Radioiodine treatment after surgery for differentiated thyroid cancer: a reasonable option

Clerc, Jérôme; Verburg, Frederik A.; Avram, Anca M.; Giovanella, Luca; Hindié, Elif; Taïeb, David

doi:10.1007/s00259-017-3654-z

Cited by 18 publications

(12 citation statements)

References 49 publications

(82 reference statements)

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“…The effectiveness of 131I ablation in patients with PTMC is controversial (27–29). Though currently no study precisely indicate which patients with PTMC may benefit from post-operative RAI, examination results obtained pre- or post RAI provides information for dynamic risk stratification, and thus helps determine the long-term follow-up strategy (30). In line with our data, a prospective study revealed that diagnostic 131I scans identified unsuspected nodal metastases in about 30% of the DTC patients initially assigned pathologic N0 or Nx (30).…”

Section: Discussionmentioning

confidence: 99%

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

et al. 2019

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Background: The current management of papillary thyroid micro carcinoma (PTMC) has become more conservative. However, high-risk characteristics that can only be revealed post-surgically exist. Patients and clinicians need to estimate the risks and understand the prognostic meaning of these factors. Methods: We retrospectively analyzed 246 consecutive patients with PTMC who underwent surgery at our institution between 2015 and 2017. Clinical and histopathological parameters that may indicate recurrent disease were investigated. The responses to therapy in cases with different risks of recurrence were analyzed. Results: A total of 79.26% (195/246) of patients received total thyroidectomy (TT), of whom 177 (90.77%) also received central lymph node dissection. Radioiodine ablation (RAI) was applied in 64.23% (158/246) of patients. Intermediate-high risk features were identified in 27.64% (68/246) after primary treatment. After a median follow-up of 18 months (range, 6–39 months), 121 of 158 (76.58%) patients who received TT+RAI were evaluated as an excellent response. An incomplete response (IR) was observed in 14.56% (23/158) of this group of PTMC. Multivariate analysis identified extra thyroid extension ( P = 0.001) and intermediate-high risk stratification ( P = 0.014) as significant and independent risk factors for an IR. Conclusions: A total of 27.64% of PTMC cases evaluated as a low risk of recurrence pre-surgery showed intermediate to high risk disease post-surgery, and this leads to a higher rate of IR.

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Section: Discussionmentioning

confidence: 99%

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

et al. 2019

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“…In 2015, the American Thyroid Association (ATA) released the new version of the guidelines for the management of patients with thyroid nodules and DTC (4), compared to the previous version (5); these guidelines show a huge effort to guide decision making with more than 100 recommendations. Despite this, many doubts and objections are arising about these guidelines (6,7,8) and probably they should be a matter of debate and further discussions. One of the major critical issue is the indication for post-operative iodine-131 (I-131); 2015 ATA guidelines in 'Recommendation 51A' and ' Table 14' established that post surgery I-131 treatment should not be routinely performed in patients considered at low risk; this include patients with unifocal microcarcinoma and patients with larger tumor sizes up to 4 cm.…”

Section: Introductionmentioning

confidence: 99%

Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines

Albano

Bertagna

Bonacina

et al. 2018

European Journal of Endocrinology

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“…A recent 5-year median follow-up study in Brazil also confirmed that DTC patients with the postsurgical (non-stimulated) Tg level <0.3 ng/mL did not require RAI ablation [38]. However, their Western counterpart (European) strongly disagreed [16] and suggested that the postoperative serum Tg value may be more helpful in identifying patients that benefit from RAI ablation rather than in the identification of those who do not require ablation [39]. Apparently, in the European population (n = 1,298), the low dose (≤54 mCi) in the first RAI ablation yielded a worse long-term 30 mCi RAI for DTC in Japan outcome, even for low-risk DTC patients [40].…”

Section: Discussionmentioning

confidence: 92%

Determining patient selection tool and response predictor for outpatient 30 mCi radioiodine ablation dose in non-metastatic differentiated thyroid carcinoma: a Japanese perspective

et al. 2018

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Abstract. The lack of isolation ward throughout Japan has long been limiting the 131 I radioactive iodine (RAI) ablation for differentiated thyroid cancer (DTC) cases. The 30 mCi RAI ablation was only recently permitted for outpatient basis. However, no patient selection tool nor response predictor has been proposed. This study evaluated factors to find response predictor and determinant for the suitable patients. The retrospective study reviewed 47 eligible non-metastatic papillary DTC patients whose had first 30 mCi RAI ablation after total thyroidectomy. Age, gender, clinical stage, risk category, and preablation serum thyroglobulin (Tg) level were among covariates analyzed to determine the patient selection factors; while the thyroid bed uptake on initial whole body scan (WBS) was later also included in determining RAI ablation response. Thirteen (28%) patients had a low risk (T1-2) while 23 (49%) and 11 (23%) had an intermediate (T3) or high risk (T4), respectively. Twenty-five patients were responders, and 22 were non-responders. All factors were similar between responders and nonresponders except pre-ablation serum Tg level (p < 0.001). In multivariate analysis, pre-ablation serum Tg level was the only significant factor for both patient selection (odd ratio (OR) = 1.52, 95% confidence interval (CI) = 1.13-2.06) and response predictor (OR = 1.48; 95% CI = 1.12-1.95). With the cut-off of 5.4 ng/mL, pre-ablation serum Tg level predicts RAI ablation response with 92% specificity and 73% sensitivity. Pre-ablation serum Tg level may help patient selection and predict the response to outpatient 30 mCi RAI ablation among post total thyroidectomy non-metastatic DTC patients.

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Radioiodine treatment after surgery for differentiated thyroid cancer: a reasonable option

Cited by 18 publications

References 49 publications

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

Papillary Thyroid Micro Carcinoma: The Incidence of High-Risk Features and Its Prognostic Implications

Possible delayed diagnosis and treatment of metastatic differentiated thyroid cancer by adopting the 2015 ATA guidelines

Determining patient selection tool and response predictor for outpatient 30 mCi radioiodine ablation dose in non-metastatic differentiated thyroid carcinoma: a Japanese perspective

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