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Total or near total thyroidectomy reduced cancer recurrence
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79th Annual Meeting of the ATA
CHICAGO — Cancer recurrence was less common in patients with multifocal micropapillary cancer treated with near total thyroidectomy or total thyroidectomy, according to recent study findings presented at the 79th Annual Meeting of the American Thyroid Association.
Researchers from various U.S. sites analyzed the National Thyroid Cancer Treatment Cooperative Study database for recurrence-free survival; 611 patients with micropapillary thyroid cancers who were free of cancer after their initial surgery were followed.
Among patients receiving less than total thyroidectomy/near total thyroidectomy, patients with multifocal disease had an 18% recurrence rate vs. 4% for patients with unifocal disease (P=.01), according to the researchers.
Patients with multifocal disease who had total thyroidectomy/near total thyroidectomy had a 6% recurrence rate vs. 18% for patients who had less than total thyroidectomy/near total thyroidectomy (P=.058).
Among patients who did not receive adjuvant radioactive iodine, the recurrence rate was 7% in patients with multifocal disease vs. 2% in patients with unifocal disease (P=.02). Radioactive iodine did not affect recurrence in node-positive or multifocal disease patients, according to the researchers.
Node-positive patients had a higher recurrence rate compared with node-negative patients, and recurrence was more common in patients with unifocal disease who received radioactive iodine, according to the researchers.
“These findings support the use of total or near total thyroidectomy in treating patients with multifocal micropapillary cancer to reduce the risk for recurrence, and indicate the feasibility of a prospective randomized trial to determine whether radioiodine might further reduce the risk for recurrence,” Douglas S. Ross, MD, said in a press release.
Ross is associate professor of Clinical Medicine at Harvard Medical School, and co-director of the thyroid unit at Massachusetts General Hospital. – by Christen Haigh
This study, which focused on micropapillary thyroid cancer, is consistent with what other studies have shown for larger tumors. Bilateral thyroidectomy — at least in the setting of multicentric disease — reduced recurrences compared with unilateral thyroidectomy. The impact of radioactive iodine remnant ablation in those with low stage disease — particularly after bilateral surgery — however, remains uncertain. The authors point out that the mean time for recurrence, which occurred in 6.2% of patients, was only 2.8 years after primary treatment. This underscores the feasibility of doing a randomized controlled trial over a relatively short period of time to study the benefit of radioactive iodine remnant ablation in micropapillary thyroid cancer, an increasingly frequently diagnosed entity.
– Jeffrey R. Garber, MD
Endocrine Today Editorial Board member
For more information:
- Ross DS. #82. Presented at: 79th Annual Meeting of the American Thyroid Association; Oct. 1-5, 2008; Chicago.