Rare renal metastases from differentiated thyroid carcinoma: early clinical detection and treatment based on radioiodine

Qiu, Zhong-Ling; Xue, Yan-Li; Luo, Quan-Yong

doi:10.1590/0004-2730000002913

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artigos originais • Arq Bras Endocrinol Metab 58 (3) • Apr 2014 • https://doi.org/10.1590/0004-2730000002913 copy

Rare renal metastases from differentiated thyroid carcinoma: early clinical detection and treatment based on radioiodine

Metástases renais raras de carcinoma diferenciado da tireoide: detecção clínica precoce e tratamento com radioiodoterapia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

: The aim of this study was to explore the clinical characteristics of renal metastatic cancer, the methods for its detection by radioiodine (¹³¹I), and the response to ¹³¹I treatment in fourteen patients with renal metastases from differentiated thyroid carcinoma (DTC).

Subjects and methods

: DTC patients (n = 2,955) that received treatment with ¹³¹I were retrospectively analyzed. Scans (¹³¹I-WBS, ³¹I-SPECT/CT and/or ¹⁸F-FDG-PET/CT) were performed after an oral therapeutic dose of ¹³¹I. Therapeutic efficacy was evaluated based on changes in Tg and anatomical imaging changes at renal lesions.

Results

: Among these 14 patients, 11 had avidity for ¹³¹I, but three patients did not accumulate ¹³¹I after ¹³¹I treatment. In the 11 ¹³¹I-positive renal lesions, 10 cases were detected by ¹³¹I-SPECT/CT combined with another imaging modality and one case by ¹³¹I-WBS combined with ultrasonography (US). In the three ¹³¹I-negative renal lesions, two cases were detected by 18F-FDG-PET/CT and one case by computed tomography (CT). In 11 patients with ¹³¹I-avid renal metastases, Serum Tg levels in 81.82% (9/11) patients showed a gradual decline, and 18.18% (2/11) of the patients showed a significant elevation. There was no marked difference in serum Tg before the last ¹³¹I treatment (Z = 0.157; p = 0.875). Only one patient presented partial response, eight patients exhibited stable disease, and renal metastases progressed in two patients showing progressive disease. No patients reached complete response.

Conclusion

: ¹³¹I-SPECT/CT, combined with another imaging modality after ¹³¹I-WBS, can contribute to the early detection of renal metastases of DTC. ¹³¹I therapy is a feasible and effective treatment for most DTC renal metastases with avidity for ¹³¹I. Arq Bras Endocrinol Metab. 2014;58(3):260-9

Differentiated thyroid cancer; renal metastases; radioiodine therapy; ¹³¹I-SPECT/CT; ¹⁸F-FDG-PET/CT

Patient No	Sex	Age of total thyroidectomy(years)	Age of diagnosing renal metastases of DTC	Years after detection of primary tumor (years)	Histology	Other synchronous distant metastases	Detecting modality	Confirmation modality	Localization of renal metastases	(diameter) cm)	Symptoms	NO. of RIT courses	131	131
1	F	51	65	14.3	F	Lungs, bones, liver	¹³¹I-WBS, ultrasonography	FNAB	Left	5.2	Low back pain	8	Yes	59.2
2	F	25	34	9.2	P	Lungs, mediastinum	¹³¹I-SPECT/CT, MRI	FNAB	Left	1.2	No	6	Yes	40.7
3	M	29	29	0.4	P	Lungs, erector spinae	¹³¹I-SPECT/CT, enhanced CT	Follow-up	Right	0.9	No	5	Yes	35.15
4	M	28	40	12.6	P	Lungs, mediastinum	¹³¹I-SPECT/CT, MRI	Follow-up	Left	0.6	No	7	Yes	49.95
5	F	43	51	8.1	F	Lungs and Bones	Biopsy, CT	FNAB	Left	3.1	Low back pain, hematuria	1	No	11.1
6	F	48	52	4.3	F	Lungs, bones	¹³¹I-SPECT/CT	FNAB	Right	1.8	No	5	Yes	35.15
7	M	34	35	1.2	F	Lungs	¹³¹I-SPECT/CT, MRI	Follow-up	Bilateral	L: 0.4 R: 0.6; 0.4	No	5	Yes	31.45
8	M	11	19	8.6	P	Lungs, bones	¹³¹I-SPECT/CT	FNAB	Bilateral	L: 3.2 R: 2.8	Hematuria	3	Yes	22.2
9	M	21	24	3.2	P	Lungs, bone	¹³¹I-SPECT/CT, ultrasonography	FNAB	Left	1.1	No	4	Yes	14.8
10	F	63	66	3.7	P	Lungs, bone	¹³¹I-SPECT/CT	FNAB	Left	3.3	No	3	Yes	12.95
11	M	57	62	5.4	F	Bones	¹⁸F-FDG-PET/CT,MRI	FNAB	Right	1.9	No	1	No	11.1
12	M	24	25	0.9	P	Mediastinum	¹³¹I-SPECT/CT, Ultrasonography	FNAB	Right	2.4	No	4	Yes	18.5
13	M	67	74	7.9	P	Brain, lungs, parapharyngeal, lung mediastinum	¹⁸F-FDG-PET/CT	FNAB	Left	2.3	Low back pain	1	No	22.2
14	F	30	31	1.4	P	–	¹³¹I-SPECT/CT, ultrasonography	Follow-up	Left	0.5	No	4	Yes	11.1

Patient nº	Stimulated Tg before first ¹³¹131I treatment(ng/mL)	131	131
1	8,752	6,923	PD
2	640.7	289	SD
3	567	19	SD
4	401	123	SD
6	5,463	6,376	SD
7	18,191	602	PR
8	17,016	31,701	PD
9	87	22	SD
10	39.38	22.64	SD
12	94	52	SD
13	13,562	17,817	PD
14	2.56	9.3	SD

No.	Author	Publication (year)	Age/sex	Histopathology	Diagnostic methods	Localization of renal metastases (size, cm)	Other synchronous distant metastases	Years
1	Borde and cols. (16)	2011	56/M	Papillary	¹³¹I-WBS, F-FDG PET, SPECT, CT, biopsy	Bilateral (L: 5.5; R: 1.4, 1.5)	–	–
2	Malhotra and cols. (17)	2010	30/M	Papillary	¹³¹I-SPECT/CT, biopsy	R (1.5)	Lungs, liver, bones, mediastinum, and adrenal	20
3	Djekidel and cols. (18)	2010	75/M	Hurthle cell	Biopsy	R (5)	Bone	9
4	Luo and cols. (19)	2008	29/M	Papillary	¹³¹I-SPECT/CT	R	Erector spinae	–
5	von Falck and cols. (20)	2007	64/F	Follicular	¹³¹I-SPECT/CT	L	Lungs and bone	20
6	Ahmed and cols. (7)	2006	24/F	Papillary	Ultrasonography	R (1.3)	–	26
7	Kumar and cols. (21)	2005	66/F	Follicular	¹³¹I-WBS, biopsy	L	Adrenal	–
8	Iwai and cols. (22)	2005	76/F	Follicular	CT, MRI, biopsy	R (3)	Muscle, lung	13
9	Liou and cols. (23)	2005	50/F	P/F	CT, biopsy	R (1.9)	Lungs, and bone	-
10	Inahara and cols. (24)	2002	66/M	Papillary	Hematuria, biopsy	Bilateral	–	11
11	Smallridge and cols. (25)	2001	61/F	Papillary	¹³¹I-WBS, CT	L (3)	Muscle	–
11	Smallridge and cols. (25)	2001	53/F	Papillary	CT	R (3.5)	Lungs	–
12	Garcia-Sanchis and cols. (26)	1999	65/F	Follicular	¹³¹I-WBS	L (10)	Lungs and bones	–
13	Benchekroun and cols. (27)	1999	56/M	Papillary	Low back pain	L (5.6)	–	3
14	Lam and cols. (28)	1996	91/F	Papillary	–	L (5)	–	-
15	Graham and cols. (29)	1995	75/M	P/F	IVP	L (7.7)	–	< 1
16	Ro and cols. (30)	1995	47/F	Follicular	Hematuria	R (1.2)	–	7
17	Tur and cols. (31)	1994	72/F	P/F	¹³¹I-WBS	Bilateral	Liver	3
18	Sardi and cols. (32)	1992	53/M	Papillary	Hematuria	R (12)	Lungs	7
19	Marino and cols. (33)	1991	-/ F	Follicular	²⁰¹T , ¹²³I scan	R	–	26
20	Johnson and cols. (34)	1982	66/F	Follicular	Hematuria	L	Lungs	37
21	Davis and Corson (35)	1979	49/F	Follicular	–	Bilateral (R: 3.5; L: 4.4)	–	18
22	Takayasu and cols. (36)	1968	44/F	Follicular	IVU	Bilateral	Bone	3

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[1] Correspondence to: Quan-Yong Luo Department of Nuclear Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai, 200233, P. R. China lqyn@sh163.net