Recurrent differentiated thyroid cancer: towards personalized treatment based on evaluation of tumor characteristics with PET (THYROPET Study): study protocol of a multicenter observational cohort study

BMC Cancer

Jakob W Kist³  Bart de Keizer²  Marcel PM Stokkel³  Otto S Hoekstra¹  Wouter V Vogel³ 

[1] Department of Nuclear Medicine & PET research, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HZ, The Netherlands

[2] Department of Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands

[3] Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands

关键词: Thyropet;    Cross-calibration;    PET/CT;    ¹⁸F-FDG;    ¹²⁴I;    Recurrence;    Thyroid cancer;   

Others  :  858712
DOI  :  10.1186/1471-2407-14-405

 received in 2013-12-17, accepted in 2014-05-20,  发布年份 2014

【 摘 要 】

Background

After initial treatment of differentiated thyroid carcinoma (DTC) patients are followed with thyroglobulin (Tg) measurements to detect recurrences. In case of elevated levels of Tg and negative neck ultrasonography, patients are treated 'blindly' with Iodine-131 (¹³¹I). However, in up to 50% of patients, the post-therapy scan reveals no ¹³¹I-targeting of tumor lesions. Such patients derive no benefit from the blind therapy but are exposed to its toxicity. Alternatively, iodine-124 (¹²⁴I) Positron Emission Tomography/Computed Tomography (PET/CT) has become available to visualize DTC lesions and without toxicity. In addition to this, ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT detects the recurrent DTC phenotype, which lost the capacity to accumulate iodine. Taken together, the combination of ¹²⁴I and ¹⁸F-FDG PET/CT has potential to stratify patients for treatment with ¹³¹I.

Methods/Design

In a multicenter prospective observational cohort study the hypothesis that the combination of ¹²⁴I and ¹⁸F-FDG PET/CT can avoid futile ¹³¹I treatments in patients planned for ‘blind’ therapy with ¹³¹I, is tested.

One hundred patients planned for ¹³¹I undergo both ¹²⁴I and ¹⁸F-FDG PET/CT after rhTSH stimulation. Independent of the outcome of the scans, all patients will subsequently receive, after thyroid hormone withdrawal, the ¹³¹I therapy. The post ¹³¹I therapeutic scintigraphy is compared with the outcome of the ¹²⁴I and ¹⁸F-FDG PET/CT in order to evaluate the diagnostic value of the combined PET modalities.

This study primary aims to reduce the number of futile ¹³¹I therapies. Secondary aims are the nationwide introduction of ¹²⁴I PET/CT by a quality assurance and quality control (QA/QC) program, to correlate imaging outcome with histopathological features, to compare ¹²⁴I PET/CT after rhTSH and after withdrawal of thyroid hormone, and to compare ¹²⁴I and ¹³¹I dosimetry.

Discussion

This study aims to evaluate the potential value of the combination of ¹²⁴I and ¹⁸F-FDG PET/CT in the prevention of futile ¹³¹I therapies in patients with biochemically suspected recurrence of DTC. To our best knowledge no studies addressed this in a prospective cohort of patients. This is of great clinical importance as a futile ¹³¹I is a costly treatment associated with morbidity and therefore should be restricted to those likely to benefit from this treatment.

Trial registration

Clinicaltrials.gov identifier: NCT01641679

【 授权许可】

   
2014 Kist et al.; licensee BioMed Central Ltd.

【 图 表 】

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