Comparison of Recombinant Human Thyroid-Stimulating Hormone and Thyroid Hormone Withdrawal for 131 I Therapy in Patients With Intermediate- to High-Risk Thyroid Cancer : A Systematic Review and Meta-analysis.

Ji-In Bang, Sohyun Park, Keunyoung Kim, Youngduk Seo, Ari Chong, Chae Moon Hong, Sang-Woo Lee, So Won Oh, Miyoung Choi, Dong-Eun Lee

Journal: Clinical nuclear medicine 2024;49(3):e96-e104

PMID: 38271262

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Abstract

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the therapeutic efficacy and advantages associated with the use of recombinant human thyroid-stimulating hormone (rhTSH) for radioactive iodine (RAI) therapy in patients with intermediate- to high-risk differentiated thyroid cancer.

PATIENTS AND METHODS

MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles reporting clinical outcomes of rhTSH compared with thyroid hormone withdrawal (THW) in patients with intermediate- to high-risk differentiated thyroid cancer published between January 2012 and June 2023. Meta-analyses were performed (PROSPERO registration number: CRD42022340915) to assess the success rate of radioiodine remnant ablation (RRA) in patients with intermediate to high risk and determine the disease control rate among patients with distant metastases, evaluated using the RECIST criteria.

RESULTS

Thirteen studies involving 1858 patients were included in the meta-analysis. Pooled analyses revealed significantly higher overall RRA success rate in the rhTSH group compared with the THW group, with a risk ratio (RR) of 1.12 (95% confidence interval [CI], 1.01-1.25). However, in the subgroup analysis of high-risk patients, pooled analyses showed no significant differences in RRA success rate between the rhTSH group compared with the THW group with a pooled RR of 1.05 (95% CI, 0.88-1.24). In patients with distant metastases, there were no significant differences in the disease control rate between groups, with a pooled RR of 1.06 (95% CI, 0.78-1.44).

CONCLUSIONS

rhTSH for RAI therapy is a practical option for RAI therapy in patients with intermediate- to high-risk thyroid cancer, including those with distant metastases.

Address: From the Department of Nuclear Medicine, National Cancer Center Hospital, Goyang.; Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.; Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Pusan.; Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong.; Department of Nuclear Medicine, Chosun University Hospital and College of Medicine, Gwangju.; Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu.; Biostatistics Collaboration Team, National Cancer Center, Goyang.; Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul.; Department of Nuclear Medicine, Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu.; Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.

DOI: 10.1097/RLU.0000000000005022

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MeSH Terms: Humans, Thyrotropin Alfa, Thyroid Neoplasms, Iodine Radioisotopes, Thyrotropin, Thyroid Hormones, Recombinant Proteins, Treatment Outcome, Retrospective Studies