• Title/Summary/Keyword: remnant ablation

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Controversies about Radioactive Iodine-131 Remnant Ablation in Low Risk Thyroid Cancers: Are We Near A Consensus?

  • Zaman, Maseeh Uz;Fatima, Nosheen;Padhy, Ajit Kumar;Zaman, Unaiza
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.11
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    • pp.6209-6213
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    • 2013
  • Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review is an attempt to update readers about the previous and existing practice based on results of non-randomized trials and evolving trends fueled by recently published randomized studies.

Low-dose Radioactive I-131 Therapy after Total Thyroidectomy for Differentiated Thyroid Cancer (갑상선 분화암 수술 후 저용량 방사성 옥소(I-131)요법)

  • Choi Chung-Jin;Jung Sung-Hoo
    • Korean Journal of Head & Neck Oncology
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    • v.14 no.2
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    • pp.214-219
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    • 1998
  • Objectives: To assess the effectiveness of the low-dose(30mCi) I-131 ablation therapy for remnant thyroid tissue following total thyroidectomy for differentiated thyroid cancer. Methods: Between March 1995 and December 1997, forty-eight patients were given ablative doses(30mCi) of I-131 after total thyroidectomy for differentiated thyroid cancer in the presence of I-131 uptake in remnant thyroid tissue. Effective ablation of remnant thyroid tissue was determined by following I-131 whole body scan. if remnant thyroid tissue remained, we repeated the same management at 6 months interval. Results: Thirty-eight(79.1%) patients had papillary, 8(16.7%) follicular, 1(2.1%) medullary and 1(2.1%) Hurthle cell type cancer. Forty-eight patients underwent total thyroidectomy, among those central neck dissection was performed in 35 cases, and modified radical neck dissection in 14 cases. Postoperative complication developed in 8 cases, which included 4 cases of transient hypoparathyroidism, 1 case of permanent hypoparathyroidism, 2 cases of transient recurrent laryngeal nerve palsy, and 1 case of wound hematoma. There were significant remnant thyroid tissue in 46 cases(95.8%) of patients after total thyroidectomy, which could be ablated by low dose(30mCi) I-131. There were no statistical difference between operative procedures and number of treatment of I-131. Conclusions: These results suggested that repeated low-dose(30mCi) I-131 therapy would be needed, therefore, high -dose I-131 therapy could be considered as ablation therapy for the remnant thyroid tissue after total thyroidectomy for differentiated thyroid cancer.

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Baseline Stimulated Thyroglobulin Level as a Good Predictor of Successful Ablation after Adjuvant Radioiodine Treatment for Differentiated Thyroid Cancers

  • Fatima, Nosheen;uz Zaman, Maseeh;Ikram, Mubashir;Akhtar, Jaweed;Islam, Najmul;Masood, Qamar;Zaman, Unaiza;Zaman, Areeba
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.15
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    • pp.6443-6447
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    • 2014
  • Background: To determine the predictive value of the baseline stimulated thyroglobulin (STg) level for ablation outcome in patients undergoing adjuvant remnant radioiodine ablation (RRA) for differentiated thyroid carcinoma (DTC). Materials and Methods: This retrospective study accrued 64 patients (23 male and 41 female; mean age of $40{\pm}14$ years) who had total thyroidectomy followed by RRA for DTC from January 2012 till April 2014. Patients with positive anti-Tg antibodies and distant metastasis on post-ablative whole body iodine scans (TWBIS) were excluded. Baseline STg was used to predict successful ablation (follow-up STg <2 ng/ml, negative diagnostic WBIS and negative ultrasound neck) at 7-12 months follow-up. Results: Overall, successful ablation was noted in 37 (58%) patients while ablation failed in 27 (42%). Using the ROC curve, a cut-off level of baseline STg level of ${\leq}14.5ng/ml$ was found to be most sensitive and specific for predicting successful ablation. Successful ablation was thus noted in 25/28 (89%) of patients with baseline STg ${\leq}14.5ng/ml$ and 12/36 (33%) patients with baseline STg >14.5 ng/ml ((p value <0.05). Age >40 years, female gender, PTS >2 cm, papillary histopathology, positive cervical nodes and positive TWBIS were significant predictors of ablation failure. Conclusions: We conclude that in patients with total thyroidectomy followed by I-131 ablation for DTC, the baseline STg level is a good predictor of successful ablation based on a stringent triple negative criteria (i.e. follow-up STg < 2 ng/ml, a negative DWBIS and a negative US neck).

Ablation of Remnant Thyroid Tissue with I-131 in Well Differentiated Thyroid Cancer After Surgery (분화성 갑상선암에서 수술 후 I-131을 이용한 잔여 갑상선 조직의 제거 성적)

  • Kim, Yu-Kyeong;Lee, Dong-Soo;Cho, Bo-Yeon;Jeong, Jae-Min;Lee, Myung-Chul;Koh, Chang-Soon;Chung, June-Key
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.3
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    • pp.339-345
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    • 1997
  • To evaluate the effectiveness of I-131 in ablation of residual thyroid tissue, we analyzed 350 patients with thyroid cancer who were treated with various doses of I-131 after surgery for thyroid cancer Two hundred fifty five patients were treated with 1.1GBq(30mCi) of I-131 for ablation of remnant thyroid and one hundred seventeen patients received more than 2.8GBq(75mCi) of I-131. We determined the effectiveness of ablation by following I-131 whole body scan. Absent visible uptake or minimal uptake in thyroid tissue were considered as successful ablation. Of 255 patients who received doses of 30mCi I-131 therapy, 131 patients(51%) showed successful ablation of residual thyroid tissue with $2.6{\pm}1.7$ times of I-131 therapy. Of 117 patients who received doses of the more than 75mCi I-131, 84 patients(72%) had successful remnant thyroid ablation with $1.6{\pm}1.1$ times of I-131 therapy, According to the extent of surgery, successful ablation rates were 78%, 62%, 54%, 33% in patients who underwent total thyroidectomy, subtotal thyroidectomy, lobectomy and isthmectomy, lobectomy or tumorectomy, respectively. This study showed that ablation of remnant thyroid after surgery with 30mCi I-131 was successful only in 50%. Therefore, in cases of patients with high risk for recurrence, we recommend high dose I-131 for ablation of remnant after total thyroidectomy.

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Changes in Quality of Life and Related Factors in Thyroid Cancer Patients with Radioactive Iodine Remnant Ablation (방사성요오드 치료를 받는 갑상선암 환자의 삶의 질 변화와 영향요인)

  • Yoo, Seon Hee;Choi-Kwon, Smi
    • Journal of Korean Academy of Nursing
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    • v.43 no.6
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    • pp.801-811
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    • 2013
  • Purpose: To investigate changes in Quality of life (QOL) and related factors in patients with thyroid cancer undergoing Radioactive Iodine remnant ablation (RAI). Methods: Data were collected longitudinally 3 times for 6 months (2 weeks post-surgery, post RAI, 3 months post RAI) in a hospital located in Seoul. Questionnaires were used to measure levels of physical symptoms, anxiety, depression, and QOL. Ninety-eight patients with thyroid cancer who had RAI were included in the analysis. Data were analyzed using SPSS (18.0). Results: Findings for the three data collection times respectfully were: mean scores for physical symptoms, 0.53, 1.21 and 0.62, patients with depression, 47%, 36.7% and 37.7%, patients with anxiety, 18.4 %, 19.4% and 20.4%, mean scores for QOL, 7.06, 7.01 and 7.28. QOL score was highest 3 months post RAI (p=.031). In the stepwise multiple regression analysis, depression and fatigue were predicting factors for low QOL at all data collection times. Dysponia was a predicting factor for low QOL post RAI and 3 months post RAI. Conclusion: To increase QOL, it is necessary to provide information in advance regarding physical & psychological symptoms and to develop nursing intervention programs to decrease depression and fatigue.

Comparison of Urine Iodine/Creatinine ratio between Patients following Stringent and Less Stringent Low Iodine Diet for Radioiodine Remnant Ablation of Thyroid Cancer (갑상선암의 방사성요오드치료를 위한 저요오드식이 방법 차이에 따른 소변 중 요오드/크레아티닌 비의 비교)

  • Roh, Jee-Ho;Kim, Byung-Il;Ha, Ji-Su;Chang, Sei-Joong;Shin, Hye-Young;Choi, Joon-Hyuk;Kim, Do-Min;Kim, Chong-Soon
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.6
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    • pp.322-326
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    • 2006
  • A low iodine diet (LID) for $1{\sim}2$ weeks is recommended for patients who undergoing radioiodine remnant ablation. However, the LID educations for patients are different among centers because there is no concrete recommendation for protocol of LID. In this investigation, we compared two representative types of LID protocols performed in several centers in Korea using urine iodine to creatinine ratio (urine I/Cr). Methods: From 2006, April to June, patients referred to our center for radioiodine remnant ablation of thyroid cancer from several local hospitals which had different LID protocols were included. We divided into two groups, stringent LID for 1week and less stringent LID for 2 weeks, then measured their urine I/Cr ratio with spot urine when patients were admitted to the hospital. Results: Total 27 patients were included in this investigation (M:F=1:26; 13 in one-week stringent LID; 14 in two-week less stringent LID. Average of urine I/Cr ratio was $127.87{\pm}78.52{\mu}g/g$ in stringent LID for 1 week, and $289.75{\pm}188.24{\mu}g/g$ in less stringent LID for 2 weeks. It was significantly lower in stringent LID for 1 week group (p=0.008). The number of patients whose urine I/Cr ratios were below $100{\mu}g/g$ was 6 of 13 in stringent LID for 1 week group, and 3 of 14 in less stringent LID for 2 weeks group. Conclusion: Stringent LID for 1 week resulted in better urinary I/Cr ratio in our investigation compared with the other protocol. However it still resulted in plenty of inadequate range of I/Cr ratio, so more stringent protocol such as stringent LID for 2 weeks is expected more desirable.

Analysis of Urine Iodine Excretion Decrease by Two-Week Stringent Low Iodine Diet for Remnant Thyroid Ablation with Radioactive Iodine in Korean Patients with Thyroid Cancer; Prospective Study (한국 갑상선암 환자들에서 잔여갑상선 제거를 위한 방사성요오드 치료 전 2주간의 엄격한 저요오드식이에 의한 소변 내 요오드량 감소 분석; 전향적 연구)

  • Choi, Joon-Hyuk;Kim, Hoon-Il;Park, Jang-Won;Song, Eun-Hoon;Ko, Bong-Jin;Cheon, Gi-Jeong;Kim, Byung-Il
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.5
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    • pp.375-382
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    • 2008
  • A low iodine diet (LID) is the recommended preparation for radioactive iodine treatment. However, the recommended duration and stringency of LID are different among each recommendation. More stringent LID is expected in Korea because Korea is a iodine-rich region. We investigated the decrement of urine iodine excretion by two-week stringent LID for remnant thyroid ablation with radioactive iodine in Korean patients with thyroid cancer, prospectively. Material and Method: From November 2006, patients who referred to our hospital for remnant ablation after total thyroidectomy were included in this study. To decrease total body iodine, our protocol included three strategies. First, we checked medication which could inhibit the radioactive iodine uptake. Second, the date of 1-131 treatment was scheduled at least 3 months later if contrast agent had been used. The last strategy was two-week stringent LID education by specialized nutritionist. Before and after two-week stringent LID, 24hr-urine iodine was analyzed respectively. 24hr-urine creatinine was also analyzed for determining more valid 24hr urine sampling subgroup. Results: Total 51 patients were finally enrolled. Average of 24hr-urine iodine excretion was significantly lowered ($787{\pm}2242\;{\rightarrow}\;85{\pm}85\;{\mu}g/d$, p=0.03) after LID and 74.4% of patients reached below the recommended urine iodine excretion level ($<100\;{\mu}g/d$). In subgroup (n=14), similar results was showed ($505{\pm}666\;{\rightarrow}\;99{\pm}116\;{\mu}g/d$, p=0.05) and 78.6% of patients met the criteria. Conclusion: Most patients could reach below the recommended urine iodine level after two-week stringent LID. Therefore, in our opinion, at least two-week stringent LID should be recommended in Korea.

Resurfacing the Large Penoscrotal Defects with Various Local Flaps after Ablation of Extramammary Paget's Disease (유방외 파제트병의 제거 후 발생한 음경-음낭부 결손의 다양한 국소피판을 이용한 재건)

  • Lee, Seung Ryul;Kang, Nak Heon;Oh, Sang Ha
    • Archives of Plastic Surgery
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    • v.34 no.6
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    • pp.753-758
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    • 2007
  • Purpose: Penoscrotal extramammary Paget's disease is a rare cutaneous malignancy that primarily affects the elderly. To prevent local recurrence, adequate surgical excision with its intraoperative frozen section, proper reconstruction, and careful follow-ups are required. The present study describes the treatment of patients with penoscrotal extramammary Paget's disease, focusing on the reconstruction after the ablation of lesion. Methods: Nine patients were selected who had undergone a local pedicle flap procedure due to the large defects after ablation of extramammary Paget's disease of the penoscrotal area, during the period of 1999 to 2005. Wide excision combined with intraoperative frozen sectioning was performed, and the penoscrotal wound was reconstructed with a local skin flap. Three flaps were chosen depending on the size of the defect. If the defect size was small and the scrotal tissue was adequate, scrotal flap(n=5) was enough for its reconstruction. However, as there were large defects with insufficient remnant scrotal tissue, a groin flap(n=2) or an anterolateral thigh flap(n=2) were performed. Results: There were no complications with the postoperative wound. Furthermore, no local recurrence was noted during two to six years of follow-up period (mean average 3.7 years). Conclusion: For the resurfacing the penoscrotum at large defects after ablation of extramammary Paget's disease, we performed reconstruction with a local flap. In the aspect of both function and cosmetic concerns, the results were satisfactory. 

Selective Ablation of Emissive Polymer Using Nanosecond-pulsed Laser (나노초 펄스 레이저를 이용한 발광폴리머 패터닝)

  • Ko, J.S.;Oh, B.K.;Kim, D.Y.;Lee, J.Y.;Lee, S.K.;Jung, S.H.;Hong, S.K.
    • Laser Solutions
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    • v.14 no.3
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    • pp.7-11
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    • 2011
  • As an active emission display using emissive polymer has had much attention recently, needs for a selective patterning of emissive layer for those displays have been increased abruptly. Therefore, the various laser sources in terms of its wavelength has been used for laser direct patterning. In this work, the feasibility of those processes is examined using numerical analysis and the experimental investigation. A sample has multi-layered structure, emissive polymer on aluminum which is deposited on a glass substrate. Key factors for optimizing the laser patterning of the emissive polymer are considered into the control of ablation products, large-sized particle, and the choice of the appropriate wavelength for minimizing the heat affected zone and the remnant layer.

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A Study on the Structural and Electrical Properties of PLZT Thin Films Prepared by Laser Ablation (레이저 에블레이션법으로 제작된 PLZT 박막의 구조 및 전기적 특성에 관한 연구)

  • Jang, Nak-Won;Mah, Suk-Bum;Paik, Dong-Soo;Choi, Hyung-Wook;Park, Chang-Yub
    • Journal of the Korean Institute of Electrical and Electronic Material Engineers
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    • v.11 no.10
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    • pp.866-870
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    • 1998
  • PLZT thin films were fabricated with different Zr/Ti ratios by pulsed laser deposition. PLZT films deposited on Pt/Ti/SiO$_2$/Si substrate. This PLZT thin films of 5000$\AA$ thickness were crystallized at $600^{\circ}C$, $O_2$ pressure 200m Torr. 2/55/45 PLZT thin film showed a maximum dielectric constant value of $\varepsilon$\ulcorner=1550 and dielectric loss was 0.03 at 10kHz. At 2/70/30 PLZT thin film, coercive field and remnant polarization was respectively 19[kV/cm], 8[$\mu$C/$\textrm{cm}^2$]. Raman spectroscopy results showed that the bands of spectra became broader as the amount of Zr mol% increased and two crystal phase coexisted at 2/55/45 PLZT film. Raman spectroscopy was useful for crystal structure analysis of PLZT thin films.

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