Radioactive iodine in differentiated thyroid cancer: a national database perspective

Abstract

Radioactive iodine (RAI) is a key component in the treatment of differentiated thyroid cancer. RAI has been recommended more selectively in recent years as guidelines evolve to reflect risks and utility in certain patient subsets. In this study we sought to evaluate the survival impact of radioactive iodine in specific thyroid cancer subgroups. Nationwide retrospective cohort study of patients using the National Cancer Database (NCDB) from 2004-2012 and Surveillance, Epidemiology, and End Results (SEER) database from 1992-2009 examining patients with differentiated thyroid cancer treated with or without RAI. Primary outcomes included all-cause mortality (NCDB and SEER), and cancer-specific mortality (SEER). Cox multivariate survival analyses were applied to each dataset, and in 135 patient subgroups based on clinical and non-clinical parameters. A total of 199,371 NCDB and 77,187 SEER patients were identified. RAI was associated with improved all-cause mortality (NCDB: RAI hazard ratio (HR) 0.55, P<0.001; SEER: HR 0.64, P<0.001); and cancer-specific mortality (SEER: HR 0.82, P=0.029). Iodine therapy showed varied efficacy within each subgroup. Patients with high-risk disease experienced the greatest benefit in all-cause mortality, followed by intermediate-risk, then low-risk subgroups. Regarding cancer-specific mortality, radioactive iodine therapy was protective in high-risk patients, but did not achieve statistical significance in most intermediate-risk subgroups. Low-risk T1a subgroups demonstrated an increased likelihood of cancer-specific mortality with iodine therapy. The efficacy of RAI in patients with differentiated thyroid cancer varies by disease severity. A negative cancer-specific survival association was identified in patients with T1a disease. These findings warrant further evaluation with prospective studies.

LncRNAs as Potential Therapeutic Targets in Thyroid Cancer

“…The incidence of TC has been escalating for the past thirty years. In the US alone endocrine cancers prevalence is mounting with roughly 1-1.5% of all newly diagnosed cancers every year (Orosco et al, 2019). The annual percentage change of thyroid tumors is increasing in the globe except Africa at where detection is not popular (Kilfoy et al, 2009).…”

Surgery and Radioactive Iodine Therapeutic Strategy for Patients Greater than 60 Years of Age with Differentiated Thyroid Cancer

“…RAI-131 can avoid unnecessary treatment, cost, and adverse effects at the same time [4,16,19,20]. Evidence surrounding the use of RAI-131 in patients with intermediate-risk DTC is less robust and there is no consensus regarding the benefit-to-risk ratio [21].…”

Ablation rate after radioactive iodine therapy in patients with differentiated thyroid cancer at intermediate or high risk of recurrence: a systematic review and a meta-analysis

“…After total thyroidectomy with or without lymph node dissection for differentiated thyroid cancer (DTC), radioiodine (RAI) may be administered for 3 main goals [1]: remnant ablation (to facilitate the detection of recurrent disease by destroying post-operative remnants of non-tumoral thyroid tissue and to permit initial staging with a whole-body scan), adjuvant therapy (to decrease the risk of recurrence by destroying suspected, but unproven persistent disease), or therapy (to treat known persistent disease). Successful ablation (SA) can be assessed some months later by an undetectable serum thyroglobulin (Tg) level on L-T4 using a sensitive method and unremarkable ndings at neck ultrasound [2][3][4].…”