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Radioiodine After Thyroidectomy in Patients with Low-Risk Differentiated Thyroid Cancer?
Surgery (either thyroidectomy or lobectomy) is the mainstay of treatment for patients with differentiated thyroid cancer. After thyroidectomy, many patients — particularly those whose cancers have intermediate- or high-risk characteristics — also receive radioiodine to ablate residual thyroid tissue or residual subclinical tumor. To determine whether patients with low-risk cancers benefit from postoperative radioiodine, researchers in France conducted this randomized trial that involved 776 patients with small, differentiated tumors and no evidence of lymph node involvement. Patients received either postoperative radioiodine or no radioiodine and were followed for 3 years.
The primary outcome was a composite of “functional events” (uptake of radioiodine outside the thyroid bed in the radioiodine group), “structural events” (abnormal neck ultrasound suggesting recurrent disease), or “biological events” (elevated levels of thyroglobulin or thyroglobulin antibodies). This outcome occurred in 4% of patients in both groups during follow-up.
Comment
In this trial, adjuvant treatment with radioiodine did not improve outcomes — at least during a 3-year period — in selected patients with low-risk differentiated thyroid cancer. An editorialist notes that use of post-thyroidectomy radioiodine in low-risk patients has been decreasing in recent years, and these results support that trend. A similar trial (IoN) is in progress in the U.K.
Citation(s)
Author:
Leboulleux S et al.
Title:
Thyroidectomy without radioiodine in patients with low-risk thyroid cancer.
Source:
N Engl J Med
2022
Mar
10; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Allan S. Brett, MD