PMID- 38214553
OWN - NLM
STAT- Publisher
LR  - 20240112
IS  - 1945-7197 (Electronic)
IS  - 0021-972X (Linking)
DP  - 2024 Jan 12
TI  - Optimal Cumulative I-131 Activity in Metastatic Differentiated Thyroid Cancer: 
      Balancing Efficacy and Adverse Events.
LID - dgae024 [pii]
LID - 10.1210/clinem/dgae024 [doi]
AB  - BACKGROUND: The optimal cumulative activity (CA) of I-131 therapy for patients 
      with metastatic differentiated thyroid cancer (mDTC) remains contentious. This 
      study aimed to determine the maximum CA of I-131 that could be administered 
      without a significant increase in adverse events (AEs) by analyzing a long-term 
      cohort of patients. METHODS: Data from mDTC patients treated with I-131 therapy 
      and followed for at least two years from 1967 to 2019 were reviewed. Patients 
      were categorized into three groups based on the received CA: Group-A (</=600mCi), 
      Group-B (>600-1000mCi), and Group-C (>1000mCi). The study assessed long-term AEs 
      and survival outcomes. RESULTS: The study included 671 adult mDTC patients (mean 
      age 48 years, range: 19-81) with a median follow-up of 122 months (IQR: 82-180). 
      Group A, Group B, and Group C comprised 269 (40.0%), 212 (31.6%), and 190 (28.4%) 
      patients, respectively. Ten-year survival rates were 72%, 42.7%, and 29% in 
      Groups A, B, and C, respectively. A total of 40/671 (6%) AEs were observed in 38 
      patients: 3 (1.1%), 12 (5.7%), and 25 (13.2%) in Groups A, B, and C, 
      respectively. Five patients developed second primary malignancy (SPM): 3 in Group 
      A and one each in Group B and C. However, CA >1000mCi of I-131 was associated 
      with significant increase in bone marrow suppression, decreased pulmonary 
      function, and xerostomia (p < 0.001). CONCLUSIONS: The study suggests that a 
      maximum CA of up to 1000mCi strikes a favorable balance between keeping AEs low 
      and benefiting a subset of patients with extensive metastases showing intense 
      I-131 concentration.
CI  - (c) The Author(s) 2024. Published by Oxford University Press on behalf of the 
      Endocrine Society. All rights reserved. For permissions, please e-mail: 
      journals.permissions@oup.com.
FAU - Bharadwaj, Mangu Srinivas
AU  - Bharadwaj MS
AD  - Department of Nuclear Medicine, All India Institute of Medical Sciences, New 
      Delhi-110029.
FAU - Ballal, Sanjana
AU  - Ballal S
AD  - Department of Nuclear Medicine, All India Institute of Medical Sciences, New 
      Delhi-110029.
FAU - Bal, Chandrasekhar
AU  - Bal C
AUID- ORCID: 0000-0003-4378-5584
AD  - Department of Nuclear Medicine, All India Institute of Medical Sciences, New 
      Delhi-110029.
LA  - eng
PT  - Journal Article
DEP - 20240112
PL  - United States
TA  - J Clin Endocrinol Metab
JT  - The Journal of clinical endocrinology and metabolism
JID - 0375362
SB  - IM
OTO - NOTNLM
OT  - Differentiated Thyroid Cancer
OT  - adverse events
OT  - cohort study
OT  - cumulative I-131 activity
OT  - long-term outcome
OT  - metastatic disease
EDAT- 2024/01/12 12:41
MHDA- 2024/01/12 12:41
CRDT- 2024/01/12 09:23
PHST- 2023/10/10 00:00 [received]
PHST- 2023/12/29 00:00 [revised]
PHST- 2024/01/09 00:00 [accepted]
PHST- 2024/01/12 12:41 [medline]
PHST- 2024/01/12 12:41 [pubmed]
PHST- 2024/01/12 09:23 [entrez]
AID - 7517595 [pii]
AID - 10.1210/clinem/dgae024 [doi]
PST - aheadofprint
SO  - J Clin Endocrinol Metab. 2024 Jan 12:dgae024. doi: 10.1210/clinem/dgae024.