Radioactive iodine should only be used in treatment of some patients with papillary thyroid cancer

Radioactive iodine should only be used in the treatment of some patients with papillary thyroid cancer, according to data presented at the 82nd Annual Meeting of the American Thyroid Association (ATA) in Québec City, Québec, Canada.

ATA guidelines on the management of well-differentiated thyroid cancer currently recommend the routine use of radioactive iodine for the treatment of tumors >4 cm and selective use of radioactive iodine in patients with intrathyroidal disease that is <1 cm or who have evidence of nodal metastases. However, the guidelines recognize that there are conflicting and inadequate data to make firm recommendations for most patients.

A team of researchers led by Iain Nixon, MD, Memorial Sloan Kettering Cancer Center, used the GAMES stratification method to retrospectively analyze 1,129 patients who underwent total thyroidectomy at Memorial Sloan Kettering Cancer Center between 1986 and 2005. They found that select patients with early primary disease (pT1/T2) and low-volume metastatic disease in the neck (pT1/T2 N1) who were managed without radioactive iodine had excellent outcomes. In the group with advanced local disease (pT3/T4), select patients with pT3N0 disease were also safely managed without radioactive iodine. The 5-year disease-specific survival and recurrence-free survival in the pT1/T2N0, pT1/T2N1, and pT3/T4 were 100% and 92%, 100% and 92%, and 98% and 87%, respectively.

"Though radioactive iodine has a place in the treatment of papillary thyroid cancer, new data show that it should not be a blanket treatment for all patients," said Elizabeth Pearce, MD, of the Boston Medical Center and Program Co-Chair of the ATA annual meeting. "Instead clinicians must make the decision on whether to recommend adjuvant radioactive iodine to manage thyroid cancer."


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