Journal article
Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity
European thyroid journal, Vol.6(4), pp.187-196
07/2017
DOI: 10.1159/000468927
PMCID: PMC5567113
PMID: 28868259
Abstract
Management recommendations for differentiated thyroid cancer are evolving. Total thyroidectomy is the backbone of curative-intent therapy, with radioiodine ablation (RAI) of the thyroid remnant routinely performed, in order to facilitate serologic surveillance and reduce recurrence risk. Several single-institution series have identified patient subsets for whom recurrence risk is sufficiently low that RAI may not be indicated. Further, the appropriate dose of RAI specific to variable clinicopathologic presentations remains poorly defined. While recent randomized trials demonstrated equivalent thyroid remnant ablation rates between low- and high-dose RAI, long-term oncologic endpoints remain unreported. While RAI may be employed to facilitate surveillance following total thyroidectomy, cancer recurrence risk reduction is not demonstrated in favorable-risk patients with tumor size ≤1 cm without high-risk pathologic features. When RAI is indicated, in patients without macroscopic residual disease or metastasis, the evidence suggests that the rate of successful remnant ablation following total thyroidectomy is equivalent between doses of 30–50 mCi and doses ≥100 mCi, with fewer acute side effects; however, in the setting of subtotal thyroidectomy or when preablation diagnostic scan uptake is >2%, higher doses are associated with improved ablation rates. Historical series demonstrate conflicting findings of long-term cancer control rates between dose levels; long-term results from modern series have yet to be reported. For high-risk patients, including those with positive surgical margins, gross extrathyroidal extension, lymph node involvement, subtotal thyroidectomy, or >5% uptake, higher-dose RAI therapy appears to provide superior rates of ablation and cancer control.
Details
- Title: Subtitle
- Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity
- Creators
- Nicholas S Andresen - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USAJohn M Buatti - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USAHamed H Tewfik - Iowa City Cancer Treatment Center, Iowa City, Iowa, USANitin A Pagedar - Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USACarryn M Anderson - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USAJohn M Watkins - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- European thyroid journal, Vol.6(4), pp.187-196
- Publisher
- S. Karger AG
- DOI
- 10.1159/000468927
- PMID
- 28868259
- PMCID
- PMC5567113
- ISSN
- 2235-0640
- eISSN
- 2235-0802
- Language
- English
- Date published
- 07/2017
- Academic Unit
- Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984047682202771
Metrics
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