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Nuklearmedizin 2020; 59(05): 356-364
DOI: 10.1055/a-1177-9728
Original Article

Impact of FDG-PET on therapy management and outcome of differentiated thyroid carcinoma patients with elevated thyroglobulin despite negative iodine scintigraphy

Die Bedeutung der FDG-PET für das Therapiemanagement und Outcome von Patienten mit differenziertem Schilddrüsenkarzinom und negativer Iodszintigrafie
Marie Carolin Schleupner
1   University of Münster Faculty of Medicine, Münster, Nordrhein-Westfalen, Germany
,
Burkhard Riemann
2   University Hospital Münster, Nuclear Medicine, Albert-Schweizer-Campus 1, Münster, Germany
,
Michael Schäfers
2   University Hospital Münster, Nuclear Medicine, Albert-Schweizer-Campus 1, Münster, Germany
,
Philipp Backhaus‡
2   University Hospital Münster, Nuclear Medicine, Albert-Schweizer-Campus 1, Münster, Germany
,
Alexis Vrachimis‡
2   University Hospital Münster, Nuclear Medicine, Albert-Schweizer-Campus 1, Münster, Germany
3   Current address: Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
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Abstract

Aim The objective of this study was to assess the impact of implementing FDG-PET imaging in treatment algorithms for differentiated thyroid cancer with suspected recurrence. Primary end points were overall, event-free and disease-specific survival. Secondary end points were therapies, disease control and the sensitivity and specificity of PET imaging.

Methods 194 patients with DTC treated at our center from 1996 to 2014 following thyroidectomy and routine 131I ablation with no remaining 131I uptake in whole-body scans but persisting or rising thyroglobulin values were enrolled in this retrospective analysis. Of these, 149 (76.8 %) received an 18F-FDG scan (PET group) whereas the remaining 45 patients (23.2 %) did not (non-PET group). Survival, disease-specific characteristics at inclusion, disease control and therapies were compared.

Results Patients of the PET group generally showed characteristics associated with higher disease activity from inclusion onwards. This did not translate to statistically significant differences in survival. If PET imaging was performed following inclusion, patients received significantly less radioiodine treatments during the first nine months after inclusion (63.1 % of the PET-group vs 82.2 % of the non-PET group). Simultaneously, patients tended to receive more surgeries following PET imaging (27.5 % PET-group vs 13.3 % non-PET group). No significant differences regarding disease control were observed.

Conclusion The early use of FDG-PET imaging in cases of suspected recurrence or existence of dedifferentiated DTC can lead to changes in therapy management, specifically identifying patients unlikely to benefit from additional radioiodine therapy who would instead qualify for surgical therapy methods.

Zusammenfassung

Ziel Ziel dieser Studie war, die Auswirkung der FDG-PET(/CT)-Bildgebung bei der Behandlung des differenzierten Schilddrüsenkarzinoms bei Rezidivverdacht zu analysieren. Primäre Endpunkte waren Gesamt-, ereignisfreies und krankheitsspezifisches Überleben. Sekundäre Endpunkte waren biochemisches Therapieansprechen, Therapien und Sensitivität sowie Spezifität des PET(/CT).

Methoden In die Studie wurden 194 Patienten eingeschlossen, die in unserer Klinik von 1996 bis 2014 im Anschluss an die Thyreoidektomie und ablative 131I-Radioiodtherapie behandelt wurden und trotz negativer Iodszintigraphien persistierende oder steigende Thyreoglobulinspiegel aufwiesen. Davon erhielten 149 (76,8 %) eine 18F-FDG-Bildgebung (PET-Gruppe), die anderen 45 Patienten (23,2 %) bildeten die non-PET-Gruppe. Die Gruppen wurden im Hinblick auf Überlebenszeiten, Patientencharakteristika bei Inklusion, biochemisches Therapieansprechen und Therapien verglichen.

Ergebnisse Patienten der PET-Gruppe wiesen generell ab Inklusion mehr Merkmale auf, die mit einer höheren Krankheitslast einhergehen. Dies resultierte nicht in statistisch signifikanten Unterschieden der Überlebenszeiten. Wurde eine PET(/CT)-Bildgebung durchgeführt, erhielten die Patienten signifikant weniger Radioiodtherapien in den ersten 9 Monaten nach Inklusion (63,1 % PET; 82,2 % non-PET). Gleichzeitig wurden tendenziell mehr Patienten operative Therapien zugeführt (27,5 % PET; 13,3 % non-PET). Das biochemische Therapieansprechen unterschied sich nicht signifikant.

Zusammenfassung Der frühe Einsatz der PET(/CT)-Bildgebung bei Rezidivverdacht des differenzierten Schilddrüsenkarzinoms kann den Behandlungspfad verändern, indem diejenigen Patienten identifiziert werden, die von weiteren RIT wahrscheinlich nicht profitieren und stattdessen operativen Therapien zugeführt werden können.

Key words

DTC - thyroid cancer - therapy management - survival - FDG-PET - FDG-PET/CT

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - Schilddrüsenkrebs - FDG-PET - Gesamtüberleben - Therapiemanagement


Publication History

Received: 17 March 2020

Accepted: 12 May 2020

Article published online:
15 June 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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