A randomized controlled trial for the use of Thymus Honey indecreasing salivary gland damage following radioiodine therapy for Thyroid cancer: research protocol

Aim: To test the effectiveness of thymus honey as a complementary intervention for decreasing the salivary gland damage due to Radioiodine (131I) therapy. Background: Radioiodine is the treatment of choice in people diagnosed with thyroid cancer following total thyroidectomy. Although its value has been acknowledged in eradicating remnant thyroid tissue and treating residual disease in patients with visible, inoperable, iodine-avid metastases, it has been associated with various salivary gland side effects. Design: This is a randomized controlled trial with a 2×3 mixed between-within subjects design. Methods: In total, 120 participants of postsurgical differentiated thyroid cancer, who will be referred to this centre for 131I therapy to ablate the remnant thyroid tissue or to treat metastatic tumour, will be prospectively studied under varying regimens of lemon candy (standard treatment) and thymus honey mouthwashes (experimental intervention). Patients will be randomized in four equally numbered groups based on the assumptions and hypothesis of the study. The recruiting process will be informed by predefined inclusion and exclusion criteria. Mixed statistical modelling will be adopted taking into consideration between and within subjects' effects and repeated measures. Discussion: The recommended intervention protocol is expected to improve the comprehensive management of salivary gland-related side effects induced by the radioiodine treatment in people diagnosed with thyroid cancer. Through the methodological approach chosen, the ideal intervention protocol in terms of the time to initiate the intervention and the frequency of the intervention to acquire optimal results in minimizing salivary glands damage will be tested

Positron emission tomography in breast cancer: 18F- FDG and other radiopharmaceuticals

Abstract Background Breast cancer heterogeneity reflects the complex biology of this disease. Breast cancer subtypes, as identified either by immunohistochemistry (IHC) or by gene expression analysis, present different molecular characteristics and prognosis. In this context, molecular imaging techniques providing functional information, contribute in evaluating response to treatment and long-term prognosis among different subtypes. Nuclear imaging diagnosis modalities play an important role for conducting research on cancer biology and developing new treatment approaches. Positron Emission Tomography (PET) is a radionuclide based imaging method that has the potential to locate the tumor, define its staging, and monitor its response to treatment. Results In the current study, we will review the utility of the most widely used molecular imaging technique, 18F-fluorodeoxyglucose (18F-FDG) PET, in order to determine the relationship between standardized uptake values (SUVs) and immunohistopathological factors, as well as to clarify whether PET is able to predict breast cancer phenotypes. Moreover, we will discuss the rising development of new radiopharmaceuticals in PET imaging, such as 18F-fluoro-17-estradiol (FES), 18F-fluoro-l-thymidine (FLT), 18F-fluoromisonidazole (FISO), and 89Zr-immuno-PET, which give more information about tumor characteristics. Conclusions In order to improve clinical decision making, enabling hereafter more successful individualized therapies, it is imperative to combine PET radiopharmaceuticals and imaging techniques of critical biologic and pathologic phenomena, including ER, PR and HER2 expression, angiogenesis, hypoxia, apoptosis and metabolic changes in the microenviroment of breast tumors

RET Proto-Oncogene Variants in Patients with Medullary Thyroid Carcinoma from the Mediterranean Basin: A Brief Report

Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant (AD) condition with very high penetrance and expressivity. It is characterized into three clinical entities recognized as MEN2A, MEN2B, and familial medullary thyroid carcinoma (FMTC). In both MEN2A and MEN2B, there is a manifestation of multicentric tumor formation in the major organs such as the thyroid, parathyroid, and adrenal glands where the RET proto-oncogene is expressed. The FMTC form differs from MEN2A and MEN2B, since medullary thyroid carcinoma (MTC) is the only feature observed. In this present brief report, we demonstrate a collection of RET proto-oncogene genotype data from countries around the Mediterranean Basin with variable characteristics. As expected, a great extent of the Mediterranean RET proto-oncogene genotype data resemble the data reported globally. Most interestingly, higher frequencies are observed in the Mediterranean region for specific pathogenic RET variants as a result of local prevalence. The latter can be explained by founder effect phenomena. The Mediterranean epidemiological data that are presented herein are very important for domestic patients, their family members’ evaluation, and ultimately their treatment

Clinical Studies of Nonpharmacological Methods to Minimize Salivary Gland Damage after Radioiodine Therapy of Differentiated Thyroid Carcinoma: Systematic Review

. Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000-10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly ( < 0.0001, < 0.05, < 0.10, and < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly ( < 0.001). Additionally, vitamin C had some limited effect ( = 0.37), whereas no effect was present in the case of chewing gum ( = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions

Clinical Studies of Nonpharmacological Methods to Minimize Salivary Gland Damage after Radioiodine Therapy of Differentiated Thyroid Carcinoma: Systematic Review

Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000-10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly (p < 0.0001, p < 0.05, p < 0.10, and p < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly (p < 0.001). Additionally, vitamin C had some limited effect (p = 0.37), whereas no effect was present in the case of chewing gum (p = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions

A Neck-Thyroid Phantom with Small Sizes of Thyroid Remnants for Postsurgical I-123 and I-131 SPECT/CT Imaging

Post-surgical I-123 and I-131 SPECT/CT imaging can provide information on the presence and sizes of thyroid remnants and/or metastasis for an accurate re-staging of disease to apply an individualized radioiodine therapy. The purpose of this study was to develop and validate a neck–thyroid phantom with small sizes of thyroid remnants to be utilized for the optimization of post-surgical SPECT/CT imaging. 3D printing and molding techniques were used to develop the hollow human-shaped and -sized phantom which enclosed the trachea, esophagus, cervical spine, clavicle, and multiple detachable sections with different sizes of thyroid remnant in clinically relevant positions. CT images were acquired to evaluate the morphology of the phantom and the sizes of remnants. Triple-energy window scattered and attenuation corrected SPECT images were acquired for this phantom and for a modified RS-542 commercial solid neck–thyroid phantom. The response and sensitivity of the SPECT modality for different administered I-123 and I-131 activities within the equal-size remnants of both phantoms were calculated. When we compared the phantoms, using the same radiopharmaceutical and similar activities, we found that the measured sensitivities were comparable. In all cases, the I-123 counting rate was higher than the I-131 one. This phantom with capabilities to insert different small sizes of remnants and simulate different background-to-remnants activity ratios can be utilized to evaluate postsurgical thyroid SPECT/CT imaging procedures