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CLINICAL STUDY |
University of Siena, Siena, Italy, 1 Institut Gustave Roussy, Villejuif, France, 2 Royal Marsden Hospital, London, United Kingdom, 3 Sahlgrenska University Hospital, Gothenburg, Sweden, 4 Chaim Sheba Medical Center, Tel Hashomer, Israel, 5 Evgenidion Hospital, Athens, Greece, 6 University of Louvain Medical School, Brussels, Belgium, 7 Maria Sklodowska-Curie Memorial Institute, Gliwice, Poland, 8 Portuguese Cancer Institute, Lisbon, Portugal, 9 PET Center, Klagenfurt, Austria, 10 University of Würzburg, Würzburg, Germany, 11 Hospital Carlos III, Madrid, Spain, 12 University Medical Center, Leiden, The Netherlands, 13 Academic Medical Center, Amsterdam, The Netherlands
(Correspondence should be addressed to F Pacini; Email: pacini8{at}unisi.it)
Objective: To determine, based on published literature and expert clinical experience, current indications for the post-surgical administration of a large radioiodine activity in patients with differentiated thyroid cancer.
Design and methods: A literature review was performed and was then analyzed and discussed by a panel of experts from 13 European countries.
Results: There is general agreement that patients with unifocal microcarcinomas = 1 cm in diameter and no node or distant metastases have a <2% recurrence rate after surgery alone, and that post-surgical radioiodine confers recurrence and cause-specific survival benefits in patients, strongly suspected of having persistent disease or known to have tumor in the neck or distant sites. In other patients, there is limited evidence that after complete thyroidectomy and adequate lymph node dissection performed by an expert surgeon, post-surgical radioiodine provides clear benefit. When there is any uncertainty about the completeness of surgery, evidence suggests that radioiodine can reduce recurrences and possibly mortality.
Conclusion: This survey confirms that post-surgical radioiodine should be used selectively. The modality is definitely indicated in patients with distant metastases, incomplete tumor resection, or complete tumor resection but high risk of recurrence and mortality. Probable indications include patients with tumors >1 cm and with suboptimal surgery (less than total thyroidectomy or no lymph node dissection), with age <16 years, or with unfavorable histology.
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