ПРИНЦИПЫ МАРТИНИКИ В РАДИОЙОДТЕРАПИИ ДИФФЕРЕНЦИРОВАННОГО РАКА ЩИТОВИДНОЙ ЖЕЛЕЗЫ

The latest recommendations of the American Thyroid Association have caused serious disagreements between the  nuclear medicine and endocrinologist communities regarding the radioactive iodine use. In 2018 eighteen experts  from 8 countries and 4 leading organizations (ATA, EANM, SNMMI and ETA) met for the first time to establish mutual understanding in the role of radioiodine therapy for differentiated thyroid cancer. After much discussion and exchange of experience, the participants developed a consensus document based on the so-called nine principles of  Martinique. We present an overview of the article published 2019 in Thyroid, entitled «Controversies, consensus, and collaboration in the use of 131I therapy in differentiated thyroid cancer: a joint statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association».Последние рекомендации Американской тиреоидологической ассоциации 2015 г. вызвали серьезные разногласия между сообществами ядерной медицины и эндокринологов относительно применения радиоактивного йода. С целью установления взаимопонимания относительно роли радиойодтерапии дифференцированного рака щитовидной железы (ДРЩЖ) в 2018 г. состоялась первая встреча 18 экспертов из 8 стран и 4 ведущих организаций (ATA, EANM, SNMMI и ETA). После долгих дискуссий и обмена опытом участниками конференции был разработан консенсусный документ, в основу которого легли так называемые девять принципов Мартиники. Представляем обзор статьи, опубликованной в журнале «Thyroid» в 2019 г., под названием «Споры, консенсус и сотрудничество в использовании 131I при ДРЩЖ: совместное заявление Американской тиреоидологической ассоциации, Европейской ассоциации ядерной медицины, Общества ядерной медицины и молекулярной визуализации и Европейской тиреоидологической ассоциации»

The use of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in patients with differentiated thyroid cancer after initial treatment

Establishment of new centers for nuclear medicine in our country made diagnostic and treatment procedures more accessible for patients with differentiated thyroid cancer (DTC). It includes radioiodine therapy, considered as a non-alternative method of treatment, and positron emission tomography combined with computed tomography (PET/CT), which is essential in some clinical cases. For many years suspected tumor relapse with increased level of thyroglobulin and negative radioiodine scan was the only indication for PET/CT use among patients with DTC. But over the last decade the indications for PET/CT use in DTC cases expanded significantly. This review is aimed to analyze currently available data on PET/CT in DTC patients, its indications for use, advantages and limitations, new trends and recommendations

Diagnostic features of lung metastases differentiated thyroid cancer

Background. The worldwide increasing incidence of thyroid cancer (TC) is mainly due to a rise in its major form of differentiated TC (DTC): papillary. Most patients with DTC have a good prognosis; 10-year survival overall rates are as high as 85 %, but not greater than 40 % in a group of patients with distant metastases. At the same time, the lung is the most frequent target for distant metastases, accounting for 70 % of all sites.Objective: to estimate and compare the capabilities of different diagnostic techniques to detect lung metastases of DTC. Materials and methods. The results of diagnosing lung metastases were retrospectively analyzed in 36 patients (33 women and 3 men; mean age 53 years) with DTC (29 patients with papillary TC and 7 with follicular TC) treated at the department of radiotherapy with systemic therapy, Chelyabinsk Regional Clinical Oncology Center from 2011 to 2014.Results. Chest X-ray could reveal pulmonary metastases in 13 (36 %) patients; lung pathology foci were absent in 23 (64 %) patients. 131I whole-body scintigraphy (WBS) proved to be of informative value in 24 (66.7 %) patients, it displayed no increased accumulation of the radiopharmaceutical in the lung of 12 (33.3 %) cases. Multislice spiral computed tomography (MSCT) of the chest was carried out in 22 (61 %) patients; out of them 21 (95.5 %) were found to have 1.4-to-20-mm lung cancer foci. 18Fluorodeoxyglucose (18FDG) positron emission tomography / computed tomography (PET / CT) was performed in 18 (50 %) patients, which showed 3–26-mm lung pathology foci in all the patents; out of them 16 (88.9 %) were detected to have metastases owing to the CT component of this method. Thus, the highest sensitivity was exhibited by MSCT (95.5 %), 18FDG PET / CT (100 % due to its CT component), and 131I WBS (66.7 %).Conclusion. When lung metastases of DTC are suspected, 1) chest X-ray should be used as a screening test; 2) 131I WBS should be performed in all patients; 3) MSCT of the chest is the gold standard for diagnosis; 4) 18FDG PET / CT should not be employed in routine practice

Experience in the use of targeted therapy in patients with radio-resistant forms of thyroid cancer in the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine

Radioiodine therapy of metastatic differentiated thyroid cancer is a highly effective method of treatment which makes it possible to achieve the complete cure of the majority of patients, however in some cases radioiodine refractory type develops, it leads to significant deterioration in overall and relapse-free survival. The article presents own experience of the therapy of radioiodine refractory thyroid cancer by the nexavar (sorafenib)

¹⁸F-fluorodeoxyglucose positron emission tomography combined with computed tomography for the prediction of radioiodine therapy response in patients with metastatic differentiated thyroid cancer

The study objective was to investigate the role of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography combined with computed tomography (PET-CT) as an indirect determination of the differentiation status of metastases and for the prediction of radioactive iodine (RAI) therapy response in patients with metastatic differentiated thyroid cancer.Materials and methods. The 40 metastatic differentiated thyroid cancer patients were enrolled in the study that underwent both post-therapeutic radioiodine scan and PET-CT at the same period.Results. The study found that 12 (30 %) patients responded to RAI therapy. The remaining 28 (70 %) patients not responded to RAI therapy showed stabilization or progression. The accumulation of radioiodine by metastases positively correlated with the total response rate, while the 18 F-FDG avidity is negative. Significant direct correlation with response rate was observed in the group with only radioiodine uptake. However, this correlation was not observed in the patients with both tracers uptake. The patients with 18 F-FDG-positive metastases showed poor response to RAI therapy, regardless of the degree of radioiodine uptake.Conclusion. The 18 F-FDG uptake by metastases is a predictor of a poor response to RAI therapy, even in the presence of RAI uptake. The use of 18 F-FDG PET-CT in patients with metastatic differentiated thyroid cancer can be recommended at the beginning of RAI therapy to clarify the prognosis and provide a personalized approach to the treatment and observation of the most difficult category of patients