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Changes in the pulmonary function test after radioactive iodine treatment in patients with pulmonary metastases of differentiated thyroid cancer.

Jang EK, Kim WG, Kim HC, Huh JW, Kwon H, Choi YM, Jeon MJ, Kim TY, Shong YK, Ryu JS, Kim WB - PLoS ONE (2015)

Bottom Line: The median age of the patients was 44.1 years and 18 of them were female patients.Coexisting pulmonary diseases, presence of respiratory symptoms, and metastatic disease progression were significantly associated with severe decrease in forced vital capacity during follow-up (p =.047, p =.011, and p =.021, respectively).Serial PFT might be considered for some high-risk patients during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea; Division of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea.

ABSTRACT

Objective: Pulmonary function test (PFT) is a useful tool for an objective assessment of respiratory function. Impaired pulmonary function is critical for the survival and quality of life in patients with pulmonary metastases of solid cancers including thyroid cancer. This study aimed to evaluate clinical factors associated with severely impaired pulmonary function by serial assessment with PFT in patients with pulmonary metastasis of differentiated thyroid cancer (DTC) who received radioactive iodine treatment (RAIT).

Patients: This retrospective study enrolled 31 patients who underwent serial PFTs before and after RAIT for pulmonary metastasis of DTC. We evaluated the risk factors for severe impairment of pulmonary function.

Results: The median age of the patients was 44.1 years and 18 of them were female patients. Severe impairment of pulmonary function was observed in five patients (16%) after a median of three RAITs (cumulative I-131 activity = 20.4 GBq). These patients were older and more frequently had mild impairment of baseline pulmonary function, respiratory symptoms, or progressive disease compared with patients with stable pulmonary function. Neither cumulative dose nor number of RAIT was associated with decreased pulmonary function. Coexisting pulmonary diseases, presence of respiratory symptoms, and metastatic disease progression were significantly associated with severe decrease in forced vital capacity during follow-up (p =.047, p =.011, and p =.021, respectively).

Conclusions: Pulmonary function was severely impaired during follow-up in some patients with pulmonary metastasis of DTC after a high-dose RAITs. Neither the number of RAIT nor the cumulative I-131 activity was associated with decreased pulmonary function. Serial PFT might be considered for some high-risk patients during follow-up.

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Serial changes in pulmonary function during follow-up after RAIT in patients with pulmonary metastases of differentiated thyroid cancer.Patients were classified according to their baseline pulmonary function. We entered the values of baseline PFT at the time of the first RAIT (time ‘0’) into this figure. (A) Changes in FVC and FEV1 in patients with normal pulmonary function at baseline (n = 21). (B) Changes in FVC and FEV1 in patients with restrictive pulmonary function at baseline (n = 7). (C) Changes in FVC and FEV1 in patients with obstructive pulmonary function at baseline (n = 3). The bold lines indicate the patients who demonstrated a significantly decreased pulmonary function (severe restrictive or obstructive pattern) during follow-up. Each number of the bold lines corresponds to the patient number as shown in Table 2. (D) Patient #4 had mild interstitial lung disease, and chest radiography before RAIT demonstrated ill-defined patch reticular opacities in sub-pleural areas. About 12 years after the first RAIT, her chest radiography showed an increased extent of multifocal patch reticular and ground-glass opacities in peripheral areas of both lungs compared with chest radiography before RAIT. (E) Patient #5 was diagnosed with pulmonary metastases before thyroid surgery and 1-2cm sized multiple metastatic nodules were seen in both lungs on chest radiography before RAIT. The size of the metastatic nodules was increased in follow-up chest radiography even after high-dose RAITs. %, % of measured to predicted values. RAIT, radioactive iodine treatment; PFT, pulmonary function test; FVC, forced vital capacity; FEV1, forced expiratory volume 1 second.
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pone.0125114.g001: Serial changes in pulmonary function during follow-up after RAIT in patients with pulmonary metastases of differentiated thyroid cancer.Patients were classified according to their baseline pulmonary function. We entered the values of baseline PFT at the time of the first RAIT (time ‘0’) into this figure. (A) Changes in FVC and FEV1 in patients with normal pulmonary function at baseline (n = 21). (B) Changes in FVC and FEV1 in patients with restrictive pulmonary function at baseline (n = 7). (C) Changes in FVC and FEV1 in patients with obstructive pulmonary function at baseline (n = 3). The bold lines indicate the patients who demonstrated a significantly decreased pulmonary function (severe restrictive or obstructive pattern) during follow-up. Each number of the bold lines corresponds to the patient number as shown in Table 2. (D) Patient #4 had mild interstitial lung disease, and chest radiography before RAIT demonstrated ill-defined patch reticular opacities in sub-pleural areas. About 12 years after the first RAIT, her chest radiography showed an increased extent of multifocal patch reticular and ground-glass opacities in peripheral areas of both lungs compared with chest radiography before RAIT. (E) Patient #5 was diagnosed with pulmonary metastases before thyroid surgery and 1-2cm sized multiple metastatic nodules were seen in both lungs on chest radiography before RAIT. The size of the metastatic nodules was increased in follow-up chest radiography even after high-dose RAITs. %, % of measured to predicted values. RAIT, radioactive iodine treatment; PFT, pulmonary function test; FVC, forced vital capacity; FEV1, forced expiratory volume 1 second.

Mentions: The median time interval between the first RAIT and last PFT was 4.1 years [inter-quartile range (IQR), 1.7–9.9]. The median values of the worst pulmonary function during follow-up were as follows: FVC = 87.0%, FEV1 = 85.0%, FEV1/FVC = 79.0% and DLCO = 82.0%. In 26 of 31 patients (84%), there were no significant changes in serial PFTs during follow-up. However, five patients (16%) had a significant decrease in their pulmonary function (severe restrictive or obstructive pattern) during follow-up as shown in Fig 1 and Table 2.


Changes in the pulmonary function test after radioactive iodine treatment in patients with pulmonary metastases of differentiated thyroid cancer.

Jang EK, Kim WG, Kim HC, Huh JW, Kwon H, Choi YM, Jeon MJ, Kim TY, Shong YK, Ryu JS, Kim WB - PLoS ONE (2015)

Serial changes in pulmonary function during follow-up after RAIT in patients with pulmonary metastases of differentiated thyroid cancer.Patients were classified according to their baseline pulmonary function. We entered the values of baseline PFT at the time of the first RAIT (time ‘0’) into this figure. (A) Changes in FVC and FEV1 in patients with normal pulmonary function at baseline (n = 21). (B) Changes in FVC and FEV1 in patients with restrictive pulmonary function at baseline (n = 7). (C) Changes in FVC and FEV1 in patients with obstructive pulmonary function at baseline (n = 3). The bold lines indicate the patients who demonstrated a significantly decreased pulmonary function (severe restrictive or obstructive pattern) during follow-up. Each number of the bold lines corresponds to the patient number as shown in Table 2. (D) Patient #4 had mild interstitial lung disease, and chest radiography before RAIT demonstrated ill-defined patch reticular opacities in sub-pleural areas. About 12 years after the first RAIT, her chest radiography showed an increased extent of multifocal patch reticular and ground-glass opacities in peripheral areas of both lungs compared with chest radiography before RAIT. (E) Patient #5 was diagnosed with pulmonary metastases before thyroid surgery and 1-2cm sized multiple metastatic nodules were seen in both lungs on chest radiography before RAIT. The size of the metastatic nodules was increased in follow-up chest radiography even after high-dose RAITs. %, % of measured to predicted values. RAIT, radioactive iodine treatment; PFT, pulmonary function test; FVC, forced vital capacity; FEV1, forced expiratory volume 1 second.
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pone.0125114.g001: Serial changes in pulmonary function during follow-up after RAIT in patients with pulmonary metastases of differentiated thyroid cancer.Patients were classified according to their baseline pulmonary function. We entered the values of baseline PFT at the time of the first RAIT (time ‘0’) into this figure. (A) Changes in FVC and FEV1 in patients with normal pulmonary function at baseline (n = 21). (B) Changes in FVC and FEV1 in patients with restrictive pulmonary function at baseline (n = 7). (C) Changes in FVC and FEV1 in patients with obstructive pulmonary function at baseline (n = 3). The bold lines indicate the patients who demonstrated a significantly decreased pulmonary function (severe restrictive or obstructive pattern) during follow-up. Each number of the bold lines corresponds to the patient number as shown in Table 2. (D) Patient #4 had mild interstitial lung disease, and chest radiography before RAIT demonstrated ill-defined patch reticular opacities in sub-pleural areas. About 12 years after the first RAIT, her chest radiography showed an increased extent of multifocal patch reticular and ground-glass opacities in peripheral areas of both lungs compared with chest radiography before RAIT. (E) Patient #5 was diagnosed with pulmonary metastases before thyroid surgery and 1-2cm sized multiple metastatic nodules were seen in both lungs on chest radiography before RAIT. The size of the metastatic nodules was increased in follow-up chest radiography even after high-dose RAITs. %, % of measured to predicted values. RAIT, radioactive iodine treatment; PFT, pulmonary function test; FVC, forced vital capacity; FEV1, forced expiratory volume 1 second.
Mentions: The median time interval between the first RAIT and last PFT was 4.1 years [inter-quartile range (IQR), 1.7–9.9]. The median values of the worst pulmonary function during follow-up were as follows: FVC = 87.0%, FEV1 = 85.0%, FEV1/FVC = 79.0% and DLCO = 82.0%. In 26 of 31 patients (84%), there were no significant changes in serial PFTs during follow-up. However, five patients (16%) had a significant decrease in their pulmonary function (severe restrictive or obstructive pattern) during follow-up as shown in Fig 1 and Table 2.

Bottom Line: The median age of the patients was 44.1 years and 18 of them were female patients.Coexisting pulmonary diseases, presence of respiratory symptoms, and metastatic disease progression were significantly associated with severe decrease in forced vital capacity during follow-up (p =.047, p =.011, and p =.021, respectively).Serial PFT might be considered for some high-risk patients during follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea; Division of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea.

ABSTRACT

Objective: Pulmonary function test (PFT) is a useful tool for an objective assessment of respiratory function. Impaired pulmonary function is critical for the survival and quality of life in patients with pulmonary metastases of solid cancers including thyroid cancer. This study aimed to evaluate clinical factors associated with severely impaired pulmonary function by serial assessment with PFT in patients with pulmonary metastasis of differentiated thyroid cancer (DTC) who received radioactive iodine treatment (RAIT).

Patients: This retrospective study enrolled 31 patients who underwent serial PFTs before and after RAIT for pulmonary metastasis of DTC. We evaluated the risk factors for severe impairment of pulmonary function.

Results: The median age of the patients was 44.1 years and 18 of them were female patients. Severe impairment of pulmonary function was observed in five patients (16%) after a median of three RAITs (cumulative I-131 activity = 20.4 GBq). These patients were older and more frequently had mild impairment of baseline pulmonary function, respiratory symptoms, or progressive disease compared with patients with stable pulmonary function. Neither cumulative dose nor number of RAIT was associated with decreased pulmonary function. Coexisting pulmonary diseases, presence of respiratory symptoms, and metastatic disease progression were significantly associated with severe decrease in forced vital capacity during follow-up (p =.047, p =.011, and p =.021, respectively).

Conclusions: Pulmonary function was severely impaired during follow-up in some patients with pulmonary metastasis of DTC after a high-dose RAITs. Neither the number of RAIT nor the cumulative I-131 activity was associated with decreased pulmonary function. Serial PFT might be considered for some high-risk patients during follow-up.

Show MeSH
Related in: MedlinePlus