Second Primary Malignancy After Radioiodine Therapy in Thyroid Cancer Patient: A Nationwide Study

홍채문 대한핵의학회 2023 핵의학 분자영상 Vol.57 No.6

Objective This study aimed to investigate the risk of second primary malignancy after radioiodine (RAI) therapy in patientswith thyroid cancer, using the National Health Insurance Service (NHIS) database. Methods We extracted data from the NHIS database of South Korea, which covers the entire population of the nation. Riskof second primary malignancy in the thyroid cancer patients who received RAI therapy were compared with the thyroidcancer patients who received surgery only. Results Between January 1, 2004, and December 31, 2018, we identified 363,155 patients who underwent thyroid surgerydue to thyroid cancer for analysis. The surgery only cohort was 215,481, and the RAI cohort was 147,674 patients. A totalof 19,385 patients developed second primary malignancy (solid cancer, 18,285; hematologic cancer, 1,100). There was nosignificant increase in the risk of second primary malignancy in patients who received a total cumulative dose of 100 mCi orless (hazard ratio [HR], 1.013; 95% confidence interval [CI], 0.979–1.049). However, a statistically significant increase in therisk of second primary malignancy was observed in patients who received 101–200 mCi (HR, 1.214; 95% CI, 1.167–1.264),201–300 mCi (HR, 1.422; 95% CI, 1.258–1.607), and > 300 mCi (HR, 1.693; 95% CI, 1.545–1.854). Conclusion Total cumulative doses of 100 mCi or less of RAI can be safely administered without concerns about secondprimary malignancy. However, the risk of second primary malignancy increases in a dose-dependent manner, and the risk–benefit needs to be considered for doses over 100 mCi of RAI therapy.

Treatment Effect of Combining Lenvatinib and Vemurafenib for BRAF Mutated Anaplastic Thyroid Cancer

홍채문,오지민,GANGADARAN PRAKASH,Ramya Lakshmi Rajendran,안병철 대한갑상선학회 2021 International Journal of Thyroidology Vol.14 No.2

Background and Objectives: Even though most of the thyroid cancer shows good prognosis, de-differentiatedthyroid cancer is still refractory to conventional treatments. Recently, kinase inhibitors including multi-kinase andBRAF inhibitors are widely used for treatment of de-differentiated thyroid cancers, but resistant to single kinaseinhibitor treatment eventually encountered. Therefore, combination therapy may have better therapeutic effectthan single therapy for thyroid cancer. In this study, we evaluated therapeutic effect of multi-kinase and BRAFinhibitor combination to anaplastic thyroid cancer cell lines with and without BRAF mutation. Materials andMethods: We used anaplastic thyroid cancer cell lines with BRAFV600E mutation (8505C) and with NRAS mutation(HTh7). Both cell lines were treated with various concentration of multi-kinase inhibitor (lenvatinib) and BRAFinhibitor (vemurafenib). And combination of various concentration of both kinase inhibitors were used to treatboth cell lines. Cytotoxic effect was assessed with cell counting kit-8 and therapeutic effect of single kinaseinhibitor therapy and the combination therapy was compared. Results: Anti-proliferative effect of vemurafenibon 8505C BRAFV600E-mutated cells was demonstrated from 0.25 μM concentration. However, HTh7 cells withNRAS mutation represented drug resistance up to 4 μM of vemurafenib. In case of lenvatinib treatment as amulti-kinase inhibitor, 8505C and HTh7 cells showed decreased cell viability dose-dependent manner. Combinationtreatment with vemurafenib and lenvatinib showed synergistic cytotoxic effect in BRAF mutated 8505C cell line,even at lower concentrations. Conclusion: Combination treatment with multi-kinase inhibitor and BRAF inhibitorshowed promising therapeutic results in BRAF mutated anaplastic thyroid cancer cell line.

Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer

홍채문,안병철 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.4

Radioactive iodine (RAI) therapy for differentiated thyroid cancer has been successfully used for more than 70 years. However,there is still plenty of controversy surrounding the use and doses of radioiodine. There is insufficient evidence to answer thequestions. Recent American Thyroid Association (ATA) guidelines seem to favor low-dose RAI, based on recent clinical trialsand meta-analyses. However, long-term follow-up data remains limited, and there are additional factors we should consider thatmight affect the efficacy of RAI therapy. Therefore, until sufficient data are available, it is necessary to remain cautious aboutdetermining RAI doses by considering multiple patient-specific variables.

KSNM60 in Nuclear Endocrinology: from the Beginning to the Future

홍채문,정영진,김해원,안병철 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.1

Nuclear endocrinology is the main ignitor for founding the Korean Society of Nuclear Medicine (KSNM) in the early 1960s by outstanding pioneering medical doctors. Management of thyroid diseases required nuclear medicine technology in the early days of the KSNM and was rapidly developed by advancements in nuclear medicine technology. Nuclear thyroidology remains one of the main clinical applications in nuclear medicine worldwide. Nuclear medicine technology provides essential information for diagnosing and assessing diseases of the parathyroid glands, pituitary gland, and neuroendocrine tumors (NETs). In addition, therapeutic nuclear medicine is essential for managing nonresectable NETs. Nuclear endocrinology remains a major section in clinical nuclear medicine, and members of the KSNM have contributed to progressing better management of benign and malignant endocrine diseases. This review summarizes the historical activities and milestone contributions to nuclear endocrinology made by the members of the KSNM over the past 60 years to congratulate the KSNM on its 60-year anniversary.

Subacute Thyroiditis Developed While Waiting for Papillary Thyroid Cancer Surgery: Pathologically Proven Two Cases

김도훈,홍채문,한만훈,이재태 대한갑상선학회 2021 International Journal of Thyroidology Vol.14 No.2

Co-existence of subacute thyroiditis and papillary thyroid cancer (PTC) is rarely reported. We have recentlyexperienced interesting cases of subacute thyroiditis, which developed while waiting for elective surgery of thyroidcancer in two patients. Two women, aged 52 and 55 years, suspected or diagnosed as PTC complained of anteriorneck pain and febrile sensation several weeks before the scheduled surgery. Both cases showed elevated serumthyroid hormones and erythrocyte sedimentation rate, and decreased thyroid-stimulating hormone. Ill-definedhypoechoic lesions on ultrasonography and decreased uptake on Tc-99m pertechnetate scan were noted in bothlobes. Total thyroidectomy for PTC was performed after relief of symptoms either by steroid or non-steroidanti-inflammatory drug treatment. Pathologic evaluation of surgical specimen revealed multinucleated giant cellsand mononuclear cell infiltration. Pathognomic findings of subacute thyroiditis in addition to PTC were observedin both cases.

갑상선 질환의 방사성요오드 치료와 이차암 발생

이재태,홍채문,하정희 대한갑상선학회 2023 International Journal of Thyroidology Vol.16 No.1

Radioiodine has been effectively applied for the management of hyperthyroidism and differentiated thyroid cancers in most countries of the world. The majority of thyroid cancers are differentiated thyroid cancer that has an overall excellent prognosis, which attributed to appropriate treatment of the disease including administration of radioiodine, I-131. I-131 therapy has usually been undertaken for the ablation of remnant tissue or adjuvant treatment after surgical resection of the thyroid. I-131 therapy was routinely recommended for patients with high-risk disease, and should be considered for intermediate-risk disease as an adjuvant purpose. Several latest studies refute worries of increase cancer risk with I-131 treatment for thyroid cancer. Thus, recent ATA guidelines have shifted toward a more individual and stratified approach, because of benign nature of the differentiated thyroid cancer as well as awareness of side effects including potential increasing incidence of second primary malignancy after I-131 treatment. While some retrospective studies also pointed out that potential increases in cancer development after I-131 treatment for hyperthyroidism recently. Treatment decisions regarding the use of radioiodine therapy should consider the balance of risks and benefits for individual patients with low risk differentiated thyroid cancer and hyperthyroidism, if it is true. Thus, we will review current understanding for the association of increased secondary malignancy and I-131 treatment of thyroid diseases.

Prevalence and Risk Factors of Atypical Femoral Fracture Bone Scintigraphic Feature in Patients Experiencing Bisphosphonate-Related Osteonecrosis of the Jaw

이창희,손승현,홍채문,정주혜,정신영,이상우,이재태,권대근,안병철 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.4

Purpose Bisphosphonate (BP) is the first-line therapy for the management of osteoporosis. BP-related osteonecrosis of the jaw(BRONJ) and atypical femoral fracture (AFF) are increasingly common comorbidities in patients with osteoporosis under longtermBP treatment. The aim of this study was to evaluate the incidence and risk factors for AFF features on bone scintigraphy inpatients with BRONJ. Methods Among total of 373 BRONJ patients treated between September 2005 and July 2014, 237 (220 women, 17 men;median age 73 years) who underwent three-phase bone scintigraphy were enrolled for this retrospective study. AFF features onbone scintigraphy and the related clinical factors were assessed. Results Among 237 patients with BRONJ, 11 (4.6%) showed AFF features on bone scintigraphy. BP medicationduration (p = 0.049) correlated significantly with AFF features on bone scintigraphy in patients with BRONJ. BPintake duration of 34 months was the cutoff value for predicting the presence of AFF features on bone scintigraphy. Among the patients with BRONJ, all those with AFF features on bone scintigraphy were female patients with osteoporosiswho were on oral BP medication; however, these factors were not significantly different along with AFFfeatures on bone scintigraphy. Conclusion The incidence of AFF features on bone scintigraphy was relatively high in patients with BRONJ. A careful observationof patients presenting with the AFF features on bone scintigraphy may be needed, particularly for female BRONJ patientswith osteoporosis who have been on BP medication for over 34 months.

Biliary Flow in Septate Gallbladder on Hepatobiliary Scintigraphy with SPECT/CT

김춘영,이상우,홍채문,정신영,안병철,이재태 대한핵의학회 2013 핵의학 분자영상 Vol.47 No.3