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ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into “favorable” (excellent/indeterminate) or “unfavorable” (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

ABSTRACT Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. Subjects and methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

Introdução/Justificativa: A radioembolização interna seletiva (SIRT) é uma terapia promissora dirigida ao fígado para pacientes com câncer hepático primário e metastático. A SIRT oferece diversas vantagens sobre os métodos de tratamento tradicionais devido ao seu perfil de baixa toxicidade. A grande maioria dos estudos com aplicação intra-arterial hepática de microesferas com ítrio-90 tem sido descrita para tratamento do hepatocarcinoma e metástases hepáticas do câncer colorretal. As metástases hepáticas no câncer do colo do útero são raras, ocorrem em menos de 5% dos casos e oferecem pior prognóstico, principamente na falha dos esquemas de quimioterapia. A sobrevida global em 12 meses é de 20% e em 24 meses de 8%, com mediana de 6,8 meses. A terapia local hepática direcionada, de menor toxicicidade, para casos bem selecionados, pode retardar a progressão da doença. Relato: Este caso relata o histórico oncológico de uma mulher de 39 anos, com diagnóstico de carcinoma espinocelular endocervical estádio IV ao diagnóstico, com metástase pulmonar, linfonodal e hepática, submetida a conização e tratamento quimioterápico com 6 ciclos de Carboplatina + Paclitaxel e Bevacizumab. Após quimioterapia, apresentou resposta completa das lesões linfonodais e pulmonar, porém com persistência de doença ativa metastática no segmento VI do fígado ao estudo de PET/CT com 18F-FDG. Após discussão multidisciplinar, optou-se por tratamento local com ítrio-90. Paciente recebeu 1 Gbq de ítrio-90 na lesão única do segmento VI do fígado, dosimetria realizada pelo método Partition, com resposta completa e necrose da lesão tumoral. Realizou teste do PDL1, com resultado negativo. Foi mantida em tratamento com Bevacizumab (anticorpo monoclonal anti-VEGF humanizado) e o PET/CT de controle, após 3 anos e 3 meses da radioembolização não demonstra atualmente evidência de doença. Conclusão: Este é o segundo caso na literatura com resposta completa de metástase hepática por neoplasia do colo do útero, tratado com radioembolização hepática com ítrio-90. A aplicação deste tratamento em metástases hepáticas por diversos tumores como: mama, rim, tumores neuroendócrinos, pâncreas e ovário, tem sido reportados com bons resultados. No entanto, para o colo do útero, são muito poucos os casos descritos. A demonstração de resposta segura e satisfatória ao tratamento locorregional com radioembolização com microesferas de ítrio-90 em metástases não habituais do fígado, possibilita ampliação da indicação deste tratamento em casos bem selecionados.