Selective postoperative radioactive iodine treatment of thyroid carcinoma

McHenry, Christopher R.; Jarosz, H; Davis, Melva; Barbato, Anthony L.; Lawrence, A. M.; Paloyan, Edward

doi:10.1002/bjs.1800770140

Cited by 11 publications

(18 citation statements)

References 15 publications

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“…Systematic lymphadenectomy or scintigra- phy after remnant ablation would therefore not be necessary for definitive N staging. Extensive lymph node involvement is seen in cases with diffuse lung metastases [9,17,18]. In young patients (TNM stage II) the tumors are usually curable with radioiodine [17,18] (one patient in our series).…”

Section: Papillary Carcinomamentioning

confidence: 96%

“…In some patients the course is favorable even with limited therapeutic measures, whereas other patients die of the tumor despite radical therapy [1][2][3][4][5][6][7]. In some, however, radical therapy does improve outcome in terms of cure, curable recurrence, serious recurrence, and death from the tumor [2,3,[5][6][7][8][9]. Some studies indicate that patients can be selected for less radical procedures without incurring the risk of a fatal outcome and without recurrence being a major problem [2,9].…”

mentioning

confidence: 99%

“…In some, however, radical therapy does improve outcome in terms of cure, curable recurrence, serious recurrence, and death from the tumor [2,3,[5][6][7][8][9]. Some studies indicate that patients can be selected for less radical procedures without incurring the risk of a fatal outcome and without recurrence being a major problem [2,9]. We have studied the selective use of less aggressive therapy (i.e., surgical treatment without remnant ablation) for appropriately favorable tumors, namely for occult (Ͻ 1.5 cm) and intrathyroidal papillary carcinoma without nodal or distant metastases (pT1-3 N0) and minimally invasive follicular carcinoma.…”

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confidence: 99%

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Selective Treatment of Differentiated Thyroid Carcinoma

Gemsenjäger

Heitz

Martina³

1997

World j. surg.

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Over a period of 20 years 84 papillary and 82 follicular carcinomas operated on by one surgeon and examined by one pathologist were documented prospectively, treated selectively, and followed for 1 to 20 years (median 7 years). Tumors with a low risk of recurrence or incurable disease-i.e., papillary carcinoma pT1-3 N0 M0 (n = 56) and minimally invasive follicular carcinoma (n = 37)-were treated by a limited-radicality hemithyroidectomy or total thyroidectomy without radioiodine in 79 of the 93 cases (85%). No unfavorable course was observed, and only one curable recurrence (1.3%) developed contralaterally after hemithyroidectomy for papillary cancer. Of the remaining 73 patients, including 100% of those with nodal involvement, 65 (89%) underwent total thyroidectomy with radioiodine. Total thyroidectomy was achieved in 34% of the cases by completion thyroidectomy, based on definitive histologic examination. No instance of a serious, potentially incurable recurrence and no tumor-related death was observed in patients with a papillary TNM stage I+II or with a minimally invasive follicular carcinoma. Five of the patients (6%) with papillary carcinoma, all with TNM stage III or IV, and seven of the patients (8.5%) with follicular carcinoma, all grossly invasive and pT3 or pT4, had tumor-related deaths following total thyroidectomy in all and with remnant ablation in 10 cases. A potentially curable node recurrence occurred in two patients 1 and 10 years, respectively, after primary treatment. Permanent hypoparathyroidism (n = 4) (2.4%) and permanent recurrent laryngeal nerve palsy (n = 2) (1.2%) were observed only in patients with a grossly invasive follicular carcinoma and concomitant benign recurrent goiter. We conclude that (1) hemithyroidectomy or total thyroidectomy without radioiodine is adequate for papillary carcinoma pT1-3 N0 and minimally invasive follicular carcinoma; (2) there were no nodal recurrences in tumors recognized as node-negative; and (3) extracapsular excision of one or both lobes can be carried out technically with low morbidity. The study confirms the prognostic value of age-related TNM classification for papillary carcinoma; classification of follicular thyroid carcinoma as minimally invasive or grossly invasive proved to be useful.

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Section: Papillary Carcinomamentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Selective Treatment of Differentiated Thyroid Carcinoma

Gemsenjäger

Heitz

Martina³

1997

World j. surg.

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“…Therefore, Mazzaferri and Jhiang [5] have concluded that near-total thyroidectomy followed by radioiodine therapy plus thyroid hormone administration confers a distinct outcome advantage for tumors 15 mm or more that are not initially metastatic to distant sites. However, McHenry et al [13] have found no recurrences in patients with DTC without local tumor extension or regional or distant metastases who were treated with postoperative thyroid hormone therapy, and they have recommended that radioactive therapy be omitted for these patients (Table III). Varma et al [14] also have reported no significant difference in death rates between patients under 40 years of age treated with radioiodine therapy versus those treated with surgery alone, while the former group had a significantly lower death rate than the latter in patients 40 years of age and older (Table III).…”

Section: Radioiodine Treatment and Thyroid Hormone Replacementmentioning

confidence: 96%

“…However, there are considerable controversies concerning not only the extent of thyroidectomy but also the indications for, and the extent of, cervical lymph node dissection [11], although surgical resection is the most effective treatment for DTC. Moreover, there is disagreement about the prophylactic use of radioiodine therapy [12][13][14]. Although no prospective studies have been performed evaluating the efficacy of surgical treatment and postoperative radioiodine therapy [15,16], the therapeutic approach to DTC should be unified to a more rational approach.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic strategies and long-term results in differentiated thyroid cancer

Noguchi¹,

Katev²,

Miwa³

1998

J. Surg. Oncol.

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Avoiding Reoperation for Indeterminate Thyroid Nodules Identified as Malignant After Surgery

Block

Dailey²,

Muchmore³

1991

Arch Surg

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Thyroid nodules that are indeterminate as carcinoma by needle biopsy before surgery and by study of frozen sections at the time of surgery are occasionally identified to be malignant in later studies. If only a lobectomy has been performed, the advisability of reoperation to remove the remaining thyroid tissue to facilitate radioactive iodine therapy may cause concern. To obviate this difficulty as well as to reduce the occurrence of nodules later in a preserved contralateral thyroid lobe and to provide additional thyroid tissue for study, contralateral subtotal or near total lobectomy has been performed for indeterminate thyroid nodules. The small remnant of remaining thyroid tissue can later be ablated by radioactive iodine if desired. Of 37 patients with indeterminate thyroid nodules, none required reoperation, although the diagnosis of carcinoma was established after surgery for eight patients, three of whom were treated with radioactive iodine.

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Selective postoperative radioactive iodine treatment of thyroid carcinoma

Abstract: (SURGERY 7989; From the

Cited by 11 publications

References 15 publications

Selective Treatment of Differentiated Thyroid Carcinoma

Selective Treatment of Differentiated Thyroid Carcinoma

Therapeutic strategies and long-term results in differentiated thyroid cancer

Avoiding Reoperation for Indeterminate Thyroid Nodules Identified as Malignant After Surgery

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