The benefits of radioactive iodine ablation for patients with intermediate-risk papillary thyroid cancer

Abstract

Background The beneficial effects of radioactive iodine (RAI) ablation for intermediate-risk papillary thyroid cancer (PTC) patients are still controversial. Materials and methods To determine the impact of RAI therapy on disease-specific survival (DSS) in patients with intermediate-risk PTC, we retrospectively analyzed the data of 23107 intermediate-risk PTC patients who underwent primary thyroidectomy with or without RAI in the Surveillance, Epidemiology, and End Results (SEER) database. Results RAI therapy was significantly associated with improved DSS (adjusted HR = 0.65, P = 0.017) in intermediate-risk PTC patients after multivariate adjusting for clinicopathological characteristics. However, subgroup analyses demonstrated that RAI ablation was only associated with improved DSS in patients with male gender (adjusted HR = 0.47, P = 0.005), age � 45 years (adjusted HR = 0.34, P < 0.001) and tumor size > 20 mm (adjusted HR = 0.58, P = 0.007). Conclusion RAI decision-making should be considered on an individual basis rather than "one size fits all" in intermediate-risk PTC patients; only patients with male gender, age � 45 years, and tumor size > 20 mm may benefit from RAI therapy.

Annual Hazard Rate of Recurrence in Middle Eastern Papillary Thyroid Cancer over a Long-Term Follow-Up

“…Giving RAI in intermediate-risk PTC has been a subject of controversy. On the one hand, studies have shown that RAI therapy could reduce recurrence and hence should be considered in intermediate-risk PTC patients [21,40], whereas others have suggested that RAI ablation may not have a beneficial role in decreasing the risk of recurrence in intermediate-risk PTC patients [41,42].…”

Radioactive Iodine Following Total Thyroidectomy Is Comparable to Lobectomy in Low/Intermediate-Risk Differentiated Thyroid Carcinoma: A Meta-Analysis

“…The single study that assessed recurrence used three different methods (AMES [Age, Metastasis, Extracapsular tumor, Size], MACIS [Metastases, Age, Completeness of resection, Invasion, Size], and De Groot); we combined the results and reversed the outcomes because recurrence and survival are not going in the same line. Two of the included studies showed a negative effect of RAI on outcomes [ 8 , 11 ], three showed a beneficial effect [ 3 , 12 , 13 ], and the remaining two were neutral [ 14 , 15 ]. The fixed effect was used due to the substantial heterogeneity (I2=93%; p<0.001).…”

“…Besides, they suggested beneficial effects of RAI remnant ablation in loco-regional recurrence (relative risk: 0.31; 95% CI: 0.2-0.49) and distant metastases (absolute decrease in risk: 3%; 95% CI: -0.01 to 0.04). In our meta-analysis, six of seven recent studies, of which five were adjusted [ 3 , 12 - 15 ], examined survival rate. Our results are in agreement with Sawka et al’s results regarding the benefits of RAI use in remnant ablation.…”

A practical individualized radiation precaution based on the dose rate at release time after inpatient 131I ablation therapy

“…Radioactive iodine (RAI) therapy is an integral part of the standard care for differentiated thyroid cancer (DTC) [1]. For DTC patients with intermediate or high risk of recurrence following total thyroidectomy, RAI ablation therapy is recommended [2][3][4]. Moreover, when 131 I used is more than 1.22 GBq (33 mCi) for RAI therapy, which is equivalent to a dose limit of >5mSv, several days of hospitalization in a licensed facility is mandatory [5,6].…”