Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis
- 3 Downloads
The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies.
To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (PTC) patients undergoing minimal intervention.
We retrospectively analyzed 137 patients with low-risk PTC (stage I: n=77; stage II: n=60). Of these patients, 107 (Group 1) had macro-PTC and underwent near-total thyroidectomy and received postoperatively 50mCi RAI. The remaining 30 patients (Group 2) had micro-PTC (<1cm) and were treated only by means of near-total thyroidectomy.
The median follow-up for Group 1 patients was 10 years (range: 3–30). At 1-year evaluation, 8 patients of Group 1 had indeterminate or incomplete biochemical response, of whom 4 had also incomplete structural response to initial therapy. Only 1 of 4 patients with structural incomplete response underwent cervical lymph node dissection and then received an additional dose of 100mCi RAI. The remaining 7 patients received only an additional dose of 100mCi RAI. These patients have been continuously followed till the present time with no recurrences or deaths (median follow-up: 17.5 years; 3–30 years). At 15 years, 2 patients of Group 1 experienced biochemical recurrence and they received 100mCi RAI. Three patients of Group 2 experienced recurrence, with 2 receiving 50mCi RAI and 1 undergoing cervical lymph node dissection with 50mCi RAI.
Patients with low-risk macro-PTC treated by means of near-total thyroidectomy without PCCLND and receiving postoperatively a low dose of 50mCi RAI have excellent long-term prognosis.
Key wordsLow risk Prognosis Papillary thyroid carcinoma RAI Recurrence Prognosis
- 5.Randolph GW, Duh QY, Heller KS, et al, American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery, 2012 The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid 22: 1144–1152.CrossRefGoogle Scholar
- 6.American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeos, American Academy of Otolaryngology Head and Neck Surgery, American Head and Neck Society, Carty SE, Cooper DS, Doherty GM, et al, 2009 Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19: 1153–1158.CrossRefGoogle Scholar
- 27.Vaisman F, Shaha A, Fish S, Michael Turtle R, 2011 Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol 75: 112–119.CrossRefGoogle Scholar