The Effectiveness of Radioactive Iodine for Treatment of Low-Risk Thyroid Cancer: A Systematic Analysis of the Peer-Reviewed Literature from 1966 to April 2008

Sacks, Wendy; Fung, Constance H.; Chang, John T.; Waxman, Alan D.; Braunstein, Glenn D.

doi:10.1089/thy.2009.0455

Cited by 169 publications

(125 citation statements)

References 74 publications

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“…Furthermore, in this pT3 PMC group, the ablative dose of 131 I was the only variable significantly associated with a lower risk of recurrence. Although RAI remnant ablation was not significantly associated with recurrence in our entire series of PMC patients or in several other studies (37,38), it may be mandatory for patients with pT3 PMC. Ideally, this needs to be confirmed in a prospective study comparing the two therapeutic options (RAI ablation or abstention).…”

Section: Discussioncontrasting

confidence: 52%

Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Buffet

Golmard

Hoang

et al. 2012

European Journal of Endocrinology

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Context: Papillary thyroid microcarcinomas (PMC) defined as tumors %10 mm in diameter (including pT1a and pT3 according to the latest pTNM classification) have good prognosis, although recurrence is possible. Clinicians are interested in using a scoring system for predicting recurrences. Objective: To identify the prognostic factors for recurrence in patients with PMC and to develop a scoring system based on lymph node involvement, multifocality, and sex. To determine the impact of extrathyroidal invasion (ETI) and a threshold value for analyzing multifocality. Methods: Single-center retrospective study of a cohort of 1669 patients with PMC managed from 1960 to 2007. The Kaplan-Meier survival rate and prognostic factors of events were analyzed using logrank tests and uni-and multivariate Cox model-based analyses. A scoring system was proposed. Results: Sixty-eight recurrences were observed. Initial lymph node metastases (PZ0.0001), multifocality (PZ0.05), and male sex (PZ0.01) were significantly associated with recurrence, although there was a period effect (after 1990). PMC size was not a significant variable. Our scoring system allows us to separate patients into three risk groups according to their recurrence-free probability. For PMC Nx patients, total foci size of multifocal tumors O20 mm was significantly associated with recurrence (P!0.0001). Radioiodine (RAI) ablation was associated with better outcome only in PMC with ETI. Conclusion: Our scoring system classifies recurrence risk. In PMC Nx patients, multifocality is important in planning therapeutic strategies. Recurrence probability of pT3 PMC appears lower if RAI ablation is performed.

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Section: Discussioncontrasting

confidence: 52%

Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Buffet

Golmard

Hoang

et al. 2012

European Journal of Endocrinology

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“…1,16,25 The overall mortality in low-risk DTC patients for a median follow-up of 10 years is approximately 5%, either with or without RAI ablation. 26 Furthermore, several studies and meta-analyses have demonstrated that postoperative RAI administration in low-risk DTC patients fails to improve the overall survival rate.…”

Section: Discussionmentioning

confidence: 99%

“…1, 16,26 The role of postoperative RAI administration in recurrence in low-risk DTC patients is less clear due to the lack of randomized, controlled studies. one recently published retrospective controlled study with 1,298 low-risk macrocarcinoma DTC patients failed to demonstrate any benefit as regards the structural recurrence rate or overall survival during a median follow-up duration of 10.3 years.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 In an extensive literature review it was also found that low-risk DTC patients treated with RAI ablation did not experience improved disease-specific survival. 16 It is possible, however, that RAI ablation may be beneficial in decreasing disease recurrence. 17 Post-surgical RAI ablation after thyroidectomy is not routinely recommended for low-risk patients by the current ATA guidelines.…”

Section: 2mentioning

confidence: 99%

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Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

Michalaki

Bountouris

Roupas

et al. 2016

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BAcKgrounD: The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies. oBjEcTIVE: To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (pTc) patients undergoing minimal intervention. DEsIgn: we retrospectively analyzed 137 patients with low-risk pTc (stage I: n=77; stage II: n=60). of these patients, 107 (group 1) had macro-pTc and underwent near-total thyroidectomy and received postoperatively 50mci rAI. The remaining 30 patients (group 2) had micro-pTc (<1cm) and were treated only by means of near-total thyroidectomy. rEsulTs: The median follow-up for group 1 patients was 10 years (range: 3-30). At 1-year evaluation, 8 patients of group 1 had indeterminate or incomplete biochemical response, of whom 4 had also incomplete structural response to initial therapy. only 1 of 4 patients with structural incomplete response underwent cervical lymph node dissection and then received an additional dose of 100mci rAI. The remaining 7 patients received only an additional dose of 100mci rAI. These patients have been continuously followed till the present time with no recurrences or deaths (median follow-up: 17.5 years; 3-30 years). At 15 years, 2 patients of group 1 experienced biochemical recurrence and they received 100mci rAI. Three patients of group 2 experienced recurrence, with 2 receiving 50mci rAI and 1 undergoing cervical lymph node dissection with 50mci rAI. conclusIons: patients with low-risk macro-pTc treated by means of near-total thyroidectomy without pcclnD and receiving postoperatively a low dose of 50mci rAI have excellent long-term prognosis.

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“…The recurrence rate of these low-risk DTCs is !5% and the benefits of radioactive iodine (RAI) ablation on the survival rate or on the risk of recurrence have not been demonstrated (4,5,6). RAI ablation for low-risk DTC patients is therefore recommended in only selected cases, preferably using a minimal RAI activity and recombinant human thyroid-stimulating hormone (rhTSH) stimulation (7,8,9,10,11).…”

Section: Introductionmentioning

confidence: 99%

Ultrasensitive serum thyroglobulin measurement is useful for the follow-up of patients treated with total thyroidectomy without radioactive iodine ablation

Nascimento

Borget

Troalen

et al. 2013

European Journal of Endocrinology

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Context: Thyroglobulin (Tg) measurement is a major tool for the follow-up of differentiated thyroid cancer (DTC) patients; however, in patients who do not undergo radioactive iodine (RAI) ablation, normal ultrasensitive Tg levels measured under levothyroxine treatment (usTg/L-T 4 ) are not well defined. Objective and design: This single-center retrospective study assessed usTg/L-T 4 level in 86 consecutive patients treated with total thyroidectomy without RAI ablation for low-risk DTC (nZ77) or for tumors of uncertain malignant potential (TUMP) (nZ9). Results: DTCs were classified as pT1, pT2, and pT3 in 75, 1, and 1 case respectively and pN0, pN1, and pNx in 40, 6, and 31 respectively. Following surgery, ten patients had Tg antibodies (TgAb). Among those without TgAb, the first usTg/L-T 4 determination obtained at a mean time of 9 months after surgery was %0.1 ng/ml in 62% of cases, %0.3 ng/ml in 82% of cases, %1 ng/ml in 91%, and %2 ng/ml in 96% of cases. After a median follow-up of 2.5 years (range: 0.6-7.2 years), one patient had persistent disease with an usTg/L-T 4 at 11 ng/ml and an abnormal neck ultrasonography (US) and two patients had usTg/L-T 4 level O2 ng/ml (3.9 and 4.9 ng/ml) with a normal neck US. Within the first 2 years following total thyroidectomy without RAI ablation, usTg/L-T 4 level is %2 ng/ml in 96% of the cases. Conclusion: After total thyroidectomy, sensitive serum Tg/L-T 4 level is %2 ng/ml in most patients and can be used for patient follow-up.

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The Effectiveness of Radioactive Iodine for Treatment of Low-Risk Thyroid Cancer: A Systematic Analysis of the Peer-Reviewed Literature from 1966 to April 2008

Cited by 169 publications

References 74 publications

Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma

Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

Ultrasensitive serum thyroglobulin measurement is useful for the follow-up of patients treated with total thyroidectomy without radioactive iodine ablation

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