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to establish the probability of a structural incomplete response (SIR) [ 18 ], which made it necessary to create a risk of recurrence (RR) stratification system that was validated in several cohorts of patients around the world [ 18 , 19 , 20 , 21
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. Structural incomplete response: structural or functional evidence of disease with any Tg level, with or without anti-Tg Ab. Indeterminate response: nonspecific biochemical or structural findings that cannot be confidently classified as either benign or
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Background
Second 131I treatment is commonly performed in clinical practice in patients with differentiated thyroid cancer and biochemical incomplete or indeterminate response (BiR/InR) after initial treatment.
Objective
The objective of the is study is to evaluate the clinical impact of the second 131I treatment in BiR/InR patients and analyze the predictive factors for structural incomplete response (SiR).
Patients and methods
One hundred fifty-three BiR/InR patients after initial treatment who received a second 131I treatment were included in the study. The clinical response in a short- and medium- long-term follow-up was evaluated.
Results
After the second 131I treatment (median 8 months), 11.8% patients showed excellent response (ER), 17% SiR, while BiR/InR persisted in 71.2%. Less than half (38.5%) of SiR patients had radioiodine-avid metastases. Patients who, following the second 131I treatment, experienced SiR had larger tumor size and more frequently aggressive histology and vascular invasion than those experienced BiR/InR and ER. Also, the median values of thyroglobulin on levothyroxine therapy (LT4-Tg), Tg peak after recombinant human TSH stimulation (rhTSH-Tg) and thyroglobulin antibodies (TgAb) were significantly higher in patients who developed SiR. At last evaluation (median: 9.9 years), BiR/InR persisted in 57.5%, while 26.2% and 16.3% of the patients showed ER and SiR, respectively. About half of BiR/InR patients (71/153 (46.4%)) received further treatments after the second 131I treatment.
Conclusions
Radioiodine-avid metastatic disease detected by the second 131I is an infrequent finding in patients with BiR/InR after initial treatment. However, specific pathologic and biochemical features allow to better identify those cases with higher probability of developing SiR, thus improving the clinical effectiveness of performing a second 131I treatment.
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findings, or (4) a structural incomplete response if they had structural evidence of disease regardless of Tg or TgAb levels. Patients who received a total thyroidectomy without RAI ablation were classified as having: (1) an excellent response if they
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patient based on the response to initial therapy (excellent, indeterminate, biochemical incomplete and structural incomplete response) using Preablation thyroglobulin (pTg), preablation AntiTg antibodies (pAntiTgAb), ultrasonography (US), diagnostic whole
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disease; a structural incomplete response if there were persistent or newly identified loco-regional or distant metastases and, finally, an indeterminate response if there were non-specific biochemical or structural findings that could not be confidently
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initial management, 5 (4.4%) patients were in an excellent response, 24 (21.1%) in an indeterminate response, 15 (13.2%) in a biochemically incomplete response, and 70 (61.4%) in a structurally incomplete response (online suppl. Table 3). The response to
Institute of Pathology, University Hospital Halle (Saale), Halle (Saale), Germany
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the percentages of indeterminate response, structural incomplete response, and biochemical incomplete response, or the mean and median follow-up time. Analysis B included 44 patients distinct from those included in Analysis A; 42 of these patients
Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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Endocrinology Service, Department of Medicine, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
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(c) structural incomplete response – persistent/recurrent structural disease regardless of calcitonin and CEA. To determine the final status, at the end of the follow-up period the patients were categorized as (a) free of disease – undetectable
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response initially did so. On follow-up, 40.1% of the patients, who were in the indeterminate category initially also had NED. Among the patients with structural incomplete response, 57.1% remained as PSD. Only 9.1% of patients, who had biochemical