO

As for other tyrosine kinase inhibitors, a prolongation of ECG-recorded QTc intervals may be observed during lenvatinib treatment; a warning on this phenomenon has been stated. However, methods and frequency of ECG recordings have seldom been reported in this context. We present two cases of patients treated with lenvatinib for radioiodine-refractory differentiated thyroid cancer in whom the QTc interval was long monitored through a weekly 12-lead ECG registration. Overall, the maximum QTc increase above baseline was 3 and 31 ms in the first and second patient, respectively. QTc interval did not reach the toxicity value for drug withdrawal in either of the patients. These data may provide further information on cardiac safety profile of lenvatinib in a real-life practice.


Assuntos
Ventrículos do Coração/efeitos dos fármacos , Recidiva Local de Neoplasia/tratamento farmacológico , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/tratamento farmacológico , Terapia Combinada , Eletrocardiografia , Ventrículos do Coração/fisiopatologia , Humanos , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Compostos de Fenilureia/administração & dosagem , Intervalo Livre de Progressão , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia
9.
Future Oncol ; 15(24s): 3-6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385526

RESUMO

We report a case of a 37-year-old man with metastatic differentiated thyroid carcinoma, previously submitted to total thyroidectomy, radio-iodine therapy and lung metastasectomy, who underwent systemic treatment with lenvatinib for tumor recurrence in the lung, mediastinal lymph nodes, left gluteus and left orbit. Lenvatinib induced rapid and durable disease regression; the drug effect has continued after >1 year, as well as a very considerable clinical benefit. The results achieved by lenvatinib in treatment of metastatic differentiated thyroid carcinoma are clear and irrefutable. Real-life data, obtained by case reports and retrospective studies, are equally important to increase the knowledge about this drug and improve the clinical management.


Assuntos
Neoplasias Pulmonares/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Compostos de Fenilureia/administração & dosagem , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adulto , Terapia Combinada , Humanos , Radioisótopos do Iodo/administração & dosagem , Radioisótopos do Iodo/efeitos adversos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Metastasectomia , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Recidiva Local de Neoplasia/cirurgia , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
10.
Future Oncol ; 15(24s): 35-40, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385535

RESUMO

Lenvatinib is a tyrosine kinase inhibitor (TKI) with antiproliferative and antiangiogenic effects indicated for the treatment of progressive, locally advanced or metastatic progressive thyroid carcinoma, refractory to radioactive iodine therapy. Antiangiogenic therapies induce ischemic necrosis of tumor tissue, with increased risk of hemorrhagic complications. The management of hemorrhagic risk is based on precautionary measures and for any surgical procedure, it is advised to interrupt the treatment in order to avoid complications. 'Flare-up' of tumor activity may follow TKI interruption. However, it is not known if continuing TKIs during minimally invasive interventions is safe. We report here the first case in which an embolization of metastasis is performed without interrupting lenvatinib treatment. The procedure was successful and free of complications.


Assuntos
Adenoma Oxífilo/tratamento farmacológico , Embolização Terapêutica , Compostos de Fenilureia/administração & dosagem , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/patologia , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/efeitos adversos , Terapia Combinada , Humanos , Ílio/efeitos dos fármacos , Ílio/patologia , Radioisótopos do Iodo/administração & dosagem , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Compostos de Fenilureia/efeitos adversos , Quinolinas/efeitos adversos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia
11.
Future Oncol ; 15(24s): 13-19, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31385546

RESUMO

We report a case of an elderly woman presenting with a huge cervical mass invading the tracheal lumen. Diagnosed as invasive poorly differentiated thyroid cancer, after an endotracheal biopsy, stenting and radiotherapy, it was judged eligible for total thyroidectomy, but surgery was delayed due to pulmonary thromboembolism. The patient was therefore treated with lenvatinib with a neoadjuvant intent until hemodynamic stability was obtained. Thyroidectomy and radioiodine therapy were then performed and the postdose scan revealed an area of modest uptake in the anterior part of the neck. The patient is now in a good clinical status and she continues her follow-up program without any adjuvant therapy.


Assuntos
Carcinoma Papilar/tratamento farmacológico , Compostos de Fenilureia/administração & dosagem , Quinolinas/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Idoso de 80 Anos ou mais , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Terapia Neoadjuvante , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
12.
Acta Clin Croat ; 58(1): 119-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363334

RESUMO

The aim is to present data on the treatment and follow-up in a cohort of patients with pediatric thyroid cancer who underwent total thyroidectomy and received postoperative radioactive iodine (I-131) therapy. The study was conducted in a tertiary high-volume thyroid center, in pediatric patients with differentiated thyroid cancer who were consecutively treated during the 1965-2015 period. A total of 45 patients aged ≤18 years having undergone total thyroidectomy with or without selective neck dissection were included in the study. Decision on postoperative I-131 ablation was based on tumor characteristics, postoperative thyroglobulin level, preablative whole body scintigraphy, and/or neck ultrasound. Median age at diagnosis was 15 years. The presence of cervical lymph node metastases was significantly associated with papillary thyroid cancer, larger tumor size, involvement of two thyroid lobes, and multifocal disease. The presence of distant metastases was significantly associated with larger tumor size. None of the patients died during follow-up period, and the 5-year and 10-year overall survival rates were 100%. The 5-year and 10-year progression-free survival (PFS) rates were 87% and 73%, respectively. Male gender (p=0.046), age ≤15 years (p=0.029) and tumor size >15 mm (p=0.042) were significantly associated with inferior PFS. A significant positive trend of increase in the number of newly diagnosed patients was observed over time (p=0.011). Clinical management of pediatric thyroid cancer is challenging, especially in the light of increasing incidence in this population. Male patients younger than 15 years and with tumors of more than 15 mm in size require additional caution due to lower PFS observed.


Assuntos
Radioisótopos do Iodo/administração & dosagem , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/cirurgia , Adolescente , Criança , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Esvaziamento Cervical , Recidiva Local de Neoplasia/cirurgia , Período Pós-Operatório , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/patologia
13.
Cardiovasc Intervent Radiol ; 42(10): 1420-1428, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31187228

RESUMO

PURPOSE: To investigate the feasibility and safety of a helical iodine-125 (I-125) seed implant combined with transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT). METHODS: From December 2016 to February 2018, 26 cases of HCC with MPVTT patients were enrolled in this prospective study. Helical I-125 seed implants were placed into the portal vein through the percutaneous transhepatic route. Subsequently, TACE was performed. Follow-up with enhanced CT was performed every 6-8 weeks and TACE was repeated if the residual or recurrent tumor was found. Treatment response was measured with the modified response evaluation criteria in solid tumors. Complication rates and overall survival were also evaluated. RESULTS: Implantation and TACE were successful in all patients. There were no grade ≥ 3 complications observed in the patients. The objective response rates (ORR) and disease control rates (DCR) of MPVTT at 3 months after implantation were 42.3% and 84.6%, respectively, whereas ORR and DCR of the liver lesions were 34.6% and 46.2%, respectively. The median overall survival was 10.7 months (95% CI 6.2-15.2 months). CONCLUSION: Helical I-125 seed implants can be safely placed into the human main portal vein. Helical I-125 seed implants combined with TACE for HCC with MPVTT are safe and feasible.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Radioisótopos do Iodo/uso terapêutico , Neoplasias Hepáticas/terapia , Veia Porta/patologia , Trombose Venosa/terapia , Carcinoma Hepatocelular/complicações , Terapia Combinada/métodos , Estudos de Viabilidade , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Neoplasias Hepáticas/complicações , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Critérios de Avaliação de Resposta em Tumores Sólidos , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/patologia
14.
J Cancer Res Clin Oncol ; 145(7): 1907-1916, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31161374

RESUMO

PURPOSE: To evaluate the safety and efficacy of 125I brachytherapy to treat bilateral lung recurrences from hepatocellular carcinoma (HCC) after resection or ablation. MATERIALS AND METHODS: We retrospectively recruited 95 patients with bilateral lung recurrences from hepatocellular carcinoma (HCC) after resection or ablation who had received 3-6-month sorafenib with or without stereotactic body radiotherapy (SBRT), from October 2011 to January 2015; patients were then randomly divided into two groups, 44 patients received computed tomography (CT)-guided 125I brachytherapy (group A), and 51 patients were treated with supportive and symptomatic treatments (group B). RESULTS: The median survival time was 19 months (range of 3-36 months). The local response rate (LRR) at 3, 6, 12, 18, 24, 30 and 36 months in group A was 81.8%, 65.9%, 59.1%, 45.0%, 38.6%, 22.7%, 11.4%, respectively, and 64.7%, 47.1%, 33.3%, 25.4%, 15.7%, 11.7%, 7.8%, respectively, in group B (P < 0.05). The mean progression-free survival time (PFST) and overall survival (OS) of group A were significantly longer than those of group B. Alpha fetoprotein (AFP) and tumor size were independent factors that affected the PFST and OS, normal AFP levels and less than 1-cm tumor diameter had better PFST and OS (P < 0.05). No massive bleeding or serious complications occurred. CONCLUSION: CT-guided 125I brachytherapy is safe and effective for the treatment of bilateral lung recurrences from HCC after resection or ablation.


Assuntos
Braquiterapia/métodos , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirurgia , Radioisótopos do Iodo/administração & dosagem , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Braquiterapia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
PLoS One ; 14(6): e0217865, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220100

RESUMO

Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is limited in its ability to detect diffuse interstitial fibrosis, which is commonly found in idiopathic dilated cardiomyopathy (DCM). On the other hand, Washout rate (WR) by cardiac 123I- metaiodobenzylguanidine (123I-MIBG) scintigraphy which evaluates cardiac sympathetic nervous function, is a useful tool for predicting the prognosis in DCM. We investigated the predictive value of the combination of two different types of examinations, LGE on CMR and WR by 123I-MIBG scintigraphy for outcomes in DCM compared with LGE alone. One-hundred forty-eight DCM patients underwent CMR and 123I-MIBG scintigraphy. Patients were divided into 4 groups according to the presence or absence of LGE and WR cut-off value of 45% for predicting prognosis based on receiver operating characteristic curve analysis. Cardiac deaths, re-hospitalization for heart failure, implantation of a left ventricular assist device, and life-threatening ventricular arrhythmias were defined as clinical events. Forty-two DCM patients reached the clinical events during the median follow-up for 9.1 years (interquartile range, 8.0-9.2 years).Multivariable Cox regression analysis identified WR≥45%+LGE positive group as an independent predictor of cardiac events (HR 3.18, 95%CI 1.36-7.45, p = 0.008). Notably, there was no significance in the cardiac event-free survival rate between the WR<45%+LGE positive and WR≥45%+LGE negative groups (p = 0.89). The combination of WR by 123I-MIBG scintigraphy and LGE on CMR, which evaluate different type of cardiac deterioration, serves as a stronger predictor of long-term outcomes in DCM patients than LGE alone.


Assuntos
3-Iodobenzilguanidina/administração & dosagem , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Meios de Contraste/administração & dosagem , Gadolínio/administração & dosagem , Radioisótopos do Iodo/administração & dosagem , Imagem por Ressonância Magnética/métodos , Cintilografia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento
16.
Pan Afr Med J ; 32: 121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223411

RESUMO

Thyroglossal duct carcinoma is a rare pathologic entity. The surgeon's main concern is whether to perform thyroidectomy or not. In this paper, we report another case of thyroglossal papillary duct carcinoma in a 14-old girl suspected preoperatively and confirmed postoperatively on the histological analysis of resected specimen by a Sistrunk procedure. Therapeutic strategy was completed by a total thyroidectomy with radioactive iodine therapy and suppressive levothyroxine therapy. In the absence of clear guidelines, the management of thyroglossal duct carcinoma is depending on the clinical situation and the experience of the team of surgeons.


Assuntos
Cisto Tireoglosso/patologia , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Adolescente , Feminino , Humanos , Radioisótopos do Iodo/administração & dosagem , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Tiroxina/administração & dosagem
17.
Daru ; 27(1): 295-305, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31175641

RESUMO

PURPOSE: Oral administration of Iodine-131 (I-131) solutions causes high risk of contamination for patients and dispensers. The objective of the study was to adapt hard gelatin capsules (HGCs) for filling with radiopharmaceutical solutions without deformation. METHODS: Polystyrene (PS) internally lining films with different thicknesses were used to protect HGCs. The insulated HGCs were evaluated for their physicochemical characteristics and rupturing time in different dissolution media. HGCs internally lined with PS were examined for withstand loading with different volumes and radioactivities of I-131 solutions. Radioactivity release was studied in deionized water and acidic media. Quality control of released I-131 was inspected for radiochemical purities. RESULTS: There was a directly proportion between PS lining thickness and stability of HGCs after filling with 500 µl aqueous methylene blue solution. HGCs internally lined with PS 100 µm thickness withstand deformation for ˃ two months; however showed fast in-vitro rupturing time in different dissolution media. Internally lined HGCs loaded with different volumes and radioactivities of I-131 solutions resisted for one week without radioactive leakage. Yet, revealed complete release of I-131 after 20 min in dissolution media with great radiochemical purity. CONCLUSION: The study promises safely I-131 aqueous solution delivery via adapted HGCs. Graphical abstract Oral administration of radiopharmaceuticals.


Assuntos
Radioisótopos do Iodo/química , Compostos Radiofarmacêuticos/química , Administração Oral , Cápsulas , Composição de Medicamentos , Gelatina , Humanos , Radioisótopos do Iodo/administração & dosagem , Compostos Radiofarmacêuticos/administração & dosagem
18.
J BUON ; 24(2): 642-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31128018

RESUMO

PURPOSE: Hepatocellular carcinoma (HCC) has the second-highest cancer-related mortality in patients worldwide. Recently, TACE plus Iodine-125 (125I) seed strand endovascular implantation (ISEI) was shown to be feasible in advanced HCC patients. The aim of this study was to evaluate the efficacy and safety of this combined therapy for the treatment of advanced stage HCC by meta-analysis. METHODS: A systematic search in PubMed, EMBASE and Cochrane Library Databases was conducted until April 1st 2018. Outcomes included overall survival (OS), objective response rate (ORR) of primary liver tumor, and procedure-related complications. All statistical analyses were performed using Review Manager 5.3 and Stata 12.0. RESULTS: Nine eligible studies on 1059 advanced HCC patients were included. The results showed that TACE plus ISEI had significantly improved the 6-month OS (OR, 5.01: 95%CI, 3.19~7.86: P<0. 01) and 1-year OS (OR, 4.97: 95%CI, 3.12~7.92: P<0.01) compared to TACE alone. CONCLUSION: The safety and efficacy of TACE plus ISEI is superior to TACE alone for advanced HCC.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Radioisótopos do Iodo/administração & dosagem , Neoplasias Hepáticas/terapia , Braquiterapia/métodos , Carcinoma Hepatocelular/patologia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Sorafenibe/administração & dosagem , Resultado do Tratamento
19.
Arch Endocrinol Metab ; 63(3): 293-299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038590

RESUMO

OBJECTIVE: Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. SUBJECTS AND METHODS: This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. RESULTS: Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. CONCLUSIONS: In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.


Assuntos
Autoanticorpos/sangue , Radioisótopos do Iodo/administração & dosagem , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Glândula Tireoide/radioterapia , Tireoidectomia , Resultado do Tratamento , Adulto Jovem
20.
Int J Oncol ; 54(4): 1209-1220, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30968147

RESUMO

Evaluation of human epidermal growth factor receptor 2 (HER2) expression levels in breast and gastroesophageal cancer is used for the stratification of patients for HER2­targeting therapies. The use of radionuclide molecular imaging may facilitate such evaluation in a non­invasive way. Designed ankyrin repeat proteins (DARPins) are engineered scaffold proteins with high potential as probes for radionuclide molecular imaging. DARPin G3 binds with high affinity to HER2 and may be used to visualize this important therapeutic target. Studies on other engineered scaffold proteins have demonstrated that selection of the optimal labeling approach improves the sensitivity and specificity of radionuclide imaging. The present study compared two methods of labeling G3, direct and indirect radioiodination, to select an approach providing the best imaging contrast. G3­H6 was labeled with iodine­124, iodine­125 and iodine­131 using a direct method. A novel construct bearing a C­terminal cysteine, G3­GGGC, was site­specifically labeled using [125I]I­iodo­[(4­hydroxyphenyl)ethyl]maleimide (HPEM). The two radiolabeled G3 variants preserved binding specificity and high affinity to HER2­expressing cells. The specificity of tumor targeting in vivo was demonstrated. Biodistribution comparison of [131I]I­G3­H6 and [125I]I­HPEM­G3­GGGC in mice, bearing HER2­expressing SKOV3 xenografts, demonstrated an appreciable contribution of hepatobiliary excretion to the clearance of [125I]I­HPEM­G3­GGGC and a decreased tumor uptake compared to [131I]I­G3­H6. The direct label provided higher tumor­to­blood and tumor­to­organ ratios compared with the indirect label at 4 h post­injection. The feasibility of high contrast PET/CT imaging of HER2 expression in SKOV3 xenografts in mice using [124I]I­G3­H6 was demonstrated. In conclusion, direct radioiodination is the preferable approach for labeling DARPin G3 with iodine­123 and iodine­124 for clinical single photon emission computed tomography and positron emission tomography imaging.


Assuntos
Repetição de Anquirina/genética , Radioisótopos do Iodo/administração & dosagem , Imagem Molecular/métodos , Neoplasias/diagnóstico por imagem , Receptor ErbB-2/metabolismo , Animais , Linhagem Celular Tumoral , Feminino , Humanos , Radioisótopos do Iodo/química , Radioisótopos do Iodo/farmacocinética , Marcação por Isótopo/métodos , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Neoplasias/patologia , Engenharia de Proteínas , Cintilografia/métodos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/farmacocinética , Distribuição Tecidual , Ensaios Antitumorais Modelo de Xenoenxerto
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