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Radioactive iodine improved survival in differentiated thyroid carcinoma
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CORONADO, Calif. — Use of radioactive iodine therapy was linked to improved disease-specific survival in patients with advanced differentiated thyroid carcinoma, according to study results presented at the American Thyroid Association Annual Meeting.
However, researchers noted that radioactive iodine (RAI) demonstrated negative effects among patients with micropapillary carcinoma.
“The current ATA guidelines do not recommend RAI in early-stage thyroid cancer, but we know that a significant proportion of these patients are receiving this therapy,” Ryan K. Orosco, MD, from the division of head and neck surgery at University of California, San Diego, told HemOnc Today. “The use of RAI in advanced differentiated thyroid carcinoma is not disputed, and our analysis bolsters its use in such patients.”
Ryan K. Orosco
In the current study, Orosco and and colleagues reviewed the SEER database from 1973 to 2009 to identify patients with differentiated thyroid carcinoma.
Using multivariate analyses, researchers examined the relationship between use of RAI and cancer-specific survival, controlling for age, decade of diagnosis, race, sex, tumor, nodal, metastasis stage and RAI therapy.
The analysis included 85,740 patients with differentiated thyroid carcinoma, of whom 43.3% received RAI therapy.
Researchers observed that RAI was used in 54.6% of patients with stage I disease, 40.5% of stage II, 94.2% of stage III and in 84.8% of stage IV disease. In addition, 41.9% of patients with T1a disease received RAI vs. 88.2% of patients with T4 disease.
According to study results, RAI therapy was positively associated with survival (HR=1.3; P=.002), and significantly linked to decreased risk for disease-specific mortality among patients with metastatic disease (HR range, 2.28-3.82).
The researchers observed comparable effects from RAI among patients with regional metastases (HR range, 1.4-2.9), T3+ tumors (HR range, 1.36-1.39), T4 tumors (HR=1.85) and among patients with stage IV disease (HR range, 1.47-1.73).
However, researchers identified an increased likelihood of thyroid cancer-specific mortality among patients with T1a disease when RAI was used (HR=0.13; P<.001). The researchers observed no statistically significant effect of RAI in patient subgroups with T1b or T2 tumors.
“This study brings population-based evidence to the discussion about the use of RAI in patients with thyroid cancer,” Orosco said. “This study is not the end-all, and warrants additional examination into the impact of using RAI in patient with early-stage disease. We need to make sure we are using this treatment judiciously, and critically analyzing our practices so that we can best care for our patients.”
For more information:
Orosco RK. Poster #41. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.