Dynamic risk allows us to adequately select patients with differentiated thyroid cancer who do not require radioiodine treatment

• Published in: Archives of Endocrinology and Metabolism Vol. 65; no. 3; pp. 315 - 321
• Main Authors: Abelleira, Erika, Peñaloza, Mirna Angela, Jerkovich, Fernando, Bueno, Fernanda, Pitoia, Fabián
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Endocrinologia e Metabologia 03.11.2021; Brazilian Society of Endocrinology and Metabolism
• Subjects: dynamic risk; Humans; Iodine Radioisotopes - therapeutic use; Neoplasm Recurrence, Local; Original; Retrospective Studies; structural incomplete response; Thyroid cancer; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - surgery; Thyroidectomy; Treatment Outcome; without remnant ablation; dynamic risk; structural incomplete response; without remnant ablation; Thyroid cancer
• ISSN: 2359-3997; 2359-4292
• DOI: 10.20945/2359-3997000000374

The treatment of patients with differentiated thyroid cancer (DTC) was modified in the last decade towards a more individualized approach according to the risk of recurrence (RR). We compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk. We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All patients were reclassified according to the dynamic risk stratification (low or high). Patients with high dynamic risk received RRA (141 patients). LRR patients who received RRA presented a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to 2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR of 22%, compared to 5% in patients without RRA (p=0.008). This study demonstrates the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights the adequate selection of those who would not benefit from RRA, even with an intermediate risk of recurrence.