This article is more than 5 years old. Information may no longer be current.
Differentiated thyroid carcinoma benefitted from total/near-total thyroidectomy followed by RAI
Click Here to Manage Email Alerts
CORONADO, Calif. — A survival benefit was found among patients with differentiated thyroid carcinoma who underwent total/near-total thyroidectomy followed by radioactive iodine therapy, according to study findings presented here.
“To date there are no prospective studies evaluating the longitudinal effects of initial long-term therapy in differentiated thyroid cancer. … The challenge for clinicians becomes balancing the potential risks of more aggressive therapy — such as aggressive thyroid hormone suppression — and the risks associated with long-term thyrotoxicosis with the potential benefits of treatment. This is not always clear, especially in patients who are at a variety of risks for cancer-specific mortality,” Aubrey A. Carhill, MD, of the University of Texas MD Anderson Cancer Center, said during her presentation. “There remains a need for accurate prognostication in order to identify which patients will benefit from different treatment modalities.”
Aubrey A. Carhill
Carhill and colleagues evaluated the effects of initial therapies, including thyroidectomy and radioactive iodine (RAI), and long-term thyroid-stimulating hormone-suppressive therapy in 4,941 patients to determine overall and disease-free survival (DFS).
Improved overall survival was found among patients with stage III disease who received RAI (P=.04) and those with stage IV disease who received both total/near-total thyroidectomy (T/NTT) and RAI (combined P=.049).
Improved overall survival and DFS were reported among patients of all stages who received moderate TSH-suppressive thyroid hormone therapy (TSHT).
When distant metastatic disease was diagnosed during long-term follow-up, only moderate TSHT was significantly associated with improved overall survival.
Improved overall survival was independently predicted by lower initial disease stage and moderate TSHT. In patients rendered disease free after initial therapy, improved DFS for at least the first 3 years of follow-up was independently predicted by moderate TSHT.
“We confirmed prior findings that there is survival benefit in high-risk groups treated with thyroidectomy and RAI,” Carhill said. “There’s no disease-free survival benefit in the low-risk group receiving post-operative RAI. We report for the first time that [in] a multivariate analyses of primary treatment for differentiated thyroid carcinoma in all stages, total TSHT was associated with improved overall survival and disease-free survival. Also, when examining the degree of TSHT, aggressive suppression conferred no additional benefit when compared with moderate suppression even in patients with distant metastatic disease. Lastly, we report that continued moderate TSHT is beneficial for at least 3 years after diagnosis.”
For more information:
Carhill A. Oral #11. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to Top
R. Michael Tuttle, MD
One of the topics that came up for a lot of discussion at this year’s American Thyroid Association Annual Meeting was how we treat patients with radioactive iodine-refractory disease. We had several discussions about which tyrosine kinase inhibitors should be used and what other medicines should be used. From an endocrinology standpoint, it comes down to how we define “radioactive iodine refractory.” It is important to know which patients continue to respond to radioactive iodine and, just as importantly, which patients no longer respond. We had several very good sessions at this meeting that really tried to define who is radioactive iodine refractory. The easiest of those are the patients who have structural disease that no longer concentrate radioactive iodine, meaning their scans are negative. In other situations, we have given radioactive iodine and it has not been effective, as patients’ tumors have continued to progress. So, although we are still working on the exact definitions, it is important for us to ask ourselves the question: Is radioactive iodine still effective in my advanced patient? If it is, we would certainly use that, and if it’s not, we need to be aware that there are multiple other targeted therapies that potentially could be useful in this space.Click Here to Manage Email Alerts