title: Tumour dosimetry and response in patients with metastatic differentiated thyroid cancer using recombinant human thyrotropin before radioiodine therapy.
abstract: The development of recombinant human thyrotropin (rhTSH) has given clinicians new options for diagnostic follow-up and treatment of patients with differentiated thyroid cancer (DTC). This paper evaluates the tumour dosimetry and response following -iodine-131 treatment of metastatic thyroid cancer patients after rhTSH stimulation instead of classical hormone withdrawal-induced hypothyroidism. Nineteen consecutive (131)I treatments in 16 patients were performed after rhTSH stimulation. All patients had undergone a near-total thyroidectomy followed by an ablative dosage of (131)I. They all suffered from metastatic or recurrent disease showing tumoral (131)I uptake on previous post-treatment scintigraphy. Dosimetric calculations were performed using (131)I tumour uptake measurements from post-treatment (131)I scintigrams and tumour volume estimations from radiological images. Response was assessed by comparing pre-treatment serum thyroglobulin (Tg) level with the Tg level 3 months post treatment. In 18 out of 19 treatments, uptake of (131)I in metastatic or recurrent lesions was seen. The median tumour radiation dose was 26.3 Gy (range 1.3-368 Gy), and the median effective half-life was 2.7 days (range 0.5-6.5 days). Eleven of 19 treatments (10/16 patients) were evaluable for response after 3 months. (131)I therapy with rhTSH resulted in a biochemical partial response in 3/11 or 27% of treatments (two patients), biochemical stable disease in 2/11 or 18% of treatments and biochemical progressive disease in 6/11 or 55% of treatments. Our study showed that although tumour doses in DTC patients treated with (131)I after rhTSH were highly variable, 45% of treatments led to disease stabilisation or partial remission when using rhTSH in conjunction with (131)I therapy, without serious side-effects and with minimal impact on quality of life. RhTSH is therefore adequately satisfactory as an adjuvant tool in therapeutic settings and is especially suitable in advanced recurrent or metastatic DTC patients who may be intolerant to TSH stimulation by levothyroxine withdrawal.
authors.affiliation: Department of Nuclear Medicine, Room E02.222, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. b.dekeizer@azu.nl
authors.forename: Bart
authors.initials: B
authors.lastname: de Keizer
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Brans
authors.forename: Anne
authors.initials: A
authors.lastname: Hoekstra
authors.forename: Pierre M J
authors.initials: PM
authors.lastname: Zelissen
authors.forename: Hans P F
authors.initials: HP
authors.lastname: Koppeschaar
authors.forename: Cees J M
authors.initials: CJ
authors.lastname: Lips
authors.forename: Peter P
authors.initials: PP
authors.lastname: van Rijk
authors.forename: Rudi A
authors.initials: RA
authors.lastname: Dierckx
authors.forename: John M H
authors.initials: JM
authors.lastname: de Klerk
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy / Q000556:secondary; D000231:Adenocarcinoma, Papillary / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy; D011874:Radiometry; D011879:Radiotherapy Dosage; D011994:Recombinant Proteins / Q000627:therapeutic use; D012888:Skull Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000532:radiotherapy / Q000556:secondary; D013964:Thyroid Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000532:radiotherapy*; D013972:Thyrotropin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin