| Part ?Objective:One of the presumed advantages of prophylactic central neck dissection(pCND)is offering staging basis for more aggressive radioactive iodine(RAI)therapy,which postulates the necessity of high dose for treatment efficacy.The present study aims to compare the effectiveness between low-dose and high-dose RAI in a select cohort of cN0 papillary thyroid cancer(PTC)patients with pathological Nla(pN1a)disease revealed by pCND in terms of ablation rate and response to therapy.The frequency of short-term adverse effects between the two groups was also compared.Patients and Methods:From January 2014 to April 2016,cNO PTC patients with pN1a disease revealed by pCND in our hospital were retrospectively reviewed.Patients with other indications for high-dose RAI,such as the presence of extrathyroidal extension,vascular invasion or suspicions of distant metastasis,were excluded.For the included patients,high dose(3700 MBq)was administered between January 2014 and August 2015 and low dose(1110 MBq)between August 2015 and April 2016.Ablation assessment was performed 6 months after RAI therapy.Response eva-luation after RAI therapy was performed after 46.3 ± 9.5 months for high-dose group and 29.1 ± 2.6 months for low-dose group.All patients were also evaluated for short-term adverse effects 24 and 72 hours after RAI administrationResults:A total of 84 patients were enrolled.Among them,42 were in the high-dose group and the other 42 in the low-dose group.There was no significant difference in ablation rate(P=0.7707)and response to RAI therapy(P=0.6454)between the two groups.Twenty-four hours after RAI administration,neck pain and swelling(33.3%VS.11.9%;P=0.0372)and gastrointestinal discomfort(45.2%vs.21.4%;P=0.0373)were significantly more frequent in the high-dose group.Conclusion:High-dose RAI therapy,with higher frequency of short-term adverse effects,appears to be not superior to low-dose RAI therapy for cNO PTC patients with pN1a disease revealed by pCND to achieve better response to therapy.Further randomized studies with larger series of patients and longer follow-up duration,especially with the low-dose group,are needed to validate our results.Part ?Objective:Negative 99mTc-pertechnetate uptake of the thyroid bed indicates the absence or a small volume of remnant thyroid tissue(RTT)after total thyroidectomy(TT).The aim of this study is to evaluate the predictive value of negative 99mTc-pertechnetate scintigraphy for excellent response(ER)to radioactive iodine therapy(RIT)in low to intermediaterisk differentiated thyroid cancer(DTC)patients.Patients and Methods:One-hundred and eighty-nine low to intermediate risk DTC patients who underwent TT,RIT with a single dose of 1110 MBq and suppressive therapy with thyroid-stimulating hormone(TSH)from July 2015 to February 2016 in our hospital were retrospectively evaluated.99mTc-pertechnetate thyroid scintigraphy was performed just before RIT and images were reported dichotomously as negative or positive.The response of patients was assessed for 23.2 ± 3.8 months after RIT and dichotomized as excellent response(ER)or non-excellent response(NER).99mTc-pertechnetate uptake,age at diagnosis,gender,multifocality,T stage,N stage,preablative stimulated thyroglobulin(ps-Tg),and TSH were explored as potential predictors for ER.Results:80.68%(71/88)of patients with negative 99mTc-pertechnetate uptake achieved ER.When patients were evaluated according to different ps-Tg levels,we found that 94.83%(55/58)of patients with ps-Tg<1 ng/ml and negative 99mTc-pertechnetate uptake achieved ER.Multivariate Cox regression analysis revealed that ps-Tg(P=0.0001)and 99mTc-pertechnetate uptake(P=0.0473)were independent predictors for ER.Conclusion:In addition to ps-Tg,negative 99mTc-pertechnetate uptake is also a significant independent predictor for an excellent response in low to intermediate risk patients.It may be possible to omit RIT in patients with ps-Tg<1 ng/ml and concurrent negative.Part ?Objective:To evaluate the impact of preoperative use of intravenous contrast media(ICM)on the excellent response(ER)rates in a cohort of intermediate risk differentiated thyroid cancer(DTC)patients who received total thyroidectomy(TT)and low dose radioactive iodine(RAI)therapy.Patients and Methods:A total of 683 consecutive patients were retrospectively reviewed in a single center between August 2016 and August 2018.Patients were divided into ICM group(n=532)and non-ICM group(n=151).ICM patients were 1:1 propensity matched to non-ICM patients based on age,gender,multifocality,T stage,N stage,RAI delay time,histologic subtype,99mTc-pertechnetate uptake,thyroid stimulated horomone(TSH)and pre-ablation thyroglobulin(ps-Tg).Risk adjusted logisticregression models were constructed to assess the association between the use of ICM and ER rates.Results:ICM patients had signifiantly higher T stage(P<0.001),N stage(P<0.001),urinary iodine(P<0.001),and ps-Tg(P=0.042)than non-ICM patients.Preoperative use of ICM was found to be significantly associated with decreased ER rates in both the primary cohort(OR 0.47,95%CI 0.32-0.71,P<0.001)and the matched cohort(OR 0.48,95%Cl 0.25-0.94,P=0.031).Subgroup analysis on RAI delay time in the primary cohort revealed that ER rates in ICM patients were significantly lower than that of non-ICM patients for 1-2 months(P=0.0245)and 2-3 months(P=0.0221)subgroups,but not for 3-4 months,4-5 months and 5-6 months subgroups(All P>0.05).A delay time of 3-4 months exhibits the highest ER rate(63.08%)within the ICM group.Conclusion:Preoperative use of ICM was associated with decreased ER rates in intermediate risk DTC patients who has received TT and low dose RAI therapy.For patients who had undergone contrast CT,a RAI delay time of 3-4 months seemed to be more appropriate to achieve better ER rate.Part ?Objective:The aim of this study is to evaluate the predictive value of BRAF V600E gene status for excellent response(ER)to radioactive iodine therapy(RIT)in low to intermediaterisk differentiated thyroid cancer(DTC)patients.Patients and Methods:Ninety-two low to intermediate risk DTC patients who underwent TT,RIT with a single dose of 1110 MBq and suppressive therapy with thyroid-stimulating hormone(TSH)from May 2018 to August 2018 in our hospital were prospectively evaluated.The response of patients was assessed for 14-19 months after RIT and dichotomized as excellent response(ER)or non-excellent response(NER).BRAF V600E gene status?99mTc-pertechnetate uptake,age at diagnosis,gender,multifocality,T stage,N stage,preablative stimulated thyroglobulin(ps-Tg),and TSH were explored as potential predictors for ER.Results:In BRAF V600E gene mutation group,85.25%(52/61)of patients achieved ER.There was no significant difference in clinicopathological features except metastatic lymph node.ER?NER after RAI therapy accounted for 83.87%?16.13%in BRAF V600E gene mutation group and 85.25%?14.75%in BRAF V600E gene wild group,and no statistical difference was found(P=0.7723).Conclusion:For low-intermediate risk recurrent PTC,BRAF V600E gene status may have no impact on the response to 131 I ablation therapy,and thus this molecular feature should not be used as an independent weighting factor for risk assessment in this population. |
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