Fernanda Andrade1, Geneviève Rondeau2, Laura Boucai3, Rebecca Zeuren3, Ashok R Shaha4, Ian Ganly3, Fernanda Vaisman1, Rossana Corbo1, Michael Tuttle3. 1. Department of Medicine, Endocrinology Service, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil. 2. Center Hospitalier de l'Université de Montréal, Medicine Endocrinology, Montreal, Canadá. 3. Department of Medicine, Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 4. Department of Surgery, Head and Neck Cancer, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Abstract
OBJECTIVE: Because serum calcitonin (CT) is a reliable marker of the presence, volume, and extent of disease in medullary thyroid cancer (MTC), both the ATA and NCCN guidelines use the 2-3 month post-operative CT value as the primary response to therapy variable that determines the type and intensity of follow up evaluations. We hypothesized that the calcitonin would nadir to undetectable levels within 1 month of a curative surgical procedure. SUBJECTS AND METHODS: This retrospective review identified 105 patients with hereditary and sporadic MTC who had at least two serial basal CT measurements done in the first three months after primary surgery. RESULTS: When evaluated one year after initial surgery, 42 patients (42/105, 40%) achieved an undetectable basal calcitonin level without additional therapies and 56 patients (56/84, 67%) demonstrated a CEA within the normal reference range. In patients destined to have an undetectable CT as the best response to initial therapy, the calcitonin was undetectable by 1 month after surgery in 97% (41/42 patients). Similarly, in patients destined to have a normalize their CEA, the CEA was within the reference range by 1 month post-operatively in 63% and by 6 months in 98%. By 6 months after curative initial surgery, 100% of patients had achieved a nadir undetectable calcitonin, 98% had reached the CEA nadir, and 97% had achieved normalization of both the calcitonin and CEA. CONCLUSION: The 1 month CT value is a reliable marker of response to therapy that allows earlier risk stratification than the currently recommended 2-3 month CT measurement.
OBJECTIVE: Because serum calcitonin (CT) is a reliable marker of the presence, volume, and extent of disease in medullary thyroid cancer (MTC), both the ATA and NCCN guidelines use the 2-3 month post-operative CT value as the primary response to therapy variable that determines the type and intensity of follow up evaluations. We hypothesized that the calcitonin would nadir to undetectable levels within 1 month of a curative surgical procedure. SUBJECTS AND METHODS: This retrospective review identified 105 patients with hereditary and sporadic MTC who had at least two serial basal CT measurements done in the first three months after primary surgery. RESULTS: When evaluated one year after initial surgery, 42 patients (42/105, 40%) achieved an undetectable basal calcitonin level without additional therapies and 56 patients (56/84, 67%) demonstrated a CEA within the normal reference range. In patients destined to have an undetectable CT as the best response to initial therapy, the calcitonin was undetectable by 1 month after surgery in 97% (41/42 patients). Similarly, in patients destined to have a normalize their CEA, the CEA was within the reference range by 1 month post-operatively in 63% and by 6 months in 98%. By 6 months after curative initial surgery, 100% of patients had achieved a nadir undetectable calcitonin, 98% had reached the CEA nadir, and 97% had achieved normalization of both the calcitonin and CEA. CONCLUSION: The 1 month CT value is a reliable marker of response to therapy that allows earlier risk stratification than the currently recommended 2-3 month CT measurement.
Authors: A Faggiano; F Milone; V Ramundo; M G Chiofalo; I Ventre; R Giannattasio; R Severino; G Lombardi; A Colao; L Pezzullo Journal: J Clin Endocrinol Metab Date: 2010-06-09 Impact factor: 5.958
Authors: M Engelbach; R Görges; T Forst; A Pfützner; R Dawood; S Heerdt; T Kunt; A Bockisch; J Beyer Journal: J Clin Endocrinol Metab Date: 2000-05 Impact factor: 5.958