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Differences in guidelines may affect use of RAI in Hürthle cell carcinoma
Radioactive iodine therapy is associated with improved survival in patients with Hürthle cell carcinoma and should be used in patients with tumors larger than 2 cm and those with nodal and distant metastatic disease, according to recent study findings.
Currently, the American Thyroid Association recommends radioactive iodine therapy (RAI) after total thyroidectomy in patients with Hürthle cell carcinoma, whereas the National Cancer Comprehensive Network recommends RAI for tumors that are larger than 2 cm or in the presence of vascular invasion, extrathyroidal extension, presence of lymph node metastases or elevated postoperative unstimulated thyroglobulin levels.
Julie Ann Sosa
Julie Ann Sosa, MD, professor of surgery and medicine at Duke Cancer Institute and Duke Clinical Research Institute at Duke University Medical Center in Durham, North Carolina, and colleagues evaluated data from the National Cancer Data Base on 1,909 adults with a diagnosis of Hürthle cell carcinoma who underwent total thyroidectomy between 1998 and 2006 to identify patterns of RAI use and to determine whether RAI use is associated with overall survival. In order to assess patterns of RAI administration, the cohort was limited to patients with tumors at least 2 cm or those with T1 tumors with lymph node and/or distant metastases.
Overall, 60.9% of participants received RAI; they were younger (P < .001) and more often had private insurance (P < .003) and were treated at an academic center (P < .001) compared with those who did not receive RAI.
Christa Jillard
Greater 5-year and 10-year survival rates were found among participants who received RAI (88.9% and 74.4%, respectively) compared with those who did not (83.1% and 65%, respectively; P < .001 for both). No difference existed between high and low thyroidectomy volume facilities or between community and academic facilities for RAI use. A 30% reduction in mortality was independently linked to RAI administration (P = .001).
“As Hürthle cell carcinoma is a rare phenomenon, prior studies have been limited by small sample size. This is one of the largest studies on this topic, encompassing data from more than 70% of all incident cancers in the United States,” researcher Christa Jillard, MD, told Endocrine Today.
“The implication for clinical practice is that based on these new data, unless contraindicated, clinicians can now recommend that patients with Hürthle cell cancers [at least] 2 cm, or with local and/or distant metastases, undergo post-thyroidectomy RAI treatment,” Sosa told Endocrine Today. “The current variation in practice observed implies that there is also likely uneven quality of care for patients with Hürthle cell cancer.” – by Amber Cox
For more information:
Julie Ann Sosa, MD, can be reached at Duke University School of Medicine, Duke University Medical Center #2945, Durham, NC 27710; email: julie.sosa@duke.edu.
Disclosure: Jillard reports no relevant financial disclosures. Sosa is a member of the Data Monitoring Committee for the Medullary Thyroid Cancer Consortium Registry supported by Astra Zeneca, Eli Lilly, GlaxoSmithKline and Novo Nordisk.