Effectiveness of retinoic acid treatment for redifferentiation of thyroid cancer in relation to recovery of radioiodine uptake

• Published in: Journal of endocrinological investigation Vol. 32; no. 3; pp. 228 - 233
• Main Authors: Fernández, C. A., Puig-Domingo, M., Lomeña, F., Estorch, M., Camacho Martí, V., Bittini, A. L., Marazuela, M., Santamaría, J., Castro, J., Martínez de Icaya, P., Moraga, I., Martín, T., Megía, A., Porta, M., Mauricio, D., Halperin, I.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2009
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Carcinoma, Papillary, Follicular - diagnostic imaging; Carcinoma, Papillary, Follicular - drug therapy; Carcinoma, Papillary, Follicular - rehabilitation; Cell Differentiation - drug effects; Combined Modality Therapy; Endocrinology; Female; Humans; Iodine Radioisotopes - therapeutic use; Isotretinoin - therapeutic use; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Original Article; Radionuclide Imaging; Recovery of Function - drug effects; Recovery of Function - radiation effects; Retrospective Studies; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - drug therapy; Thyroid Neoplasms - rehabilitation; Treatment Outcome; thyroid cancer; retinoic acid treatment; thyroglobulin; redifferentiation; I uptake
• ISSN: 0391-4097; 1720-8386
• DOI: 10.1007/BF03346457

Background : Retinoic acid (RA) treatment has been used for redifferentiation of metastatic thyroid neoplasia that have lost radioiodine ( 131 I) uptake with heterogeneous results. Aim : Retrospective analysis of the recovery rate of 1311 uptake after RA treatment in patients from 11 Spanish hospitals. Methods : Twenty-seven patients (14 men, 13 women) with papillary [21], follicular [4], and oncocytic [2] thyroid cancer initially treated with total thyroidectomy plus 131 I, and with 131 I negative metastatic disease, were given 13-cis RA (0.66–1.5 mg/kg for 5–12 weeks) followed by a therapeutic 131 I dose (3700–7400 MBq); 3 months later thyroglobulin levels and computed tomography imaging were performed. Results : In 9 out 27 cases (33%) (8 papillary, 1 follicular) optimal positive 131 I scan was observed after RA treatment; in the remaining 18, 10 had a suboptimal uptake (7 papillary, 2 follicular, 1 oncocytic) and in the rest there was no 131 I uptake recovery (6 papillary, 1 follicular, 1 oncocytic). In 17 positive responses to RA (either optimal or suboptimal) in which image follow-up was available, decrease or stabilization of metastatic growth was observed in 7, while tumor mass increased at short term in the remaining 10. No major side effects were detected. Conclusion : Quite a high rate of 131 I uptake recovery after RA treatment may be obtained in advanced differentiated thyroid cancer, but the potential modification of the natural course of the disease is uncertain. A better biological characterization of these tumors allowing the identification of potential responders to RA may improve the outcome of RA coadjuvant therapy.