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Radioiodine ablation, TSH stimulation warranted in low-risk patients
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Annual Meeting of the American Thyroid Association
Patients at low risk for recurrence appeared to benefit from the use of recombinant human thyroid-stimulating hormone and low-dose radioiodine ablation after surgery for thyroid cancer, according to data from the ESTIMABL study.
Researchers in France conducted a controlled, phase 3 trial at 24 centers in which they assigned patients who had undergone total thyroidectomy for differentiated thyroid cancer to one of four postoperative treatment strategies. Each method combined a thyroid-stimulating hormone (TSH) stimulation method, such as thyroid hormone withdrawal or recombinant human TSH (Thyrogen, Genzyme), and either 1.1 GBq or 3.7 GBq of radioiodine.
Of the 752 patients enrolled in the study between April 2007 and February 2010, 91% had papillary cancer. Thirty percent of tumors were pT1N0; 18% were pT1N1; 39% were pT1,Nx; and 12% were pT2,N0. After exclusion for various reasons, 687 patients were included in the analysis. Neck ultrasound was normal in 655 of these patients; stimulated thyroglobulin level was 1 ng/mL or lower in 652 patients; and thyroid ablation was complete in 633 patients. Rates of ablation were equivalent among all treatment arms, according to the researchers. Of the remaining 54 patients, 18 had persistent disease; 25 had normal subsequent work up; and 11 are still being followed.
“These results validated the use of recombinant human TSH and 1.1 GBq for ablation in low-risk patients,” the researchers concluded.
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- Schlumberger M. Oral #4.