Efficacy and Survival Analysis of I-131 Therapy for Bone Metastases from Differentiated Thyroid Cancer

Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, People's Republic of China. .
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 07/2011; 96(10):3078-86. DOI: 10.1210/jc.2011-0093
Source: PubMed


Our objective was to investigate the clinical efficacy of (131)I therapy for bone metastases from differentiated thyroid cancer (DTC) and prognostic factors as well as to assess patient survival and variables influencing survival.
One hundred six DTC patients with bone metastases treated with (131)I were retrospectively analyzed. The therapeutic efficacy was evaluated based on the change in serum thyroglobulin (Tg), the palliation of bone pain, and the anatomical imaging changes in bone lesions. The overall survival rates were estimated using the life-table method.
After (131)I therapy, a significant decrease in serum Tg was seen in 37 cases (34.9%), and serum Tg remained stable in 56 patients (52.8%). Among the 61 patients with painful bone metastases, 39 patients obtained a significant relief of bone pain, and the effective rate was 63.9%. The majority of DTC patients (76.4%) exhibited no obvious anatomical imaging changes in metastatic bone lesions after (131)I therapy. Only histopathological type and whether combined with nonosseous distant metastases had statistically significant impacts on changes in serum Tg (P = 0.009 and 0.023), and age over 45 yr and papillary thyroid carcinoma had favorable response on changes in anatomical imaging (P = 0.027 and 0.014). The 5- and 10-yr survival rates were 86.5 and 57.9%, respectively. Multivariate analyses showed that the presence of solitary bone metastases, only bone metastases, and (131)I therapy with previous bone surgery were independent factors associated with a better prognosis (P = 0.024, 0.009, and 0.031).
(131)I therapy is a feasible and effective treatment for DTC bone metastases. A better prognosis can be accomplished in patients who had a single metastatic lesion, only bone metastasis, or underwent bone surgery before (131)I therapy.

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    • "The more recent study of 106 patients with BM showed the highest 5-year and 10-year survival rates (86.5% and 57.9%, resp.) [11]. This group of patients was treated with multiple RAI therapies utilizing 200 mCi in 4−12-month intervals; also 24.5% of patients had BM excision. "
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    ABSTRACT: Objective. To present a complicated case of differentiated thyroid carcinoma (DTC) with metastases to the skull that was evident on I-131 whole body scan (WBS) but negative on other imaging modalities in a low risk patient. Methods. We will discuss clinical course, imaging, pathological findings, and treatment of the patient with skull metastasis from DTC. Pertinent literature on imaging and pathology findings as well as radioactive iodine (RAI) treatment impact on quality of life and survival in patients with bone metastases from DTC will be reviewed. Results. The patient is a 37-year-old woman with a diagnosis of DTC who had focal areas of increased uptake in the head on WBS with no correlative findings on CT and MRI. Initially, false positive findings were suspected since patient had a low risk for developing metastases. However, the persistent findings on post-RAI treatment WBS, following two courses of treatment, were highly concerning for metastatic bone disease. WBC performed 6 months following the second RAI treatment revealed resolution of the findings. Conclusions. False positive findings in WBS are frequent and may be due to contamination, perspiration, or folliculitis of the scalp as well as benign lesions such as meningioma, hematoma, cavernous angioma, and metallic sutures. However, metastatic disease should always be considered even if the patient has low risk of distant metastatic disease and correlative images do not support the diagnosis. RAI therapy appears to improve the survival rates and quality of life of thyroid cancer patients with bone metastases based on retrospective studies.
    Case Reports in Endocrinology 08/2015; 2015:434732. DOI:10.1155/2015/434732
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    • "131I therapy is effective in the treatment of postoperative recurrence and metastases of DTC 7. 131I therapy plays dual roles in the diagnosis and treatment of DTC, which is important to improve the quality of life and prolong survival, in particular in patients with metastatic thyroid cancer 8. However, the significant uptake of 131I in metastases is a prerequisite for achieving favorable therapeutic effects. "
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    ABSTRACT: The loss of I uptake ability in metastases from differentiated thyroid carcinoma (DTC) is becoming a major obstacle in radioiodine treatment. However, there is no effective way to screen for I uptake ability in metastases. The identification of differentially expressed proteins by serum proteomics may contribute to our understanding of the mechanisms underlying the dedifferentiation of DTC. Serum samples were obtained from papillary thyroid carcinoma patients with non-I-avid lung metastases and I-avid lung metastases. Differential protein analysis was performed using two-dimensional gel electrophoresis. Candidate protein spots showing differences in expression between the two groups were identified by means of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and were validated by western blotting. We found that afamin is downregulated in the serum of papillary thyroid carcinoma patients with non-I-avid lung metastases. Afamin may be a potential serum biomarker for early screening of I uptake ability in DTC metastases and could therefore be of value in guiding radioiodine treatment decisions.
    Nuclear Medicine Communications 10/2013; 34(12). DOI:10.1097/MNM.0000000000000001 · 1.67 Impact Factor
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    • "Orita et al.[38] and Hindie et al.[14] provided findings that a significant survival advantage was obtained with 131I therapy supporting that claim. Additionally, a study by Qiu et al.[41] found that 131I therapy was 63.9% effective at reducing symptoms due to bony metastasis such as pain, and could therefore be used as a palliative agent in patients with multiple bone metastases. "
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    ABSTRACT: Thyroid carcinoma generally responds well to treatment and spinal metastasis is an uncommon feature. Many studies have looked at the management of spinal metastasis and proposed treatments, plans and algorithms. These range from well-established methods to potentially novel alternatives including bisphosphonates and vascular endothelial growth factor (VEGF) therapy, amongst others.The purposes of this systematic review of the literature are twofold. Firstly we sought to analyse the proposed management options in the literature. Then, secondly, we endeavoured to make recommendations that might improve the prognosis of patients with spinal metastasis from thyroid carcinomas. We conducted an extensive electronic literature review regarding the management of spinal metastasis of thyroid cancer. We found that there is a tangible lack of studies specifically analysing the management of spinal metastasis in thyroid cancer. Our results show that there are palliative and curative options in the management of spinal metastasis, in the forms of radioiodine ablation, surgery, selective embolisation, bisphosphonates and more recently the VEGF receptor targets. The management of spinal metastasis from thyroid cancer should be multi-disciplinary. There is an absence; it seems, of a definitive protocol for treatment. Research shows increased survival with 131I avidity and complete bone metastasis resection. Early detection and treatment therefore are crucial. Studies suggest in those patients below the age of 45 years that treatment should be aggressive, and aim for cure. In those patients in whom curative treatment is not an option, palliative treatments are available.
    Head & Neck Oncology 06/2012; 4(1):39. DOI:10.1186/1758-3284-4-39 · 3.14 Impact Factor
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