Postoperative radioiodine ablation does not reduce cancer recurrence following thyroidectomy

1. The 5-year recurrence-free survival was comparable with ablation and without ablation.

2. Adverse events were comparable in both groups, with no treatment-related deaths.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Differentiated thyroid cancer is often treated with radioiodine ablation after total thyroidectomy, but its benefit in low-risk cases remains unclear. Avoiding ablation could reduce side effects and costs without harming outcomes. This randomized controlled trial aimed to determine if omitting radioiodine ablation is non-inferior to ablation in low-risk patients. The primary outcome of this study was 5-year recurrence-free survival, while key secondary outcome was safety. According to study results, recurrence-free survival was similar in both groups, demonstrating non-inferiority. Although this study was well done, it was limited by low recurrence rates and few higher-risk patients, reducing subgroup analysis power.

Click to read the study in The Lancet

Relevant Reading: Thyroidectomy without Radioiodine in Patients with Low-Risk Thyroid Cancer

In-depth [randomized controlled trial]: Between Jun 26, 2012, and Mar 18, 2020, 504 patients were assessed for eligibility across 33 UK centers. Included were patients. Included were patients with low-risk differentiated thyroid cancer who had complete resection after total thyroidectomy and pathologic stage pT1–pT3 or pT3a disease. Altogether, 480 patients (249 without ablation and 231 with ablation) were included in the final analysis. The primary outcome of 5-year recurrence-free survival showed non-inferiority for omitting ablation (97.9% without ablation vs. 96.3% with ablation, p for non-inferiority < 0.05). The secondary outcome of safety showed similar adverse event rates between groups, with fatigue, lethargy, and dry mouth being most common. Findings from this study suggest that low-risk patients can safely forgo postoperative radioiodine, reducing hospitalization, side effects, and costs.

Image: PD

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