1. Long-Term Survival and Low Effective Cumulative Radioiodine Doses to Achieve Remission in Patients With 131Iodine-Avid Lung Metastasis From Differentiated Thyroid Cancer
- Author
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Fabián Pitoia, Graciela Cross, and Fernanda Bueno
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Lung Neoplasms ,Adolescent ,Lung metastasis ,Carcinoma, Papillary, Follicular ,Iodine Radioisotopes ,Fluorodeoxyglucose F18 ,Internal medicine ,Long term survival ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Thyroid Neoplasms ,Radionuclide Imaging ,Thyroid cancer ,Survival analysis ,Aged ,Retrospective review ,Lung ,business.industry ,Remission Induction ,Radiotherapy Dosage ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,medicine.anatomical_structure ,Female ,Radiopharmaceuticals ,business - Abstract
To evaluate long-term survival and response to RAI treatment in patients with differentiated thyroid cancer (DTC) and 131Iodine-avid metastatic lung disease.A retrospective review of 639 DTC patients followed-up at the Hospital de Clínicas, Buenos Aires, Argentina, showed that 42 (6%) patients had lung metastasis, and 24 patients were included for analysis.Seventeen were women, and 7 were men (F:M=2.4:1). Eighteen patients (75%) had PTC, and 6 (25%) had FTC. The median age at diagnosis was older than 45 years in 50%, and the median follow-up was 13 years. Good response to treatment (GRT: no evidence of disease or biochemical persistence without structural correlate) was observed in 46% of patients (all with diffuse postdose radioiodine uptake and no structural images higher than 1 cm in diameter); and 21% patients died from disseminated lung metastasis. Overall survival at 5 and 10 years was 100% and 88.4%, respectively. The Cox proportional hazard ratio showed that extrathyroidal invasion, positive uptake of 18-FDG, and metachronous diagnosis of the lung metastasis were variables that significantly predicted death. Those patients who had a GRT did with a mean effective cumulative RAI dose of 457.3±29.7 mCi 131I (range, 300-600 mCi 131I).Lung metastasis showed a slow progression with a high long-term overall survival. The presence of synchronous lung metastasis, the absence of nodules larger than 1 cm, and the lack of uptake of FDG were predictive factors for an early response to treatment with RAI cumulative doses lower than 600 mCi 131I.
- Published
- 2014