Timing of Radioactive Iodine Therapy does not Impact Overall Survival in High-Risk Papillary Thyroid Carcinoma

Suman, Paritosh; Wang, Chi‐Hsiung; Abadin, Shabirhusain S.; Block, Romy; Raghavan, V.; Moo‐Young, Tricia A.; Prinz, Richard A.; Winchester, David J.

doi:10.4158/ep151088.or

Cited by 21 publications

(47 citation statements)

References 19 publications

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“…On the one hand, intravenous contrast provides better structural resolution and can be important for a well planned operation that is critical for optimal long term prognosis. On the other hand, it will delay the timing of radioactive iodine therapy after thyroidectomy for about 2 months, a delay that has not been associated with less favourable outcomes 29 , 30 …”

Section: Approach To Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnosis and management

Wong

Farrell

Grossmann

2018

Medical Journal of Australia

151

132

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Thyroid nodules are common. Their importance lies in the need to assess thyroid function, degree of and future risk of mass effect, and exclude thyroid cancer, which occurs in 7-15% of thyroid nodules. There are four key components to thyroid nodule assessment: clinical history and examination, serum thyroid stimulating hormone (TSH) measurement, ultrasound and, if indicated, fine-needle aspiration (FNA). If the serum TSH is suppressed, a thyroid scan with Tc can distinguish between a solitary hot nodule, a toxic multinodular goitre or, less commonly, thyroiditis or Graves' disease within a coexisting nodular thyroid. Scintigraphically cold nodules are evaluated in the same way as in the setting of normal or elevated serum TSH levels. Thyroid ultrasonography should be performed only for palpable goitre and thyroid nodules and by specialists with expertise in thyroid sonography. Routine thyroid cancer screening is not recommended, except in high risk individuals, as the detection of early thyroid cancer has not been shown to improve survival. FNA may be performed for nodules ≥ 1.0 cm depending on clinical and sonographic risk factors for thyroid cancer. FNA specimens should be read by an experienced cytopathologist and be reported according to the Bethesda Classification System. Molecular analysis of indeterminate FNA samples has potential to better discriminate benign from malignant nodules and thus guide management. Surgery is indicated for FNA findings of malignancy or indeterminate cytology when there is a high risk clinical context. Surgery may also be indicated for suspicion of malignancy; larger nodules, especially with symptoms of mass effect; and in some patients with thyrotoxicosis.

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Section: Approach To Thyroid Nodulesmentioning

confidence: 99%

Thyroid nodules: diagnosis and management

Wong

Farrell

Grossmann

2018

Medical Journal of Australia

151

132

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“…The dynamic risk stratification strategy that is codified in the guidelines (table 6) helps better define the goals and risks of treatment in individual patients. It is also noted that the delay in administration of RAI up to 12 months after thyroid cancer surgery does not appear to impact overall survival (Suman, et al 2016; Tsirona, et al 2014). This may not be true; however, for patients with higher risk tumors characterized by extrathyroidal extension or distant metastases (Higashi, et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Thyroid nodules and cancer management guidelines: comparisons and controversies

Nabhan¹,

Ringel²

2017

Endocrine-Related Cancer

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Thyroid cancer is an increasingly prevalent malignancy throughout the world. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. All of these guidelines recognize this increasing incidence, particularly of small papillary thyroid cancers, due in part to improved technology enabling early or even “over” diagnosis. Recent advances in molecular imaging and molecular methods have been developed to better characterize thyroid nodules, and a number of studies that have clarified risk stratification systems that can be modified over time allow for individualization of diagnosis, initial treatment, and subsequent follow-up strategies. Advances in surgical approaches and new treatments for patients with the most aggressive forms of thyroid cancer have all impacted on management guidelines. Despite substantial similarities, there also are important differences between recent guidelines for some of the common clinical scenarios encountered by physicians in clinical practice. In the present manuscript we will highlight similarities and differences between several of the most recently published guidelines focused on key areas of importance to clinical care and controversy. These are key areas for future research to strengthen the data to support future guideline recommendations.

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“…Other studies presented similar conclusions, indicating that delayed RAIT would not affect the long‐term survival or response to therapy . However, these studies focused on low‐ and intermediate‐risk patients who are not routinely recommended for RAIT . To our knowledge, this study is the first to objectively evaluate the impact of timing of the first post‐thyroidectomy RAIT in intermediate‐to‐high‐risk patients with clinically characterized PTC who are candidates for RAI administration using a propensity score‐matched cohort.…”

Section: Discussionmentioning

confidence: 58%

“…Suman et al also showed that the timing of first post‐thyroidectomy RAIT did not affect survival in a propensity score‐matched cohort with high‐risk PTC using National Cancer Database. Other studies presented similar conclusions, indicating that delayed RAIT would not affect the long‐term survival or response to therapy . However, these studies focused on low‐ and intermediate‐risk patients who are not routinely recommended for RAIT .…”

Section: Discussionmentioning

confidence: 98%

“…On the other hand, one retrospective study reported that delayed first post‐thyroidectomy RAIT may result in poor survival for patients with DTC compared with early RAIT . However, the impact of the timing of the first post‐thyroidectomy RAIT is not comparable between studies because most patients had low‐risk DTCs that are not routinely recommended for RAIT . In addition, most previous studies examined clinical outcomes based on survival, not recurrence …”

Section: Introductionmentioning

confidence: 99%

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Impact of delayed radioiodine therapy in intermediate‐/high‐risk papillary thyroid carcinoma

Kim

Han

Jeon

et al. 2019

Clinical Endocrinology

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Objective It remains unclear whether the time interval between total thyroidectomy and radioactive iodine therapy (RAIT) affects clinical outcomes in papillary thyroid carcinoma (PTC). Therefore, we evaluated the impact of timing of the first post‐thyroidectomy RAIT in intermediate‐to‐high‐risk PTC. Design and Patients This retrospective propensity score‐matched cohort study included 720 PTC patients who received RAIT for <90 or 90‐180 days (early and delayed groups, n = 360 each) after thyroidectomy. Responses to therapy, disease‐free survival (DFS) and overall survival (OS) were compared between the two groups. Results After matching, the baseline characteristics of the 360 patients in each group were similarly adjusted. Within the first 2 years after initial therapy, the number of patients classified into excellent, indeterminate, biochemical incomplete and structural incomplete response categories were 221 (61%), 74 (21%), 39 (11%) and 26 (7%) in the early group, and 204 (57%), 73 (20%), 59 (16%) and 24 (7%) in the delayed group, respectively. There was no significant difference in response to therapy between the two groups (P = 0.183). During the median follow‐up of 8.6 years, there was no significant difference in DFS (P = 0.060) and OS (P = 0.400) curves between the two groups. Delayed RAIT was not significantly associated with worse DFS (HR = 1.3, 95% CI 0.9‐1.8, P = 0.061) or OS (HR = 1.5, 95% CI 0.6‐3.4, P = 0.388). Conclusions Delaying the first RAIT until 180 days after total thyroidectomy had no impact on restaging, recurrence and mortality in intermediate‐to‐high‐risk PTC.

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Timing of Radioactive Iodine Therapy does not Impact Overall Survival in High-Risk Papillary Thyroid Carcinoma

Cited by 21 publications

References 19 publications

Thyroid nodules: diagnosis and management

Thyroid nodules: diagnosis and management

Thyroid nodules and cancer management guidelines: comparisons and controversies

Impact of delayed radioiodine therapy in intermediate‐/high‐risk papillary thyroid carcinoma

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