Sorafenib in the treatment of iodine-negative differentiated thyroid cancer

Solodiannykova O.I.1, Kmetyuk Y.V.2, Stolyarova O.Yu.1, Danylenko V.V.1, Sukach G.G.1

Summary. The aim of the work is to develop a method of treatment of iodine-negative metastases of differentiated thyroid cancer. Materials and methods of research. 38 patients with iodine-negative metastases of the thyroid gland were treated, of which in 10 the effectiveness of treatment was assessed by whole body scintigraphy (WBS) with 99mTc-MIBI. In 10 patients, the immediate results of treatment with tyrosine kinase inhibitors were evaluated by PET with 18F-FDG. 8 patients formed a group in which bone lesions were noted and treatment was carried out with the help of radionuclide and remote radiation therapy. The mean age of patients ranged from 43 to 76, the median was 57.8+3.9, of these, women — 24, men — 14. Pathohistologically, papillary cancer was diagnosed in 31, follicular — in 5, papillary-follicular — in 2. The research was carried out using the following technical means — a two-detector gamma camera from Mediso (Hungary) and a single-photon emission computer tomograph (SPECT) «E. CAM 180» by Siemens (Germany). Positron emission tomography/Computed Tomography (PET/CT) were performed on a combined tomograph «Biograph-64-TruePoint-Siemens» (Germany), according to the recommendations of the European Association of Nuclear Physicians. Results. Prior to treatment, 10 patients with ADHD underwent WBS with 99mTc-MIBI and re-examination after three months to assess the effectiveness of treatment. After the diagnostic examination, the patients were prescribed targeted therapy with Nexavar according to the treatment protocol. As a result of treatment, regression of the focus in the lungs was achieved within 70%. Further monitoring of the effectiveness of antitumor treatment was performed using WBS with 99mTc-MIBI. 10 patients who underwent primary diagnostic testing with PET/CT — 18F-FDG prior to treatment were also treated with targeted therapy with Nexavar. Diagnostic scan with 18F-FDG after therapy revealed a decrease in the functional activity of the lesion in the neck, but no decrease in the size of the lesion was observed. Conclusions. Treatment of iodine-negative metastases of thyroid cancer with tyrosine kinase inhibitors was accompanied by a decrease in the number of metastatic foci and a decrease in the level of their functional activity. Studies have confirmed the possibility of using techniques with non-iodine RFP (99mTc-MIBI) to assess the effectiveness of treatment of iodine-negative metastases of the thyroid gland. PET/CT with 18F-FDG is a highly informative technique for assessing the effect of tyrosine kinase inhibitors on the functional activity of metastatic foci according to metabolic scanning in the treatment of iodine-negative metastases of thyroid. In the absence of positive dynamics after 3–4 courses, the use of remote radiation therapy with total focal dose (TFD) 30–50 Gy is shown, which allows to reduce the volume of metastatic foci and reduce their metabolic activity. The social and economic significance of the results, as a result of the study, allowed to improve the overall and recurrence-free survival rates in the working population of patients with thyroid disease, to reduce the cost of monitoring patients with iodine-negative forms of thyroid disease.

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