title: Comparison of Empiric Versus Whole-Body/-Blood Clearance Dosimetry-Based Approach to Radioactive Iodine Treatment in Patients with Metastases from Differentiated Thyroid Cancer.
abstract: The optimal management of radioactive iodine (RAI) treatment in patients with metastatic thyroid cancer (TC) is still a matter of debate.Methods:We retrospectively analyzed 352 patients with RAI-avid metastatic well-differentiated TC treated with131I by an empiric fixed activity of 3.7 GBq at Gustave Roussy (GR,n= 231) or by personalized activity (2.7-18.6 GBq) based on whole-body/-blood clearance (WB/BC) dosimetry at Memorial Sloan Kettering Cancer Center (MSKCC,n= 121). The primary endpoint was to compare overall survival (OS) in the 2 groups of patients by log-rank test.Results:Patients received a median cumulative activity of 14.8 GBq at GR and 24.2 GBq at MSKCC (P< 0.0001). The median follow-up after the diagnosis of metastases was 7.2 y (0.4-31 y). Five-year OS was 86.8% and 78.8% for patients treated at GR and at MSKCC, respectively (P< 0.01). However, there was no statistical difference in OS after correction for sex, age at the diagnosis of distant metastases, metastases site, and metastases extension between the 2 centers (P= 0.16). OS at 5 y was 96% and 96% for patients younger than 40 y with micrometastases, 70% and 65% for patients older than 40 y with macrometastases or multiple metastases, and 92% and 87% for younger patients with macrometastases or older patients with micrometastases treated at GR and MSKCC, respectively (P= not significant).Conclusion:Routine use of WB/BC dosimetry without lesional dosimetry provided no OS advantage when compared with empiric fixed RAI activity in the management of thyroid cancer patients with RAI-avid distant metastases.
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France desiree.deandreis@gustaveroussy.fr.
authors.forename: Désirée
authors.initials: D
authors.lastname: Deandreis
authors.affiliation: CESP (Centre d'Epidémiologie et de Santé Publique) U1018, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Rubino
authors.affiliation: Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York.
authors.forename: Hernan
authors.initials: H
authors.lastname: Tala
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Terroir
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Baudin
authors.affiliation: Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York; and.
authors.forename: Steve
authors.initials: S
authors.lastname: Larson
authors.affiliation: Endocrinology Service and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Fagin
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.affiliation: Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, New York.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005602:France / Q000453:epidemiology; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009362:Neoplasm Metastasis; D015995:Prevalence; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D016896:Treatment Outcome; D014915:Whole-Body Counting / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals
keywords: dosimetry; endocrine; oncology; radioactive iodine; radionuclide therapy; thyroid cancer