Retinoic acid for redifferentiation of thyroid cancer - does it hold its promise?

Objectives: To evaluate the effectiveness of isotretinoin for improving 131 I uptake in recurrent/metastasized thyroid cancer with no/insufficient 131 I uptake. Design: Retrospective analysis of 25 patients treated between June 1999 and May 2001. Methods: 15 female and 10 male patients were given isotretinoin at 1 mg/kg for 3 months, followed by 131 I treatment. All patients received a 131 I scan 72 h after administration, thyroglobulin measurement, chest X-ray and ultrasound of the neck, and some patients underwent a 18 F-fluorodeoxyglucose (FDG) positron emission tomography ðn ¼ 14Þ and computed tomography scan of the chest ðn ¼ 11Þ: Results: In two out of 14 patients with raised thyroglobulin but no 131 I uptake, a slightly improved 131 I uptake was seen. In a further 11 patients an improvement of 131 I uptake of known lesions was desired or further non- 131 I-accumulating lesions were known. A dosimetrically relevant improvement of uptake was seen in three of these patients. 18 F-FDG uptake and thyroglobulin did not correlate with the success/failure of the isotretinoin treatment. Side effects including a strong ‘sunburn’, cheilitis, mucositis, conjunctivitis and raised transaminases occurred in two-thirds of patients. They were of an overall tolerable level and were reversible after isotretinoin had been stopped. Conclusion: From our clinical experience over a period of 2 years we conclude that the therapeutic effect of isotretinoin in thyroid cancer is certainly less than previously reported. An indiscriminate use of isotretinoin in all patients with otherwise untreatable thyroid cancer cannot be recommended.