Short-term efficacy assessment of transarterial chemoembolization combined with radioactive iodine therapy in primary hepatocellular carcinoma

BACKGROUND Transarterial chemoembolization(TACE)is an effective treatment for primary hepatocellular carcinoma(PHC).Radioactive iodine therapy has been used in the treatment of advanced PHC,especially in patients with portal vein tumor thrombosis.However,data on the therapeutic effect of TACE combined with radioactive iodine therapy in PHC are scarce.AIM To investigate the clinical efficacy of TACE combined with radioactive iodine implantation therapy in advanced PHC via perfusion computed tomography(CT).METHODS For this study,98 advanced PHC patients were recruited and divided randomly into the study and control groups.Patients in the study group were treated with TACE combined radioactive iodine implantation therapy.Patients in the control group were treated with only TACE.The tumor lesion length,clinical effect,serum alpha-fetoprotein(AFP)and CT perfusion parameters were compared before and after therapy,and statistical analysis was performed.RESULTS There was no significant difference in tumor length and serum AFP between the study and control groups(P>0.05)before treatment.However,the tumor length and serum AFP in the study group were lower than those in the control group 1 mo and 3 mo after therapy.After 3 mo of treatment,the complete and partial remission rate of the study group was 93.88%,which was significantly higher than the control group(77.55%)(P<0.05).Before treatment,there were no significant differences between the two groups on the perfusion CT variables,including the lesion blood volume,permeability surface,blood flow,hepatic artery flow and mean transit time(P>0.05).After 3 mo of treatment,all perfusion CT variables were lower in the study group compared to the control group(P<0.05).The survival time of patients in the study group was 22 mo compared to 18 mo in the control group,which was significantly different[log rank(Mantel-Cox)=4.318,P=0.038].CONCLUSION TACE combined with radioactive iodine implantation in the treatment of advanced PHC can inhibit the formation of blood vessels in tumor tissue and reduce the perfusion level of tumor lesions,thereby improving the clinical efficacy and prolonging the survival time of patients.

Rapid progression of heart failure secondary to radioactive iodine treatment of hyperthyroidism:A case report

BACKGROUND The deterioration of thyroid health is involved in the progression of heart failure(HF).This is usually a lengthy process,so there are almost no reports on its rapid development.Here we report a case of a young male who rapidly developed hypothyroid cardiomyopathy secondary to radioactive iodine treatment,suggesting that severe HF might occur even after a short period of hypothyroidism.CASE SUMMARY A 26-year-old man was referred to our hospital for HF presenting with dyspnea on exertion and chest discomfort lasting for 1 mo.He received radioactive iodine treatment for hyperthyroidism 1 year ago and had an almost normal echocardiogram 6 mo ago.Admission echocardiogram and cardiac magnetic resonance(CMR)revealed left ventricle(LV)global hypokinesia and severely depressed systolic function.In addition,late gadolinium enhancement indicated no obvious changes in the myocardium.Thyroid function tests showed decreased serum levels of thyroid hormone(TH)and elevated thyroid-stimulating hormone.Based on an exclusionary examination,the patient was diagnosed with hypothyroid cardiomyopathy and was started on replacement therapy.His HF symptoms were completely relieved during the six-month follow-up,and echocardiogram and CMR revealed recovered LV size and ejection fraction.CONCLUSION This report demonstrates that severe fluctuations in TH levels may lead to acute HF,which can completely recover with timely thyroid hormone replacement.In addition,our findings highlight the importance of routinely detecting cardiac function in patients treated with radioactive iodine.

Relationship between Whole Body Iodine-131 Effective Half-Life and Estimated Glomerular Filtration Rate for Papillary Thyroid Cancer Patients Undergoing Radioactive Iodine Therapy

Background: The aim of this work was to examine the relationship between the estimated glomerular filtration rate (eGFR) as indicator of renal efficiency potentially related to the ability to release radioactive iodine from the patients bodies and the radioactive iodine whole body effective half-life (WBEHL) defined as the time taken for the administered activity to decay to half of its value for papillary thyroid cancer (PTC) patients undergoing radioactive iodine therapy (RAIT) in a tertiary care medical Centre. Methods: This retrospective observational study included seventy nine patients, sixty females and nineteen males. The patients were divided in two subgroups, those who have WBEHL of less than 11 hours (n = 51) and those with more than 11 (n = 28) hrs based on k-means clustering technique. Results: Analysis of variance (ANOVA) was used to find out if there is a statistically significant difference between the two subgroups Conclusion: There was not a statistically significant difference between the short and the longer WBEHL patients’ groups analyzed in this study. .

New approaches for patients with advanced radioiodine-refractory thyroid cancer

The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic disease,and about two-thirds of the latter will be defined as refractory to radioactive iodine(RAIR)treatment.Since this condition implies 10-year survival rates less than 10% after detection,using available treatments,such as systemic and targeted therapies,have become increasingly relevant.The initiation of these treatments aims to reach stabilization,tumor volume reduction,and/or symptom improvement and it should be decided by highly specialized endocrinologists/oncologists on the basis of patient’s features.Considering that despite enlarged progression-free survival was proven,multikinase inhibitors remain non-curative,their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction.In this context,molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy,progression free survival,overall survival and adverse events profile.This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC,including approved target therapies as well as those for off-label use,RAI resensitization agents,and immunotherapy.

Facile Microwave-Assisted Synthesis of 2D Imine-Linked Covalent Organic Frameworks for Exceptional Iodine Capture

Covalent organic frameworks(COFs)have emerged as auspicious porous adsorbents for radioiodine capture.However,their conventional solvothermal synthesis demands multiday synthetic times and anaerobic conditions,largely hampering their practical use.To tackle these challenges,we present a facile microwave-assisted synthesis of 2D imine-linked COFs,Mw-TFB-BD-X,(X=−CH_(3) and−OCH_(3))under air within just 1 h.The resultant COFs possessed higher crystallinity,better yields,and more uniform morphology than their solvothermal counterparts.Remarkably,Mw-TFB-BD-CH_(3) and Mw-TFB-BDOCH_(3) exhibited exceptional iodine adsorption capacities of 7.83 g g^(−1) and 7.05 g g^(−1),respectively,placing them among the bestperforming COF adsorbents for static iodine vapor capture.Moreover,Mw-TFB-BD-CH_(3) and Mw-TFB-BD-OCH_(3) can be reused 5 times with no apparent loss in the adsorption capacity.The exceptionally high iodine adsorption capacities and excellent reusability of COFs were mainly attributed to their uniform spherical morphology and enhanced chemical stability due to the in-built electron-donating groups,despite their low surface areas.This work establishes a benchmark for developing advanced iodine adsorbents that combine fast kinetics,high capacity,excellent reusability,and facile rapid synthesis,a set of appealing features that remain challenging to merge in COF adsorbents so far.

Capsaicin restores sodium iodine symportermediated radioiodine uptake through bypassing canonical TSH–TSHR pathway in anaplastic thyroid carcinoma cells

Anaplastic thyroid cancer(ATC)is a rare but highly lethal disease.ATCs are resistant to standard therapies and are extremely difficult to manage.The stepwise cell dedifferentiation results in the impairment of the iodine-metabolizing machinery and the infeasibility of radioiodine treatment in ATC.Hence,reinducing iodine-metabolizing gene expression to restore radioiodine avidity is considered as a promising strategy to fight against ATC.In the present study,capsaicin(CAP),a natural potent transient receptor potential vanilloid type 1(TRPV1)agonist,was discovered to reinduce ATC cell differentiation and to increase the expression of thyroid transcription factors(TTFs including TTF-1,TTF-2,and PAX8)and iodine-metabolizing proteins,including thyroidstimulating hormone receptor(TSHR),thyroid peroxidase,and sodium iodine symporter(NIS),in two ATC cell lines,8505C and FRO.Strikingly,CAP treatment promoted NIS glycosylation and its membrane trafficking,resulting in a significant enhancement of radioiodine uptake of ATC cells in vitro.Mechanistically,CAP-activated TRPV1 channel and subsequently triggered Ca2þinflux,cyclic adenosine monophosphate(cAMP)generation,and cAMP-responsive element-binding protein(CREB)signal activation.Next,CREB recognized and bound to the promoter of SLC5A5 to facilitate its transcription.Moreover,the TRPV1 antagonist CPZ,the calcium chelator BAPTA,and the PKA inhibitor H-89 effectively alleviated the redifferentiation exerted by CAP,demonstrating that CAP might improve radioiodine avidity through the activation of the TRPV1–Ca2þ/cAMP/PKA/CREB signaling pathway.In addition,our study indicated that CAP might trigger a novel cascade to redifferentiate ATC cells and provide unprecedented opportunities for radioiodine therapy in ATC,bypassing canonical TSH–TSHR pathway.

A study on the learning curve for a new radioactive seed template retainer assisted by CT-guided radioactive seed implantation for advanced non-small cell lung cancer

Objective:To explore the application of a new radioactive seed template retainer in the learning curve of CTguided 125I seed brachytherapy(CTISBT)for advanced non-small cell lung cancer(NSCLC).Methods:This study retrospectively analyzed the medical records of 60 patients who underwent CTISBT for advanced NSCLC by a single physician between January 2018 and December 2019.The data were sorted in order of admission and divided into three groups according to the order of surgery,group A(cases 1–20),group B(cases 21–40),and group C(cases 41–60).All patients underwent preoperative planning and postoperative dosimetry verification,and the operation time,intraoperative CT scans,postoperative hospital stay,and postoperative complications were compared among the three groups.The quality of life(QOL)score and tumor volume were compared before and 2 months after surgery.Results:There were no statistically significant differences among the three groups in QOL scores,tumor volume,and tumor site before CTISBT assisted by the new radioactive seed template retainer.However,the surgical time differed significantly between the three groups(P<0.01).The operation time was longer in group A than that in groups B and C(P<0.01).There was no significant difference between groups B and C.There were no significant differences in the number of CT scans among the three groups and the length of postoperative hospital stay.The follow-up QOL and tumor volume were significantly reduced at 2 months after surgery compared with those before surgery(P<0.01).Conclusions:The short-term efficacy of the new radioactive seed template retainer-assisted CTISBT was definitive for advanced NSCLC.After the physician had accumulated experience with 20 cases of a new type of radioactive seed template retainer-assisted CTISBT surgery,the follow-up operation time was significantly shortened and the learning curve entered the plateau stage.

Bisindole [3]arenes—Indolyl Macrocyclic Arenes Having Significant Iodine Capture Capacity

Several novel macrocyclic arenes that are composed of six indole subunits,so-called bisindole[3]arenes(BID[3]s),were conveniently synthesized by the aluminum trichloride-catalyzed one-pot condensation of bisindole derivatives and paraformaldehyde in dichloromethane at room temperature.Their macrocyclic structures were demonstrated by X-ray single-crystal studies,and the presence of the macrocyclic cavities made it possible to accommodate specific small organic molecules.The BID[3]s have exceptionally high iodine adsorption ability due to the strong and synergic interaction of indole units toward iodine,exhibiting significant morphology changes upon adsorption and desorption of iodine.Iodine uptake capacity of up to 5.12 g·g^(−1) was found with MeBID[3],which is the highest value ever reported for macrocyclic arenes.