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. 2017:2017:9807543.
doi: 10.1155/2017/9807543. Epub 2017 Oct 19.

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

Eleonora Farina  1 , Fabio Monari  1 , Paolo Castellucci  2 , Fabrizio Romani  3 , Andrea Repaci  4 , Arianna Farina  2 , Giuseppe Zanirato Rambaldi  5 , Giovanni Frezza  6 , Renzo Mazzarotto  7 , Silvia Cammelli  1 , Luca Tagliaferri  8 , Rosa Autorino  8 , Francesco Deodato  9 , Gabriella Macchia  9 , Savino Cilla  10 , Vincenzo Valentini  8 , Stefano Fanti  2 , Alessio G Morganti  1
Affiliations

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

Eleonora Farina et al. J Thyroid Res. 2017.

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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Figures

Figure 1
Figure 1
79-year-old man with metastasis ahead the trachea from classic variant PTC previously treated with surgery and RAI. (a, b, c) Pre-EBRT focal uptake (19 mm  ×  18 mm) shown with 18F FDG PET/CT (SUVmax 6.5), CT, and MIP-scan images, respectively. (d, e, f) Disappearance of the lesion showed with post-EBRT 18F FDG PET/CT, CT, and MIP-scan images, respectively.
Figure 2
Figure 2
Actuarial progression-free survival (PFS) and actuarial overall survival (OS).
See this image and copyright information in PMC

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