Partial Remission

Treated Untreated
Table 20.1 Studies of empiric 131I therapy

Number of patients

Negative

Positive

DxWBS and

RxWBS after

Total in

empirically

empiric

Follow-Up

Authors

study

treated

treatment

duration

Results

Pachucki and

21

7 (33%)

4 (57%)

1.5-34

No data

Burmeister [69]

months

Mazzaferri and

10

10 (100%)

8 (80%)

2-4 years

3 no uptake on RxWBS and Tg-off <5 mg/L

Kloos [14]

Ronga et al. [70]

61

11 (18%)

8 (73%)

Not given

No follow-up data in pos. RxWBS group.

One of 3 patients with neg. RxWBS had

progressive disease within 5 months

De Keizer et al.

22

16 (73%)

11 (69%)

1 year

Decrease in Tg-off in 9 patients with

[71]

RxWBS pos.and in 3 with RxWBS neg.

Tg-off 8-608 mg/L

Pacini et al. [72]

17

17 (100%)

16 (94%)

12 patients;

At last follow-up decrease in serum Tg

30 months

(-off) in 7 and an increase in 1 patient

to 5 years

Pineda et al. [62]

17

17 (100%)

16 (94%)

6 months to

Decrease in Tg-off in 81% after 1st empiric

5 years

treatment and in 5 patients after 3rd

empiric 131I treatment. 50% of patients

had Tg-on <5 mg/L. RxWBS neg. in 50%;

Tg-off never <5 mg/L

Fatourechi

24

24 (100%)

6 (25%)

6-33

Tg-on increased after 131I in 75% of

et al. [13]

months

patients; 5 died, 4 with negative

RxWBS, 1 with partial neg.RxWBS (no

uptake in bone metastases)

Schaap et al. [73]

39

39 (100%)

22 (60%)

Up to 15

Tg-on after RxWBS pos. decreased and

months

increased in RxWBS-neg. group

(P = 0.006.)

Pacini et al. [27]

70

42 (60%)

30 (71%)

Mean 6.7

Decrease in Tg-off in 19 patients with

years ± 3.8

RxWBS pos. Complete remission in 33%

years

of patients with RxWBS pos., in 17%

with RxWBS neg., and in 68% of

untreated group

Van Tol et al. [64]

S6

56 (100%)

28 (50%)

Mean 4.5 ±

No change in Tg-off before and after

2.9 years

empiric 131I therapy in both groups.

Complete remission in 64% of patients

with RxWBS pos., and in 36% with

RxWBS neg. 5-year cancer survival

100% in RxWBS-pos. and 76% in

RxWBS-neg. group

Koh et al. [68]

60

28 (47%)

12 (43%)

23.8 ± 19.6

Tg-on and Tg-off decreased, respectively

months

41% and 37% in treated group versus a

Tg rise of 44% and 67%, respectively in

untreated group

Total

397

267 (67%)

161 (60%)

23.8 ± 19.6

Tg-on and Tg-off decreased, respectively

months

41% and 37% in treated group versus a

Tg rise of 44% and 67%, respectively in

untreated group

Updated and modified from van Tol et al. [64]. DxWBS, diagnostic B1I whole-body scan; RxWBS, posttreatment whole-body scan; Tg-on, serum Tg measured during thyroid hormone therapy;Tg-off,Tg measured off thyroid hormone or under rhTSH stimulation; pos., positive; neg., negative.

Updated and modified from van Tol et al. [64]. DxWBS, diagnostic B1I whole-body scan; RxWBS, posttreatment whole-body scan; Tg-on, serum Tg measured during thyroid hormone therapy;Tg-off,Tg measured off thyroid hormone or under rhTSH stimulation; pos., positive; neg., negative.

these studies,60% of 161 patients had 131I uptake on the RxWBS. The best responses occur in children and young adults with diffuse pulmonary metastases not seen on any imaging studies except on the RxWBS [15,74]. This is not uncommon. We found uptake in the lung only on the RxWBS study in 13% of 89 consecutive paired DxWBS and RxWBS studies performed in 79 patients (15% of the patients) with serum THW-Tg levels that were almost always above 15 mg/L [14]. Two to 4 years later, three of them (25%), all under 45 years, had no uptake on RxWBS and serum Tg levels <5 mg/L during THW.

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