¹⁸F-FDG Pet-Guided External Beam Radiotherapy in Iodine-Refractory Differentiated Thyroid Cancer: A Pilot Study.

IF 1.7 Q4 ENDOCRINOLOGY & METABOLISM Journal of Thyroid Research Pub Date : 2017-01-01 Epub Date: 2017-10-19 DOI:10.1155/2017/9807543

Eleonora Farina, Fabio Monari, Paolo Castellucci, Fabrizio Romani, Andrea Repaci, Arianna Farina, Giuseppe Zanirato Rambaldi, Giovanni Frezza, Renzo Mazzarotto, Silvia Cammelli, Luca Tagliaferri, Rosa Autorino, Francesco Deodato, Gabriella Macchia, Savino Cilla, Vincenzo Valentini, Stefano Fanti, Alessio G Morganti

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引用次数: 4

Abstract

Introduction: To evaluate the clinical response rate after a postoperative ¹⁸F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer.

Material and methods: Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment ¹⁸F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A ¹⁸F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment.

Results: Sixteen consecutive patients were included in this analysis (median follow-up: 6-44 months). Post-EBRT ¹⁸F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4-93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%.

Conclusions: ¹⁸F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with ¹³¹I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.

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18F-FDG pet引导外束放射治疗碘难治性分化甲状腺癌的初步研究。

目的:评价18F-FDG PET/CT引导下外束放疗(EBRT)治疗碘难治性分化型甲状腺癌术后的临床有效率。材料与方法:纳入甲状腺癌全切除术加代谢放疗后局部复发并行根治性EBRT治疗的患者。纳入标准为甲状腺球蛋白(Tg)检测，代谢放疗后全身显像阴性，无手术指征。预处理18F-FDG PET/CT结果均为阳性(喉、淋巴结和肺)。采用IMRT-SIB技术给予EBRT。治疗3个月后进行18F-FDG PET/CT重估和Tg剂量。结果:16例连续患者纳入本分析(中位随访:6-44个月)。ebrt后18F-FDG PET/CT显示CR为43.7%，PR为31.2%，SD为25.0%，肺转移所致PD为12.5%。总有效率为75.0% (CI 95%: 41.4-93.3%)。Tg水平下降75.0%，中位Δ为68.0%。2年PFS和OS分别为80.0%和93.0%。急性G3毒性为18.7%，晚期G2毒性为12.5%。结论:18F-FDG PET/CT可用于放疗计划的靶区定义，识别131I显像未检测到的阳性区域。基于IMRT的EBRT是可行的，我们的结果鼓励未来的前瞻性研究。本临床试验注册编号:NCT03191643。

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