Distinguishing Patients With Distant Metastatic Differentiated Thyroid Cancer Who Biochemically Benefit From Next Radioiodine Treatment

• Main Authors: Ri Sa, Lin Cheng, Yuchen Jin, Hao Fu, Yan Shen, Libo Chen
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-11-01
• Series: Frontiers in Endocrinology
• Subjects: thyroid cancer; radioiodine; target/background ratio; thyroglobulin; biochemical response
• Online Access: https://www.frontiersin.org/articles/10.3389/fendo.2020.587315/full

BackgroundRepeated radioiodine (131I) treatment (RT) are commonly performed in patients with 131I-avid distant metastatic differentiated thyroid cancer (DM-DTC), but more precise indications remain indeterminate. This prospective study was conducted to explore predictors for biochemical response (BR) to next RT.MethodsTotally thyroidectomized patients with 131I-avid DM-DTC demonstrated by initial post-therapeutic whole body scan (Rx-WBS) were consecutively recruited. Repeated RTs were performed at a fixed dose and a fixed interval, which was terminated once a decline in thyroid stimulating hormone-suppressed thyroglobulin (Tgon) could not be achieved or Rx-WBS was negative. BR was evaluated by change rate of Tgon level (ΔTgon%).ResultsAfter exclusion of 27 ineligible courses, a total of 166 neighboring course pairs from 77 patients were established and utilized. Univariate and multivariate analyses showed that the maximum target/background ratio (T/Bmax) on the whole body scan and ΔTgon% derived from the former RT were independently associated to the latter one. In predicting biochemical remission, the positive predictive value (PPV) and negative predictive value (NPV) of T/Bmax at the cut-off value of 8.1 were 79.1% and 84.0%, respectively; whereas the PPV and NPV of ΔTgon% at the cut-off value of 25.3% were 70.8% and 77.1%, respectively. Notably, the PPV of combined T/Bmax ≥ 8.1 and ΔTgon% ≥ 25.3% increased to 87.7%; while the NPV of T/Bmax ≥ 8.1 or ΔTgon% ≥ 25.3% reached as high as 97.7%.ConclusionsThis study revealed that combined use of the latest RT-derived T/Bmax and ΔTgon% may efficiently identify biochemical responders/non-responders to next RT, warranting management optimization of patients with 131I-avid DM-DTC.