Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial

Schlumberger, Martin; Leboulleux, Sophie; Catargi, Bogdan; Deandreis, Désirèe; Zerdoud, Slimane; Bardet, Stéphane; Rusu, Darian; Godbert, Yann; Buffet, C; Schvartz, Claire; Véra, Pierre; Morel, Olivier; Benisvy, Danielle; Bournaud, Claire; Toubert, Marie‐Elisabeth; Kelly, A.; Benhamou, E; Borget, Isabelle

doi:10.1016/s2213-8587(18)30113-x

Cited by 137 publications

(107 citation statements)

References 22 publications

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“…A similar recurrence rate after 5 years (2% in 726 patients) was observed in the ESTIMABL1 trial (105), which, like HiLo, examined preparation methods and activities for radioiodine ablation, but only in low-risk patients. However, the number of structural recurrences was low (only four patients), while the rest suffered from biochemical failure (five patients) or intermediate findings in neck US.…”

Section: Recurrence Risk Does Not Stop After 5 Years Of Observation supporting

confidence: 59%

“…Outside the radioiodine-refractory DTC setting, only two prospective randomised trials in patients with DTC have been published (104,105,106). However, neither study was designed to answer questions regarding rate or timing of disease recurrence, or need for long-term follow-up in low-risk DTC.…”

Section: Recurrence Risk Does Not Stop After 5 Years Of Observation mentioning

confidence: 99%

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Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Lamartina

Handkiewicz-Junak

2020

European Journal of Endocrinology

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Each year, the proportion of thyroid cancer patients presenting with low-risk disease is increasing. The shift in the landscape of thyroid cancer presentation is forcing clinicians to re-evaluate not only management but also surveillance paradigms. During the follow-up, patients are stratified considering their response to treatment and classified into one of the following response categories: excellent, biochemical incomplete, structural incomplete, or indeterminate. These categories reflect a real-time prognosis and thereby substantially influence and personalise disease management. Although at present, no guideline recommends stopping differentiated thyroid carcinoma (DTC) surveillance at any particular time point, the relatively low prevalence of treatment failures in low-risk patients may prompt early discontinuation of surveillance in this subgroup. Therefore, this debate will present an overview of the controversies surrounding the surveillance of low-risk patients with DTC.

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Section: Recurrence Risk Does Not Stop After 5 Years Of Observation supporting

confidence: 59%

Section: Recurrence Risk Does Not Stop After 5 Years Of Observation mentioning

confidence: 99%

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Lamartina

Handkiewicz-Junak

2020

European Journal of Endocrinology

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“…These observations are in agreement with other studies, which used the ablation success rate as a surrogate clinical end point for response to 131 I. Castagna et al provided the rst evidence that in DTC patients, high RAI activities at ablation had no major advantage over low activities (9). This was con rmed in a meta-analysis by Cheng et al and large multicenter randomized trials (10)(11)(12)(13)(14)(15), showing that low-dose radioiodine (1.1GBq [30 mCi]) is as effective as a high-dose (3.7 GBq [100 mCi]) in ablating thyroid remnant in patients with DTC.…”

Section: Discussionsupporting

confidence: 88%

Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels

Iconaru

Baleanu

Taujan

et al. 2020

Preprint

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Background 131-iodine (131I) administration after surgery remains a standard practice in differentiated thyroid cancer (DTC). In 2014, the American Thyroid Association presented new guidelines for the staging and management of DTC, including no systematic 131I in patients at low-risk of recurrence and a reduced 131I activity in intermediate risk. The present study aims at evaluating the rate of response to treatment following this new therapeutic management compared to our previous treatment strategy in patients with DTC of different risks of recurrence. Methods Patients treated and followed up for DTC according to the 2014-ATA guidelines (Group 2) were compared to those treated between 2007 and 2014 (Group 1) in terms of general characteristics, risk of recurrence (based on the 2015-ATA recommendations), preparation to 131I administration, cumulative administered 131I activity and response to treatment. Results In total, 136 patients were included: 78 in Group 1 and 58 in Group 2. The two groups were not statistically different in terms of clinical characteristics nor risk stratification: 42.3% in Group 1 and 31% in Group 2 were classified as low risk, 38.5% and 48.3% as intermediate risk and 19.2% and 20.7% as high risk (P=0.38). Two patients (one in each group) with distant metastases were excluded from the analysis. Preparation to 131I administration consisted in rhTSH stimulation in 23.4% of the patients in Group 1 and 100% in Group 2 (p<0.001). 131I was administered to 46/77 patients (59.7%) in Group 1 (5 at low risk of recurrence) and 38/57 patients (66.7%) in Group 2 (0 with a low risk). Among the patients treated by 131I, median cumulative activity was significantly higher in Group 1 (3.70GBq [100mCi] range 1.11-11.1 GBq [30-300 mCi]) than in Group 2 (1.11 GBq [30 mCi], range 1.11-7.4 GBq [30-200 mCi], P<0.001). Complete response was found in 90.9% in Group 1 vs. 96.5% in Group 2 (P=0.20). Conclusions Using the 2015-ATA evidence-based guidelines for the management of DTC, meaning no 131I administration in low-risk patients, a low activity in intermediate and even high risk patients, and a systematic use of rhTSH stimulation before 131I therapy allowed us to reduce significantly the median administered 131I activity, with a similar rate of complete therapeutic response.

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“…For example, Nixon et al demonstrate that postoperative RAI in patients with mETE did not impact recurrence‐free survival . In contrast, Schlumberger et al report that recurrence was lower in a similar cohort with the addition of RAI . Even with RAI, there have been rates of recurrence ranging from 30% to 60%, making the upfront primary management even more critical .…”

Section: Discussionmentioning

confidence: 99%

Unexpected high‐risk pathologic features following thyroidectomy in the chinese immigrant population

et al. 2019

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Objective To compare rates of unexpected high‐risk pathologic features between Chinese and non‐Asian patients who underwent thyroidectomy for papillary thyroid cancer. Methods This was a retrospective cohort study at a tertiary academic urban medical center. Patients who underwent thyroidectomy for papillary carcinoma from 2015 to 2017 were included. Patient demographics, tumor characteristics, and tumor histopathology were analyzed. Primary outcome was the presence of adverse histopathologic features such as lymphovascular invasion (LVI) or microscopic/minimal extrathyroidal extension (mETE). Differences between the groups were analyzed using multivariate logistical regression analysis and propensity score‐weighted analysis. Results One hundred seventy‐nine patients were included: 58 Chinese‐born and 121 non‐Asian. The median age of the cohort was 47 years old (36–58). Twenty‐nine percent of patients were male, and 71% were female. There was no statistically significant difference between the two cohorts in rates of LVI, multifocality, extent of surgery, or presence of thyroiditis. Patients with mETE were more likely to have larger tumors (P = 0.00247). Both the multivariate and propensity‐weighted models demonstrated that Chinese ancestry was independently associated with an increased rate of unexpected mETE (adjusted prevalence ratio, 2.52; 95% confidence interval, 1.82–3.48). Conclusion mETE is significantly higher in the immigrant Chinese compared to the non‐Asian population. Given the high prevalence of unexpected mETE in the Chinese population, the added risk of this finding should be brought into the discussion during initial surgical planning. Level of Evidence 3 Laryngoscope, 130:1844–1849, 2020

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Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial

Cited by 137 publications

References 22 publications

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Follow-up of low risk thyroid cancer patients: can we stop follow-up after 5 years of complete remission?

Can we safely reduce the administration of 131-iodine in patients with differentiated thyroid cancer? – experience of the Brugmann hospital in Brussels

Unexpected high‐risk pathologic features following thyroidectomy in the chinese immigrant population

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