Summary of Data from Studies of Empiric High-Dose 131I Treatment in Patients with Tg+ WBS− Metastases
| Reference | Histology (no. of patients) | No. of patients studied | No. of patients with Tg+ DWBS− metastases and treated empirically | Duration of follow-up | Diagnostic dose (MBq) | Therapeutic dose (MBq) | No. (%) of PTWBS+ patients | Results and outcome |
|---|---|---|---|---|---|---|---|---|
| 22 | 17 | 17 | In 12 patients, up to 2 y | 185 | 2.775 | 16 (94.1) | At last follow-up, serum Tg (Tg-off?) was decreased in 7 patients and increased in 1 patient | |
| 13 | 17 | 17 | 6 mo–5 y | 55.5–185 | 5,550–11,100 | 16 (94.1) | Decreased Tg-off in 13 of 16 patients after first empiric treatment and in 5 patients receiving third empiric dose; Tg-off never became undetectable | |
| 10 | P | 70 | 42 | 6.7 ± 3.8 y (mean ± SD) | 185 | 3,330–5,550 | 30 (71): C (3), N (18), L + N (9) | Undetectable or decreased Tg-off in 19 of 30 and 2 of 12 patients with PTWBS+ and PTWBS−, respectively; undetectable, decreased, and unchanged or increased Tg-off in 19, 6, and 3 untreated patients, respectively |
| 15 | 10 | 10 | 2–4 y | 166.5 | 3.700–7,400 | 8 (80) | PTWBS− and Tg-off of <5 ng/mL in 3 patients | |
| 11 | 22 | 16 | 1 y | No data | 7,400 | 11 (69) | Decreased Tg-off in 9 patients with PTWBS+ and in 3 patients with PTWBS−; Tg-off never became undetectable | |
| 36 | P (18), F (5), H (1) | 24 | 24 | 6–33 mo | 111 | 7,400 | 6 (25): L (1), C (1), M + C (1), thyroid bed (2), tracheostomy site (1) | Tg-on measured after 131I treatment was decreased in 5 patients and increased in 18 patients; 5 patients died—4 of them had PTWBS− and 1 had partial PTWBS− (no uptake in bone metastases) |
| 21 | P (32), F (14), H (10) | 56 | 56 | 4.5 ± 2.9 y (mean ± SD) | No data | 5,550 | 28 (50) | Complete remission was achieved ultimately in 18 of 28 patients with PTWBS+ and 10 of 28 with PTWBS−; no change in Tg-on measured before 131I treatment and Tg-on measured after 131I treatment in both groups |
| 51 | P (20), F (1) | 21 | 11 | 1.5–34 mo | 7.3 ± 1.8 (mean ± SD) | 119 ± 42 (mean ± SD) | 7 (63.6): N (4), M (2), L (1) | No data |
| 52 | 61 | 11 | Not given | No data | No data | 8 (73) | No follow-up data in PTWBS+ patients; 1 of 3 patients with PTWBS− had progressive disease within 5 mo | |
| 53 | 39 | 39 | Up to 15 mo | No data | No data | 22 (60) | Tg-on measured after 131I treatment was decreased in PTWBS+ group (P = 0.035) and increased in PTWBS− group (P = 0.006); follow-up by radiologic response showed better result (P = 0.049) in PTWBS+ group; no data about clinical outcome | |
| 14 | P | 60 | 28 | 23.8 ± 19.6 mo (mean ± SD) | 148 | 5,550 | 12 (42.9): L (2), C (8), C + M (2) | Decreased Tg-off in 16 patients with PTWBS+; percentage decreases in both Tg-on and Tg-off in treated group were significantly higher than those in untreated group (P < 0.001) |
| 32 | P (18), F (3), H (4), tall cell (2) | 27 | 27 | 6.3 ± 5.8 y (mean ± SD) | 185 | 5,550–11,100 | 19 of 24 (79) | Serum Tg levels were decreased in 8 of 16 patients (50%); among patients with micrometastases, 5 of 7 (71%) demonstrated decreased serum Tg levels; among patients with macrometastases, 3 of 9 (33%) demonstrated decreased Tg levels, and 3 (33%) died as a result of metastatic thyroid cancer |
| 19 | P (15), F (11) | 26 | 16 | 3.7 ± 1.2 y (mean ± SD) | 185 | 3,330–5,550 | 11 (68.75): C (4), L (6), B (1) | Decreased Tg-off in 14 patients in treated group; increased or unchanged Tg-off in 9 patients in untreated group; Tg-off measured after 131I treatment was significantly lower than Tg-off measured before 131I treatment in both groups (P < 0.05) |
| Total no. (%) | 337 | 194 of 314 (62) | 171 of 271 (63) |
P = papillary thyroid carcinoma; F = follicular thyroid carcinoma; H = HCC; C = cervical uptake; N = lymph node uptake; L = lung uptake; M = mediastinum uptake; B = bone uptake.