Anne-Laure Giraudet

Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients.

PURPOSE This prospective study evaluated the recurrence rate in 715 patients with differentiated thyroid cancer who had no evidence of persistent disease after total thyroidectomy and lymph node dissection in 94% of them followed up by radioiodine ablation (30-100 mCi) and assessed the predictive value of the initial thyroglobulin (Tg) levels for detecting recurrence, both during levothyroxine (LT4) treatment and after TSH stimulation. PATIENTS AND METHODS Patients had Tg determinations performed at 3 months on LT4 treatment (Tg1) and at 9-12 months after stimulation by either thyroid hormone withdrawal or recombinant human TSH (Tg2); the Access kit was used (functional sensitivity of 0.11 ng/ml); they had undetectable anti-Tg antibodies. Patients were followed up annually. Predictive values were calculated by comparing Tg levels (Tg1 and Tg2) and the outcome in terms of recurrence. RESULTS During the median follow-up of 6.2 yr, 32 patients had a recurrence. Assuming a cutoff level for Tg1 at 0.27 ng/ml, Tg1 sensitivity and specificity reached 72 and 86%, respectively, whereas predictive positive and negative values were 20 and 99%, respectively. With a cutoff level for Tg2 at 1.4 ng/ml, sensitivity and specificity reached 78 and 90%, respectively, whereas positive and negative predictive values were 26 and 99%, respectively. CONCLUSION This large prospective cohort of patients presented a low rate of recurrence. Initial Tg measurements allow to predict long-term recurrence with an excellent specificity. Stimulated Tg determination presented a slightly higher sensitivity than Tg determination on LT4. TSH stimulation may be avoided when Tg measured 3 months after ablation is less than 0.27 ng/ml during LT4 treatment.

Tyrosine kinase inhibitor treatments in patients with metastatic thyroid carcinomas: a retrospective study of the TUTHYREF network

OBJECTIVE Tyrosine kinase inhibitors (TKIs) are used to treat patients with advanced thyroid cancers. We retrospectively investigated the efficacy of TKIs administered outside of clinical trials in metastatic sites or locally advanced thyroid cancer patients from five French oncology centers. DESIGN AND METHODS THERE WERE 62 PATIENTS (37 MEN, MEAN AGE: 61 years) treated with sorafenib (62%), sunitinib (22%), and vandetanib (16%) outside of clinical trials; 22 had papillary, five had follicular, five had Hürthle cell, 13 had poorly differentiated, and 17 had medullary thyroid carcinoma (MTC). Thirty-three, 25, and four patients were treated with one, two, and three lines of TKIs respectively. Primary endpoints were objective tumor response rate and progression-free survival (PFS). Sequential treatments and tumor response according to metastatic sites were secondary endpoints. RESULTS Among the 39 sorafenib and 12 sunitinib treatments in differentiated thyroid carcinoma (DTC) patients, partial response (PR) rate was 15 and 8% respectively. In the 11 MTC patients treated with vandetanib, 36% had PR. Median PFS was similar in second-line compared with first-line sorafenib or sunitinib therapy (6.7 vs 7.0 months) in DTC patients, but there was no PR with second- and third-line treatments. Bone and pleural lesions were the most refractory sites to treatment. CONCLUSIONS This is the largest retrospective study evaluating TKI therapies outside of clinical trials. DTC patients treated with second-line therapy had stable disease as best response, but had a similar median PFS compared with the first-line treatment.

Breast cancer recurrence diagnosis suspected on tumor marker rising: value of whole-body 18FDG-PET/CT imaging and impact on patient management.

Breast cancer recurrence is often suspected on tumor marker rising in asymptomatic patients. The value of fluorine‐18 fluorodeoxyglucose (18FDG)–positron emission tomography/computed tomography (PET/CT) imaging to detect recurrence and its subsequent impact on patient management were retrospectively assessed.

Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1

OBJECTIVE Pheochromocytoma (PHEO) may occur in 0.1-5.7% of patients presenting with a neurofibromatosis type 1 (NF1). Current recommendations are to explore only symptomatic patients. The objective of the study is to evaluate the prevalence and the interest of a systematic PHEO screening in this population. DESIGN A prospective study in a French tertiary center including consecutive NF1 patients older than 18 years. METHODS A systematic screening combining abdominal imaging and urinary fractionated metanephrines was proposed. In case of positivity of one or both exams, (123)I-metaiodobenzylguanidine scintigraphy or [(18)F]-fluoro-dihydroxyphenylalanine PET imaging was performed. The diagnosis of secreting PHEO was retained in case of elevated urinary metanephrines associated with positive scintigraphy and non-secreting PHEO when urinary metanephrines were normal with a positive scintigraphy. RESULTS Between January 2014 and August 2015, 234 patients were included and 156 patients (66.7%) completed both exams. In these 156 patients, 12 PHEOs were diagnosed, representing a prevalence of 7.7%. Of these, six PHEOs were secreting, with only two symptomatic patients. The tumor size of these PHEOs were bigger than that of non-secreting PHEO (25.2 ± 6.6 vs 14 ± 6.9 mm, P = 0.0165). One lesion was bilateral. Mean metanephrine and normetanephrine levels were 3.2 ± 2.6N and 2.8 ± 1N respectively. Three patients underwent surgery. The six patients with non-secreting PHEO were asymptomatic. One of them had bilateral lesion and one underwent surgery. CONCLUSIONS PHEO in NF1, whether or not secreting, are mostly asymptomatic. The current strategy to explore only symptomatic patients leads to an underestimation of prevalence with the risks inherent to the existence of an unrecognized PHEO.

Radioactive iodine therapy, molecular imaging and serum biomarkers for differentiated thyroid cancer: 2017 guidelines of the French Societies of Nuclear Medicine, Endocrinology, Pathology, Biology, Endocrine Surgery and Head and Neck Surgery

Slimane Zerdoud a, Anne-Laure Giraudet b, Sophie Leboulleux c, Laurence Leenhardt d, Stéphane Bardet e, Jérôme Clerc f, Marie-Elisabeth Toubert g, Abir Al Ghuzlan h, Pierre-Jean Lamy i,j, Claire Bournaud k, Isabelle Keller l, Frédéric Sebag m, Renaud Garrel n, Eric Mirallié o, Lionel Groussin p, Elif Hindié q,∗, David Taïeb r,∗ a Service de médecine nucléaire, institut universitaire du cancer Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France b Médecine nucleaire, centre LUMEN, curiethérapie, thyroïde, tumeurs endocrines, centre de lutte contre le cancer Léon-Berard, 28, rue Laennec, 69008 Lyon, France c Service de médecine nucléaire et cancérologie endocrinienne Gustave-Roussy, université Paris Saclay, 114, rue Edouard-Vaillant, 94805 Villejuif, France d Unité thyroïde tumeurs endocrines, institut E3M, hôpital La Pitié-Salpêtrière, 83, boulevard de l’Hôpital, 75013 Paris, France e Service de médecine nucléaire et UCP thyroïde, centre François-Baclesse, 3, avenue Général-Harris, 14076 Caen cedex 05, France f Service de médecine nucléaire, groupe hospitalier Paris Centre, AP–HP, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France g Service de médecine nucléaire, hôpital Saint-Louis, AP–HP, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France h Département de biologie et de pathologie médicales Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France i Laboratoire d’oncologie moléculaire, institut médical d’analyse génomique, Labosud, 141, avenue Paul-Bringuier, 34080 Montpellier, France j Unité de recherche clinique, clinique Beau-Soleil, 119, avenue de Lodeve, 34070 Montpellier, France k Service de médecine nucléaire, hospices civils de Lyon, groupement hospitalier Est, 28, avenue Doyen-Lépine, 69677 Bron cedex, France l Service de médecine nucléaire, hôpitaux universitaires Est Parisien, hôpital Saint-Antoine, AP–HP, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France m Service de chirurgie endocrinienne, université Aix-Marseille, CHU de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France n Département ORL et chirurgie cervico faciale, pole neuroscience tête et cou, hôpital Gui-de-Chauliac, CHU de Montpellier, 80, rue Fliche, 34295 Montpellier, France o Service de chirurgie endocrinienne et digestive, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France p Service d’endocrinologie et maladies métaboliques, hôpital Cochin, AP–HP, 123, boulevard du Port-Royal, 75014 Paris, France q Service de médecine nucléaire, hôpital Haut-Lévêque, université de Bordeaux, CHU de Bordeaux, avenue Magellan, 33604 Pessac, France r Service central de biophysique et de médecine nucléaire, université Aix-Marseille, CHU de la Timone, 264, rue Saint-Pierre, 13005 Marseille cedex 05, France