Treatment of radioiodine-negative bone metastasis from papillary thyroid carcinoma with percutaneous ethanol injection therapy
ABSTRACT A 62-year-old woman with metastatic papillary thyroid carcinoma in the sternum was successfully treated with percutaneous
ethanol injection therapy (PEIT) when previous radioiodine therapy and external irradiation were ineffective. The patient
tolerated the treatment well and the refractory pain in the anterior chest wall that was alleviated with morphine prior to
PEIT completely disappeared. No severe complications were observed. PEIT was performed 4 times (2 times with ultrasound guidance
and 2 times with CT guidance). The posttreatment CT scan and201T1 scintigraphy demonstrated significant decrease in the tumor volume. The serum thyroglobulin level fell to less than one-twentieth
of the pretreatment value. It is suggested that PEIT has a value in treating bone metastasis from thyroid carcinoma which
do not respond to radioiodine.
- SourceAvailable from: Yong-il Kim[Show abstract] [Hide abstract]
ABSTRACT: Percutaneous cementoplasty (PC) is used for metastatic bone tumor. Bone metastases patients who are unable to avail regular surgery, because of their poor general condition, undergo PC to gain mechanical stability and pain relief. We evaluated the effect of PC using (18)F-FDG PET-CT and investigated the correlation and predictability between quantitative parameters of (18)F-FDG PET-CT and pain status after PC. Subjects comprised 18 patients (total 32 sites) who had undergone PC for the metastatic bone tumors. Pain degree of the patients was obtained by visual analog scale (VAS) in the pre-PC, immediate post-PC, and follow-up post-PC state. As PET-CT parameters, maximum and mean standardized uptake value (MaxSUV and MeanSUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were measured. Receiver operator characteristic curve analysis was performed for pre-PC, post-PC PET-CT, and delta (Δ) values of PET-CT parameters to correlate and predict the good pain improvement (VAS pain ≤2) after the PC procedure. Patients' pain status improved significantly in immediate post-PC and follow-up post-PC pain (all p < 0.001). Among PET-CT parameters, MaxSUV (p = 0.004) and MeanSUV (p = 0.007) showed significant interval decrease after PC procedure. All of the post-PC PET-CT and ΔPET-CT values showed significant prediction of pain improvement for follow-up post-PC pain, especially ΔTLG (AUC = 0.804, p = 0.0003) and ΔMTV (AUC = 0.804, p = 0.0004). There was significant reduction of patients' pain after PC, and ΔTLG and ΔMTV of PET-CT parameters showed best predictability for follow-up post-PC pain improvement. PET-CT can be the useful parameter to predict treatment response of PC.Annals of Nuclear Medicine 09/2013; · 1.41 Impact Factor
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ABSTRACT: An 86-year-old male patient was treated by percutaneous ethanol injection therapy (PEIT), following tumorectomy of a papillary thyroid carcinoma and a modified radical neck dissection for its metastasis. After seven treatments with PEIT, the patient was admitted to hospital for a tracheotomy to treat progressive severe dyspnea. Seven days later the patient died from acute renal failure caused by diabetic ketoacidosis. At autopsy, tumor masses were found to comprise mostly scar tissue, and the remaining neoplastic cells often showed anaplastic changes. Fresh coagulation necrosis and hemorrhages were scattered throughout the tumor lesions and their microvessels were occasionally occluded by thrombus. These changes were seen prominently, especially at the central areas of PEIT treatment. Given these findings, we believe that PEIT may be useful in providing local control for the progression of thyroid cancer, especially in cases of unresectable malignant thyroid tumors.Pathology International 01/2002; 52(5-6):406-9. · 1.72 Impact Factor
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ABSTRACT: Although the majority of papillary thyroid carcinoma could be successfully managed by complete surgical resection alone or resection followed by radioiodine ablation, a small proportion of patients may develop radioiodine-refractory progressive disease which is not amenable to surgery, local ablative treatment or other treatment modalities. The use of FDG-PET/CT scan for persistent/recurrent disease has improved the accuracy of restaging as well as cancer prognostication. Given that patients with RAI-refractory disease tend to do significantly worse than those with radioiodine-avid or non-progressive disease, an increasing number of phase I and II studies have been conducted to evaluate the efficacy of new molecular targeted drugs such as the tyrosine kinase inhibitors and redifferentiation drugs. The overall response rate of these drugs ranged between 0-53%, depending on whether the patients had been previously treated with these drugs, performance status and extent of disease. However, drug toxicity remains a major concern in administration of target therapies. Nevertheless, there are also ongoing phase III studies evaluating the efficacy of these new drugs. The aim of the review was to summarize and discuss the results of these targeted drugs and redifferentiation agents for patients with progressive, radioiodine-refractory papillary thyroid carcinoma.Journal of thyroid research. 01/2012; 2012:818204.