[18F]FDG PET/CT can trigger relevant oncological management changes leading to favorable outcome in iodine-negative thyroid cancer patients

Endocrine, vol. 84, pp. 656–662

Abstract

Abstract Background In patients with iodine-negative thyroid cancer (TC), current guidelines endorse an [18F]FDG PET/CT to identify dedifferentiated sites of disease. We aimed to determine the rate of oncological management changes triggered by such a molecular imaging approach, along with the impact on outcome. Methods 42 consecutive patients with negative findings on [131I] whole body scan were scheduled for [18F]FDG PET/CT and treatment based on PET results were initiated. To determine the impact on oncological management, we compared the therapeutic plan prior to and after molecular imaging. Based on imaging follow-up, the rate of controlled disease (CD, defined as stable disease, complete or partial response) was also recorded, thereby allowing to assess whether [18F]FDG-triggered management changes can also lead to favorable outcome. Results We observed no alterations of the treatment plan in 9/42 (21.4%) subjects (active surveillance in 9/9 [100%]). Oncological management was changed in the remaining 33/42 (78.6%; systemic treatment in 9/33 [27.3%] and non-systemic treatment in 24/33 [72.7%]). Among patients receiving non-systemic therapy, the following changes were noted: surgery in 20/24 (83.3%) and radiation therapy in 4/24 (16.7%). In the systemic group, tyrosine kinase inhibitor (TKI) was prescribed in 8/9 (88.9%), while radioiodine therapy based on a TKI-mediated redifferentiation approach was conducted in 1/9 (11.1%). In 26 subjects with available follow-up, rate of CD was 22/26 (84.6%) and among those, 15/22 (68.1%) had experienced previous management changes based on PET/CT findings. Conclusions In subjects with iodine-negative TC, [18F]FDG PET/CT triggered relevant management changes along with disease control in the vast majority of patients. As such, in dedifferentiated TC, [18F]FDG PET/CT may serve as a relevant management tool and therapeutic decision-aid in the clinic.

Authors 9

1. Yingjun Zhi

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany

2. Takahiro Higuchi

   Okayama University · Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

   Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan

3. Stephan Hackenberg Aachen Department of Otorhinolaryngology, Head and Neck Surgery

   Universitätsklinikum Würzburg · RWTH Aachen University

   Affiliation as printed

   Department of Otorhinolaryngology - Head and Neck Surgery, RWTH Aachen University, Aachen, Germany

   Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany

4. Rudolf Hagen

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany

5. Manuel Stöth

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany

6. Agmal Scherzad

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany

7. Andreas Konrad Buck

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

8. Rudolf Alexander Werner

   Johns Hopkins University · Johns Hopkins Medicine · Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

   Johns Hopkins School of Medicine, The Russell H Morgan Department of Radiology and Radiological Science, Baltimore, MD, USA

9. Sebastian E. Serfling corresponding

   Universitätsklinikum Würzburg

   Affiliation as printed

   Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany. serfling_s1@ukw.de

   Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany