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Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis?

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Abstract

Functioning pulmonary metastases are the most common distant lesions of differentiated thyroid cancer. About 50% of patients with such metastases die within 10 years. The impact of iodine-131 therapy is controversial. In this study we examined: (1) the early diagnostic value of post-surgery 131I ablation for lung invasion and (2) the survival of patients receiving periodic 131I therapy. Between January 1970 and December 1995 we provided initial treatment for 509 patients with thyroid cancer. Most of them (74%) underwent total thyroidectomy and 131I ablation. Functioning pulmonary metastases occurred in 20 patients. All these patients received periodic 131I therapy for as long as 131I uptake persisted. Additional therapy consisted of lung surgery in three patients and local treatment of bone lesions in four patients. Follow-up data were recorded up to December 2001. Functioning pulmonary metastases occurred late in one patient, and were visible on the post-surgery 131I therapy scan in the other 19 patients. At diagnosis of lung invasion, 11 patients had negative chest X-ray findings, and serum thyroglobulin levels were not suggestive of metastatic disease in 56% of these cases. One of the 11 patients with negative chest X-ray findings died with a neck recurrence, two have persistent pulmonary 131I uptake, and the other eight are in apparent remission after receiving an average cumulative 131I activity of 338 mCi (12.51 GBq). The nine patients with positive chest X-ray findings received an average of 939 mCi (34.74 GBq); two of them died, five are continuing to receive therapy and two are in apparent remission. Overall survival at 10 years is 84%. The average follow-up of the 17 survivors is 12.7 years. These results suggest that patients with functioning pulmonary metastases, even in advanced stages, may survive for many years on 131I therapy. Early diagnosis, during post-surgery 131I scanning, of radiologically inapparent metastases is associated with a better prognosis.

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Acknowledgements

The authors are indebted to Professors Françoise Duron and Pierre Galle for their helpful comments.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France

    Elif Hindié, Claire de Labriolle-Vaylet & Serge Askienazy

  2. Department of Endocrine Surgery, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Didier Mellière

  3. Department of Pathology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Françoise Lange

  4. Department of Endocrinology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France

    Léon Perlemuter

  5. Nuclear Medicine, Hôpital Saint-Louis, Paris, France

    Iyad Hallaj

  6. Nuclear Medicine, Hôpital Universitaire d'Angers, Angers, France

    Christian Jeanguillaume

  7. Unit of Thoracic Surgery, Clinique du Sud, Thiais, France

    Jacques Lange

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  1. Elif Hindié
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  2. Didier Mellière
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  3. Françoise Lange
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  7. Jacques Lange
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Correspondence to Elif Hindié.

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Hindié, E., Mellière, D., Lange, F. et al. Functioning pulmonary metastases of thyroid cancer: does radioiodine influence the prognosis?. Eur J Nucl Med Mol Imaging 30, 974–981 (2003). https://doi.org/10.1007/s00259-003-1174-5

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  • DOI: https://doi.org/10.1007/s00259-003-1174-5

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