Early Dynamic Risk Stratification Decreases Rate of Ablative and Adjuvant Radioiodine Use in ATA Low and Intermediate
Sarp Kaya Gorur1, Serdar Ozbas2, Seyfettin Ilgan3
1Department of General Surgery, Ankara Guven Hospital, Ankara, Türkiye.
Sisli Etfal Hastanesi Tip Bulteni
|January 25, 2024
Summary
Early risk assessment in differentiated thyroid cancer (DTC) guides radioiodine (RAI) therapy decisions. This approach reduces high-activity RAI use in low and intermediate-risk patients without increasing recurrence rates.
Area of Science:
- Endocrinology
- Oncology
- Nuclear Medicine
Background:
- Radioiodine (RAI) therapy is standard for differentiated thyroid cancer (DTC) remnant ablation and adjuvant treatment.
- RAI application in intermediate-risk (InR) DTC remains controversial.
- Early postoperative risk assessment aims to refine RAI treatment strategies.
Purpose of the Study:
- To evaluate the impact of early dynamic risk assessment (EDRA) on RAI utilization in low-risk (LoR) and InR papillary thyroid cancer (PTC) patients.
- To determine if EDRA influences the decision-making process for RAI therapy post-surgery.
Main Methods:
- A prospective registry study included 186 LoR or InR PTC patients undergoing total thyroidectomy and central lymph node dissection.
- EDRA involved neck ultrasonography, serum thyroglobulin (Tg), and anti-Tg levels at 6 weeks post-surgery.
- Patients were managed with either no RAI or low-activity (30-50 mCi) RAI based on EDRA criteria.
Main Results:
- Median follow-up was 63 months.
- A significant proportion of LoR (61%) and InR (56%) patients did not receive RAI.
- RAI use (30-50 mCi) was observed in 35% of LoR and 29% of InR patients; higher activity (≥100 mCi) was used in 4.6% of LoR and 16% of InR patients.
- Only one InR patient recurred; no significant difference in local recurrence was found between RAI-treated and untreated groups in either risk category (p=0.152 for LoR, p=0.272 for InR).
Conclusions:
- Consensus exists for omitting RAI in LoR DTC post-surgery.
- RAI indications for InR DTC require further clarification.
- EDRA-guided RAI use appears superior to relying solely on histopathology, reducing high-activity RAI administration without compromising recurrence control.
