Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Low risk thyroid cancer patients can be treated with smaller amount of radiation, suggests study

Low risk thyroid cancer patients can be treated with smaller amount of radiation, suggests study

Thyroid cancer patients whose disease is at low risk of returning can be treated safely with a smaller amount of radiation following surgery, according to results from the world’s longest running trial to investigate this.

Dr Jonathan Wadsley, a consultant clinical oncologist at the Weston Park Hospital, Sheffield, UK, and chair of the National Cancer Research Institute (NCRI) Thyroid Cancer Subgroup, told the 2018 NCRI Cancer Conference today (Monday) that the latest results from the HiLo trial showed there was no significant difference in the recurrence rate between patients given a low radiation dose compared to the standard, higher dose. He said this meant that international guidelines could be updated to recommend the lower dose in low risk patients and these patients would benefit from fewer side effects and long-term complications, and a more convenient treatment.

He reported results from 434 patients with low risk thyroid cancer in the HiLo trial with a median (average) follow-up time of 6.5 years. The patients were randomised to receive low administered radioactive iodine activity (RAI) of 1.1GBq, or the standard high RAI of 3.7GBq [1]. They also received either Thyrogen (a genetically-engineered thyroid stimulating hormone, TSH), which stimulates thyroid cancer cells to absorb as much radioactive iodine as possible, making it more effective, or they were asked to stop taking their thyroid hormone tablets, which achieves the same effect by allowing levels of their natural TSH to rise.

Dr Wadsley explained: “Activity is a measure of the amount of radiation that is administered to the patient in the form of a radioactive isotope of iodine. The aim of the treatment is to destroy any residual normal thyroid tissue and thyroid cancer cells following surgery to remove the thyroid gland. The treatment is most commonly given as a capsule to swallow. As a general principle, we would always wish to give the lowest quantity of radiation possible to prevent the recurrence of thyroid cancer. This is to reduce the risk of longer-term side effects from the treatment, most importantly reducing the risk of the treatment causing another cancer in the future. In our study the low activity 1.1GBq dose was less than a third of the higher activity 3.7GBq dose, but has been proven to be as effective.”

During the nearly seven years of follow-up, there were 21 recurrences of cancer (11 and 10 with 1.1GBq and 3.7GBq respectively). The recurrence rates were similar between the two doses, and also between patients using Thyrogen or thyroid hormone withdrawal.

“The study showed that patients receiving a lower activity experienced fewer side effects, in particular less risk of feeling sick or suffering damage to the salivary glands, which can potentially lead to a permanently dry mouth. The use of a lower activity also raises the possibility of giving the treatment in one day rather than having to admit patients to be nursed in isolation for two to three nights. This is required for the higher activity due to radiation protection regulations to avoid exposing the general public to unnecessary radiation, but can be particularly distressing for patients as they can only have very limited contact with other people during this time, which is particularly hard for someone with a recent cancer diagnosis. Therefore, not only is lower activity preferable for patients, it can also result in cost savings to the health service,” said Dr Wadsley.

“The study also showed that quality of life and ability to continue normal activities was much better for patients receiving Thyrogen than those using thyroid hormone withdrawal. If thyroid hormone withdrawal is used, patients have to come off their regular medication for at least two weeks. This leaves them feeling extremely tired and in some cases quite depressed.”

He said that the HiLo trial had the longest follow-up time of any other randomised study worldwide. Until now, there had not been enough evidence for international guidelines to do more than make weak recommendations about using 1.1GBq in low risk patients, due to the limited data and only short-term follow-up.

“Now that we have confirmation that there is no difference in recurrence rates over a longer follow-up period, these recommendations can be strengthened and clinicians and patients can be confident that use of the lower activity is acceptable and in fact preferable,” he concluded.

The HiLo trial has finished and now the researchers are investigating whether a group of patients can be identified that have such a low risk of recurrence of their thyroid cancer that they do not require radioiodine therapy at all. The IoN trial (Iodine or Not) is allocating patients with very low risk thyroid cancer to have radioiodine therapy or careful observation alone to determine whether there is any difference in recurrence rates and whether or not these patients could avoid iodine treatment altogether.

Dr Martin Forster from University College London, who is chair of the NCRI Head and Neck Clinical Studies Group and was not involved with this research said: “Nearly seven years of follow-up data from the HiLo trial provides us with confidence that the lower 1.1GBq radiation dose for patients with low risk thyroid cancer is a safe and effective treatment, and that international guidelines can be updated to reflect this. For many patients, the treatment and how it is delivered, as well as the short and long-term side effects, can have a big impact on their lives. The HiLo trial is a good example of a well-conducted clinical trial that can make a real difference to the quality of life for these patients. We look forward to the results of the IoN trial, which could determine whether some patients have such a low risk of their cancer returning that they could be spared radioiodine treatment completely.”

Thyroid cancer is rare, with approximately 3,500 cases in the UK each year, less than 1% of the total annual number of cancers. Low risk thyroid cancers have a good survival rate with approximately 99% patients surviving for ten years or more.

Tagged with:

About author

Related Articles