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Survival benefit found with RAI, all sizes of papillary thyroid carcinoma tumors
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CORONADO, Calif. — Survival benefit was found with use of RAI for all sizes of papillary thyroid carcinoma tumors, according to study findings at a presentation.
“Papillary thyroid carcinoma (PTC) is associated with excellent overall prognosis,” the researchers wrote. “Standard treatment consists of surgical resection with the possible addition of radioactive iodine (RAI) for tumors believed to have a higher risk of recurrence. The actual benefit of RAI is still debated, though, especially for microcarcinomas.”
Paritosh Suman, MD, of NorthShore University Health System in Evanston, Ill., and colleagues used data from the National Cancer Database from 1998 to 2011 to identify 284,635 patients with PTC to determine the effect of RAI on PTC mortality, particularly related to tumor size. Tumor size groups were as follows: microcarcinoma, ≤10 mm (31% of patients); 11 mm-20 mm (29%); 21mm-40 mm (24%); and >40 mm (8%). Patients were followed for an average of 7 years.
Forty-seven percent of patients received RAI; those with the biggest tumors received RAI more often compared with those patients with the smallest tumors (P<.001).
After follow-up, a survival benefit among all patients, regardless of tumor size, was associated with RAI. This held true even after correcting for age, gender, tumor grade, type of operation the patient received, cancer stage, hormone suppression and distant metastases.
Ten-year overall survival was greater among patients who received RAI (90%) vs. 87.4% of those who did not (P<.001). The 10-year survival advantage with RAI for tumor size was as follows: ≤10 mm (3.4%), 11 mm-20 mm (2.9%), 21 mm-40 mm (3.3%) and >40 mm (5.7%).
“In conclusion, we can state that RAI is associated with a statistically significant, but small, overall survival advantage for most patients,” Suman said.
For more information:
Boone D. Oral #15. Presented at: American Thyroid Association Annual Meeting; Oct. 29-Nov. 2, 2014; Coronado, Calif.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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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