The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective.

I J Nixon, J P Shah, M Zafereo, R S Simo, I D Hay, C Suárez, P Zbären, A Rinaldo, A Sanabria, C Silver, A Mäkitie, V Vander Poorten, L P Kowalski, A R Shaha, G W Randolph, A Ferlito

Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2020;46(5):754-762

PMID: 31952928

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Abstract

With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.

Address: Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, University of Edinburgh, UK. Electronic address: [email protected].; Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.; Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA.; Department of Otorhinolaryngology Head and Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.; Division of Endocrinology and Internal Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA.; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain.; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Bern, Switzerland.; University of Udine School of Medicine, Udine, Italy.; Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia.; Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA.; Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska Hospital, Stockholm, Sweden.; Department of Oncology, section Head and Neck Oncology, KU Leuven, and Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.; Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, and Head and Neck Surgery Department, Faculty of Medicine, University of Sao Paulo, São Paulo, Brazil.; Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.; Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

DOI: 10.1016/j.ejso.2020.01.010