Evaluation of response to radioiodine therapy in thyroid oncocytic carcinoma patients: A single center experience from Iran

Document Type : Original Article

Authors

1 Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Oncosurgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Thyroid oncocytic carcinoma, also known as Hürthle cell carcinoma (HCC), is a rare subtype of thyroid cancer with unique characteristics. Radioiodine therapy, while less effective for HCC due to poor radioiodine accumulation in tumor, has shown improved survival rates for tumors larger than 2 cm. Adjuvant radioiodine therapy is recommended in certain cases, particularly for older patients with a worse prognosis.
Methods: This study reviewed data from 18 HCC cases compared to the overall patient population (OPP) at our center between 2019 and 2022.
Results: The mean age at diagnosis was higher for HCC patients compared to OPP, with varying responses to therapy observed. Assessment of response to therapy after one year revealed 26.7%, 20%, 20%, and 33.3% of HCC patients with excellent, indeterminate, biochemical incomplete, and structural incomplete responses, which were 41.5%, 24.7%, 13%, and 20.7% in OPP, respectively. The Kaplan curve of patient survival showed an average of 100±13.5 months.
Conclusion: Approximately 44% of HCC patients showed excellent survival outcomes after radioiodine therapy, highlighting its importance as a treatment option for HCC. Further research is needed to optimize treatment choices and improve patient outcomes in this less common subtype of thyroid cancer.

Keywords

Main Subjects


  1. Sanabria A, Kowalski LP, Shah JP, Nixon IJ, Angelos P, Williams MD, Rinaldo A, Ferlito A. Growing incidence of thyroid carcinoma in recent years: factors underlying overdiagnosis. Head Neck. 2018 Apr;40(4):855-66. 
  2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48.
  3. Megwalu UC, Moon PK. Thyroid cancer incidence and mortality trends in the united states: 2000-2018. Thyroid. 2022 May;32(5):560-70.
  4. Guerrero MA, Suh I, Vriens MR, Shen WT, Gosnell J, Kebebew E, Duh QY, Clark OH. Age and tumor size predicts lymph node involvement in Hürthle Cell Carcinoma. J Cancer. 2010 Jun 2;1:23-6.
  5. Jillard CL, Youngwirth L, Scheri RP, Roman S, Sosa JA. Radioactive iodine treatment is associated with improved survival for patients with hürthle cell carcinoma. Thyroid. 2016 Jul;26(7):959-64.
  6. Abdulhaleem M, Aldajani A. Thyroid Hurthle Cell neoplasms: review article. Am J Otolaryngol Head Neck Surg. 2023;6(5):1243.
  7. O'Connell K, Yen TW, Quiroz F, Evans DB, Wang TS. The utility of routine preoperative cervical ultrasonography in patients undergoing thyroidectomy for differentiated thyroid cancer. Surgery. 2013 Oct;154(4):697-701; discussion 701-3.
  8. Yeh MW, Bauer AJ, Bernet VA, Ferris RL, Loevner LA, Mandel SJ, Orloff LA, Randolph GW, Steward DL; American thyroid association surgical affairs committee writing task force. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015 Jan;25(1):3-14.
  9. Tao L, Zhou W, Zhan W, Li W, Wang Y, Fan J. Preoperative prediction of cervical lymph node metastasis in papillary thyroid carcinoma via conventional and contrast-enhanced ultrasound. J Ultrasound Med. 2020 Oct;39(10):2071-80. 
  10. Tom Chi-Man C, Shirley Yuk-Wah L. Lymph node metastasis in differentiated thyroid cancers. In: Ifigenia K-A, editor. Thyroid Cancer. Rijeka: IntechOpen; 2022. p. Ch. 9.
  11. Kouvaraki MA, Shapiro SE, Fornage BD, Edeiken-Monro BS, Sherman SI, Vassilopoulou-Sellin R, Lee JE, Evans DB. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003 Dec;134(6):946-54; discussion 954-5.
  12. Mills SC, Haq M, Smellie WJ, Harmer C. Hürthle cell carcinoma of the thyroid: retrospective review of 62 patients treated at the Royal Marsden Hospital between 1946 and 2003. Eur J Surg Oncol. 2009 Mar;35(3):230-4. 
  13. Shawky M, Sakr M. Hurthle Cell lesion: controversies, challenges, and debates. Indian J Surg. 2016 Feb;78(1):41-8. 
  14. Barnabei A, Ferretti E, Baldelli R, Procaccini A, Spriano G, Appetecchia M. Hurthle cell tumours of the thyroid. Personal experience and review of the literature. Acta Otorhinolaryngol Ital. 2009 Dec;29(6):305-11. 
  15. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 Jan;26(1):1-133.
  16. Zhou X, Zheng Z, Chen C, Zhao B, Cao H, Li T, Liu X, Wang W, Li Y. Clinical characteristics and prognostic factors of Hurthle cell carcinoma: a population based study. BMC Cancer. 2020 May 12;20(1):407. 
  17. Besic N, Vidergar-Kralj B, Frkovic-Grazio S, Movrin-Stanovnik T, Auersperg M. The role of radioactive iodine in the treatment of Hürthle cell carcinoma of the thyroid. Thyroid. 2003 Jun;13(6):577-84. 
  18. Ahmadi S, Stang M, Jiang XS, Sosa JA. Hürthle cell carcinoma: current perspectives. Onco Targets Ther. 2016 Nov 7;9:6873-84. 
  19. Wang X, Zheng X, Zhu J, Li Z, Wei T. Radioactive iodine therapy does not improve cancer-specific survival in Hürthle Cell Carcinoma of the thyroid. J Clin Endocrinol Metab. 2022 Nov 23;107(11):3144-51.
  20. Bhattacharyya N. Survival and prognosis in Hürthle cell carcinoma of the thyroid gland. Arch Otolaryngol Head Neck Surg. 2003 Feb;129(2):207-10.
  21. Ito Y, Kudo T, Takamura Y, Kobayashi K, Miya A, Miyauchi A. Prognostic factors of papillary thyroid carcinoma vary according to sex and patient age. World J Surg. 2011 Dec;35(12):2684-90. 
  22. Besic N, Schwarzbartl-Pevec A, Vidergar-Kralj B, Crnic T, Gazic B, Marolt Music M. Treatment and outcome of 32 patients with distant metastases of Hürthle cell thyroid carcinoma: a single-institution experience. BMC Cancer. 2016 Feb 26;16:162. 
  23. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordoñez NG, Sherman SI. Prognostic factors in patients with Hürthle cell neoplasms of the thyroid. Cancer. 2003 Mar 1;97(5):1186-94.
  24. Randle RW, Bushman NM, Orne J, Balentine CJ, Wendt E, Saucke M, Pitt SC, Macdonald CL, Connor NP, Sippel RS. Papillary thyroid cancer: the good and bad of the "good cancer". Thyroid. 2017 Jul;27(7):902-7. 
  25. Stojadinovic A, Hoos A, Ghossein RA, Urist MJ, Leung DH, Spiro RH, Shah JP, Brennan MF, Singh B, Shaha AR. Hürthle cell carcinoma: a 60-year experience. Ann Surg Oncol. 2002 Mar;9(2):197-203.
  26. Paunovic I, Krgovic K, Tatic S, Diklic A, Zivaljevic V, Kalezic N, Havelka M. Surgery for thyroid Hürthle cell tumours--a single institution experience. Eur J Surg Oncol. 2006 May;32(4):458-61. 
  27. Pisanu A, Aste L, Piu S, Cois A, Uccheddu A. Fattori predittivi di malignità nelle neoplasie tiroidee a cellule di Hürthle. Influenza sul trattamento chirurgico [Predictive factors for malignancy in Hürthle-cell thyroid neoplasia. Effect of surgical treatment]. Tumori. 2003 Jul-Aug;89(4 Suppl):223-5.
  28. Maizlin ZV, Wiseman SM, Vora P, Kirby JM, Mason AC, Filipenko D, Brown JA. Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics. J Ultrasound Med. 2008 May;27(5):751-7; quiz 759.