RESUMEN
BACKGROUND: In patients with low-risk differentiated thyroid cancer undergoing thyroidectomy, the postoperative administration of radioiodine (iodine-131) is controversial in the absence of demonstrated benefits. METHODS: In this prospective, randomized, phase 3 trial, we assigned patients with low-risk differentiated thyroid cancer who were undergoing thyroidectomy to receive ablation with postoperative administration of radioiodine (1.1 GBq) after injections of recombinant human thyrotropin (radioiodine group) or to receive no postoperative radioiodine (no-radioiodine group). The primary objective was to assess whether no radioiodine therapy was noninferior to radioiodine therapy with respect to the absence of a composite end point that included functional, structural, and biologic abnormalities at 3 years. Noninferiority was defined as a between-group difference of less than 5 percentage points in the percentage of patients who did not have events that included the presence of abnormal foci of radioiodine uptake on whole-body scanning that required subsequent treatment (in the radioiodine group only), abnormal findings on neck ultrasonography, or elevated levels of thyroglobulin or thyroglobulin antibodies. Secondary end points included prognostic factors for events and molecular characterization. RESULTS: Among 730 patients who could be evaluated 3 years after randomization, the percentage of patients without an event was 95.6% (95% confidence interval [CI], 93.0 to 97.5) in the no-radioiodine group and 95.9% (95% CI, 93.3 to 97.7) in the radioiodine group, a difference of -0.3 percentage points (two-sided 90% CI, -2.7 to 2.2), a result that met the noninferiority criteria. Events consisted of structural or functional abnormalities in 8 patients and biologic abnormalities in 23 patients with 25 events. Events were more frequent in patients with a postoperative serum thyroglobulin level of more than 1 ng per milliliter during thyroid hormone treatment. Molecular alterations were similar in patients with or without an event. No treatment-related adverse events were reported. CONCLUSIONS: In patients with low-risk thyroid cancer undergoing thyroidectomy, a follow-up strategy that did not involve the use of radioiodine was noninferior to an ablation strategy with radioiodine regarding the occurrence of functional, structural, and biologic events at 3 years. (Funded by the French National Cancer Institute; ESTIMABL2 ClinicalTrials.gov number, NCT01837745.).
Asunto(s)
Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Pronóstico , Calidad de Vida , Neoplasias de la Tiroides/diagnóstico por imagen , UltrasonografíaRESUMEN
PURPOSE: The aim of this study was to assess the usefulness of positron emission tomography/computed tomography in staging, prognosis evaluation and restaging of patients with follicular lymphoma. METHODS: A retrospective study was performed on 45 patients with untreated biopsy-proven follicular lymphoma who underwent 18F-fluorodeoxyglucose PET/CT (FDG PET/CT) and CT before and after chemoimmunotherapy induction treatment (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisone). RESULTS: PET/CT detected more nodal (+51%) and extranodal (+89%) lesions than CT. PET/CT modified Ann Arbor staging in eight patients (18%). Five patients (11%) initially considered as being early stage (I/II) were eventually treated as advanced stage (III/IV). In this study, an initial PET/CT prognostic score was significantly more accurate than the Follicular Lymphoma International Prognostic Index score in identifying patients with poor prognosis (i.e. patients with incomplete therapeutic response or early relapse). The accuracy of PET/CT for therapeutic response assessment was higher than that of CT (0.97 vs 0.64), especially due to its ability to identify inactive residual masses. In addition, post-treatment PET/CT was able to predict patients' outcomes. The median progression-free survival was 48 months in the PET/CT-negative group as compared with 17.2 months for the group with residual uptake (p<10(-4)). CONCLUSION: FDG PET/CT is useful for staging and assessing the prognosis and therapeutic response of patients with follicular lymphoma.
Asunto(s)
Fluorodesoxiglucosa F18 , Factores Inmunológicos/uso terapéutico , Linfoma Folicular/diagnóstico , Linfoma Folicular/tratamiento farmacológico , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Radiofármacos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Técnica de Sustracción , Resultado del TratamientoRESUMEN
We carried out a study to evaluate the contribution of positron emission tomography with (18)F-fluorodeoxyglucose (PET-FDG) in the diagnosis and therapeutic care of patients presenting with metastases of unknown primary. PET-FDG was prospectively performed in 51 patients. The PET-FDG data were confirmed histologically or by a follow-up on average at 13 months. PET-FDG identified the primary in 24 percent of cases, and detected the presence of additional metastases in 41 percent of cases. PET-FDG led to a therapeutic modification for 12 patients (24 percent). Furthermore, the therapeutic impact seems more marked in localized forms than in the multifocal. This broad exploratory study confirms the important role of PET-FDG in the diagnosis and therapeutic management of patients with metastases of unknown primary.
Asunto(s)
Fluorodesoxiglucosa F18 , Neoplasias Primarias Desconocidas/diagnóstico por imagen , Tomografía de Emisión de Positrones , Proteínas de Unión al ADN/análisis , Humanos , Radiografía Torácica , Tomografía Computarizada por Rayos X , Factores de TranscripciónAsunto(s)
Absceso/diagnóstico por imagen , Puente de Arteria Coronaria/efectos adversos , Leucocitos/diagnóstico por imagen , Osteomielitis/diagnóstico por imagen , Infecciones Estafilocócicas/diagnóstico por imagen , Esternón/diagnóstico por imagen , Exametazima de Tecnecio Tc 99m , Absceso/etiología , Absceso/patología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/etiología , Osteomielitis/patología , Radiografía , Cintigrafía , Radiofármacos , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/patología , Esternón/patología , Infección de la Herida Quirúrgica/diagnóstico por imagen , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/patologíaRESUMEN
This study sought to investigate whether the presence of right ventricular systolic dysfunction with pre-existing left ventricular systolic dysfunction is associated with higher plasma brain natriuretic peptide (BNP) levels, compared with patients with isolated left ventricular dysfunction. Eighty-five patients referred for evaluation of isotopic ventricular function were prospectively included in the study. Left (LVEF) and right (RVEF) ventricular ejection fractions were evaluated by gated blood pool scintigraphy and compared with plasma BNP levels. BNP correlated negatively with LVEF, except in patients with ischaemic heart disease (P=0.09) and in patients with LVEF<40% (P=0.11). In contrast, BNP levels correlated negatively with RVEF for all subgroups. Among patients with RVEF<40%, no significant BNP difference was found between patients with or without additional left ventricular systolic dysfunction (P=0.51). Among patients with LVEF<40%, plasma BNP levels were significantly higher in patients with RVEF<40% than in patients with RVEF>/=40% (P=0.004) whereas age, renal function, clinical findings, ventricular volumes, LVEF or medication were not significantly different. In conclusion, an important increase in BNP levels in patients with left ventricular systolic dysfunction should be considered by cardiologists as an indication of high risk of right ventricular dysfunction and should justify further investigation.