Outcomes of Total Thyroidectomy with Therapeutic Central and Lateral Neck Dissection with a Single Dose of Radioiodine in the Treatment of Regionally Advanced Papillary Thyroid Cancer and Effects on Serum Thyroglobulin

Abstract

Biochemical remission can be experienced in most patients presenting with regionally advanced PTC with total thyroidectomy and compartment based therapeutic neck dissection followed by a single dose of radioiodine.

Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases not limited to the central compartment (cN1b)

“…As supporting data, in a subsequent publication of the same group, the response rate of intermediate-risk cN1b patients to initial therapy was approximately 85% (12). In another series involving N1bM0 patients, the recurrence rate ranged from 15-20% (13)(14)(15)(16)(17)(18), while this rate was approximately 10% in the present series. We attribute this apparent difference to the fact that the present study excluded cN1b patients who additionally exhibited incomplete tumor resection and extensive extrathyroid invasion (pT4) [high risk according to ATA (1)].…”

Risk Factors for Recurrence of Papillary Thyroid Carcinoma with Clinically Node-Positive Lateral Neck

“…However, our study included a larger number of patients and longer follow-up period than those of previous studies. 18,19 The results of the present study may be of value to guide clinicians in the identification of at-risk patients who would benefit from aggressive treatments and intensive surveillance.…”

“…Previous studies investigating the outcomes of lateral neck dissection for PTC have reported variable rates of recurrence. 18,19 In one study, the 1-, 3-, and 5-year disease-free survival rates were 94.4, 88.0, and 85.5 %, respectively. 18 Another recent study reported an overall recurrence rate of 18 % (11/61) during a median follow-up of 20 months (range 1-109 months).…”

“…18 Another recent study reported an overall recurrence rate of 18 % (11/61) during a median follow-up of 20 months (range 1-109 months). 19 The differences in the reported recurrence rates could be attributed to the inclusion of patients at different stages and degrees of severity at presentation. The present study showed a relatively high incidence of locally advanced PTC, including 61 % of T3 tumors and 24 % of T4a tumors, as well as recurrent laryngeal nerve invasion in 29 (21 %) cases.…”

“…In the present study, recurrence was defined as structural recurrence identified on imaging studies regardless of serum Tg levels but not as biochemical recurrence with an elevated serum Tg level and without clinical evidence of structural disease. 18,19 Statistical Analysis…”