Evaluation of Serum Tumor Markers Variation, following the Radioactive Iodine Therapy in Patients with Differentiated Thyroid Cancer| Stephy Publishers

 


Stephy Publishers:  SOJ Pediatrics and Clinical Neonatology (SOJPCN)

Abstract

Introduction: Radioactive iodine is the effective therapy in thyroid cancer. The aim of this study is to evaluate the serum tumor markers in patients under the therapy with radioactive iodine 131.

Material and methods: 45 cases of female patients aged 16-60 years with thyroid cancer surgery referred to the nuclear medicine department of Nemazi hospital for (iodine treatment after surgery) were selected. The selection was on the basis of interviewing and information of patients is consent forms. Only patients with thyroid cancer and referred for the first time without any other diseases were chosen for this study. The selected patients were prescribed a dose of 150mCi of I-131.From each patient, 4 mL of chelated serum for serological studies on tumor markers and 2 mL of oxalated serum for spectrophotometry studies on cell death were used in three stages. The first stage before the iodine therapy, the second stage, after 48 hours, and the third stage, 30 days after radioiodine therapy were studied and the results were evaluated by the one-way repeated measures ANOVA test.

Results: according to the results of dependent paired T-Test, AFP, in the periods before, 48 hours and 1 month after radioiodine therapy, respectively were 3.46±1.21 and 3.74±1.37 and 3.76±1.25 (p <0.0005). About CA 19-9 in the periods before, 48 hours and one month after radioiodine therapy, the results were 9.30±6.32, 9.95±6.92 (p = 0.040) and 11.26±7.49 (p <0.0005) respectively. About CEA, the results were 1.60±0.60, 1.47±0.55 and 2.23±0.69 (p <0.0005), respectively. In the case of tumor marker CA 15-3 results were 15.53±6.48 and 1.60±0.60 and 15.68±6.52 (p = 0.014), respectively and in the case of ALP, results were 124.22±5 and 122.2±6 and 116.7±7 (p <0.0005), respectively.

Conclusion: According to the same studies and the acquired results, it can be concluded that the tumor markers CEA and CA19-9 are more acceptable and sustainable for monitoring the malignancy and progressive disease in patients with thyroid cancer. The decreasing ALP is normal and transient. The increase of AFP and CA15-3 is not even statistically reliable. It is recommended that the period of iodine therapy and falsely elevated tumor markers can be informed to the doctor, during the gastrointestinal studies in patients with thyroid cancer, in order to prevent wrong decisions on the treatment process.

Keywords

Tumor marker, thyroid cancer, iodine therapy, iodine-131

Introduction

It is known for a long time that exposure to ionizing radiation is harmful to biological tissues and it can cause irreversible tissue damage, cancer and even death inthe case of sufficient amounts and intensities.1 Iodine therapy has been used for benign and malignant thyroid therapies since 1940.When the radioactive iodine absorbed by the thyroid, the effect of the iodine therapy was started due to the high-energy beta radiation and it resulted in the cell death after a few weeks to a few months.2 The incidence rates of thyroid cancer in both women and men have been increasing in recent years. This year, an estimated 64,300 adults (14,950 men and 49,350 women) in the United States will be diagnosed with thyroid cancer. Thyroid cancer is the fifth most common cancer in women. Women are 3 times more likely to have thyroid cancer than men, but women and men die at equal rates. This suggests that men have a worse prognosis than women when there is a diagnosis of thyroid cancer.3 Most types of thyroid cancer are papillary and follicular thyroid cancer which can be surgically removed and since their forming cells absorb iodine as normal cells do, the residual cells can be destroyed with radioactive iodine after surgery. Beta particles of iodine can destroy follicular cells and gradually leads to mass reduction and thyrotoxicosis. As a result, iodine therapy will perform to destroy remaining thyroid tissue and prevent the metastatic potential. The major feature of thyroid cancer cells that differentiate it from the rest of cancers is to absorb iodine strongly. As a result, iodine concentrates in the remaining thyroid cells destroys them and the other cells that do not absorb iodine will remain safe.4

Thyroid cancer therapy methods include surgery, radiotherapy and chemotherapy. Radiation therapy performs thorough either radioactive iodine or external radiation therapy procedures. After thyroidectomy for thyroid cancer treatment, it should be ensured that no cancer cells are left. Despite many types of cancer, chemotherapy is not an effective treatment for metastatic thyroid cancer. These patients would be treated with radioactive iodine. Iodine therapy can help to maximize the therapeutic effect in the next stages of treatment procedure and it also reduces recurrence, mortality and morbidity and prevents the metastasis to other targets. 5 Radioactive iodine is often used in imaging technology, hyperthyroidism treatment, thyroid cancer and other types of cancer. In radiography studies such as thyroid scan, the patient receives a small dose of radioactive iodine that accumulates in thyroid cells or in certain types of tumors and it can be detected using a scanner. More concentrated iodine areas represent the abnormal activity of thyroid cells (hot thyroid nodules). Radioactive iodine is used in internal radiation therapy for prostate cancer, intraocular melanoma and carcinoid tumors (brachytherapy). In order to destroy cancer cells, the radioactive iodine, in liquid form or oral capsules is applied into or near the tumor via infusion or implantation.6 A tumor marker is a chemical produced by the tumor itself or by the normal cells responding to a tumor. Some tumor markers are completely specific for particular cancer such as PSA for prostate while others, such as CIA increases in various cancers, including colon, stomach, liver, pancreas, lung and breast, and they are nonspecific.7 From the clinical point of view, an ideal tumor marker not only should be perfectly specific for particular cancer but also it should be quite sensitive and accurate for early detection of small tumors. Unfortunately, only a few numbers of specific tumor markers are specific and the others are not specific and most of them are found in many tumors.8

 

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