This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sawka, A. M. Articles by Gerstein, H. C. Search for Related Content PubMed PubMed Citation Articles by Sawka, A. M. Articles by Gerstein, H. C.

A Systematic Review and Metaanalysis of the Effectiveness of Radioactive Iodine Remnant Ablation for Well-Differentiated Thyroid Cancer

Department of Medicine and Division of Endocrinology and Metabolism (A.M.S., H.C.G.) and Department of Clinical Epidemiology and Biostatistics (M.B., L.T., G.B., H.C.G.), McMaster University, Hamilton, Ontario L8N 3Z5; Department of Medicine (A.M.S.) and Centre for Evaluation of Medicines (L.T.), St. Joseph’s Healthcare, Hamilton, Ontario L8N 4A6; Cancer Care Ontario Practice Guidelines Initiative (K.T., M.B., G.B.), Cancer Care Ontario M5G 2L7; Department of Radiation Oncology (K.T.), Hamilton Regional Cancer Centre L8V 5C2; and Department of Medicine (G.B., H.C.G.), Hamilton Health Sciences, Hamilton, Ontario L8N 3Z5, Canada

Address all correspondence and requests for reprints to: A. M. Sawka, c/o Lehana Thabane, Centre for Evaluation of Medicines, 105 Main Street East, Level P1, Hamilton, Ontario, Canada L8N 1G6.

Radioactive iodine remnant ablation destroys residual thyroid tissue after surgical resection of papillary or follicular thyroid cancer. We systematically reviewed 1543 English references to determine whether remnant ablation decreases the risk of thyroid cancer-related death or recurrence after bilateral thyroidectomy for papillary or follicular thyroid cancer. In 13 cohort studies in which the analysis of thyroid cancer-related outcomes was statistically adjusted to a variable degree for prognostic factors or cointerventions, rates of recurrences of thyroid cancer-related outcomes were significantly decreased in the following: one of seven studies examining thyroid cancer-related mortality, three of six studies examining any tumor recurrence, three of three studies examining locoregional recurrence, and two of three studies examining distant metastases. Thyroid hormone suppressive therapy was not adjusted for in the majority of these analyses. In 18 cohort studies not adjusted for prognostic factors or interventions, the benefit of radioactive iodine ablation in decreasing the thyroid cancer-related mortality and any recurrence at 10 yr was inconsistent among centers. However, pooled analyses were suggestive of a statistically significant treatment effect of ablation for the following 10-yr outcomes: locoregional recurrence (relative risk of 0.31, 95% confidence interval, 0.2, 0.49) and distant metastases (absolute decrease in risk 3%, 95% confidence interval, risk decreases 1–4%). In conclusion, radioactive iodine ablation may be beneficial in decreasing recurrence of well-differentiated thyroid cancer; however, results are inconsistent among centers for some outcomes, and the incremental benefit of remnant ablation in low-risk patients treated with bilateral thyroidectomy and thyroid hormone suppressive therapy is unclear.

This review was supported, in part, by the Program in Evidence-Based Care, Cancer Care Ontario. H.C.G. holds the McMaster University Population Health Institute Chair in Diabetes Research (sponsored by Aventis).

Abbreviations: CI, Confidence interval; RAI, radioactive iodine; RD, risk difference; RR, relative risk.

This review will serve as the basis of the practice guideline on radioactive iodine ablation for well-differentiated thyroid cancer being developed by the Radiopharmaceutical Guidelines Groups of the Program in Evidence-Based Care, Cancer Care Ontario.

This article has been cited by other articles:

				R. Elisei, M. Schlumberger, A. Driedger, C. Reiners, R. T. Kloos, S. I. Sherman, B. Haugen, C. Corone, E. Molinaro, L. Grasso, et al. Follow-Up of Low-Risk Differentiated Thyroid Cancer Patients Who Underwent Radioiodine Ablation of Postsurgical Thyroid Remnants after Either Recombinant Human Thyrotropin or Thyroid Hormone Withdrawal J. Clin. Endocrinol. Metab., November 1, 2009; 94(11): 4171 - 4179. [Abstract] [Full Text] [PDF]

				M. Xing, D. Clark, H. Guan, M. Ji, A. Dackiw, K. A. Carson, M. Kim, A. Tufaro, P. Ladenson, M. Zeiger, et al. BRAF Mutation Testing of Thyroid Fine-Needle Aspiration Biopsy Specimens for Preoperative Risk Stratification in Papillary Thyroid Cancer J. Clin. Oncol., June 20, 2009; 27(18): 2977 - 2982. [Abstract] [Full Text] [PDF]

				N. Aide, N. Heutte, J.-P. Rame, E. Rousseau, C. Loiseau, M. Henry-Amar, and S. Bardet Clinical Relevance of Single-Photon Emission Computed Tomography/Computed Tomography of the Neck and Thorax in Postablation 131I Scintigraphy for Thyroid Cancer J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 2075 - 2084. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri A Vision for the Surgical Management of Papillary Thyroid Carcinoma: Extensive Lymph Node Compartmental Dissections and Selective Use of Radioiodine J. Clin. Endocrinol. Metab., April 1, 2009; 94(4): 1086 - 1088. [Full Text] [PDF]

				M. Perrino, G. Vannucchi, L. Vicentini, G. Cantoni, D. Dazzi, C. Colombo, M. Rodari, A. Chiti, P. Beck-Peccoz, and L. Fugazzola Outcome predictors and impact of central node dissection and radiometabolic treatments in papillary thyroid cancers <=2 cm Endocr. Relat. Cancer, March 1, 2009; 16(1): 201 - 210. [Abstract] [Full Text] [PDF]

				N. A. Johnson and M. E. Tublin Postoperative Surveillance of Differentiated Thyroid Carcinoma: Rationale, Techniques, and Controversies Radiology, November 1, 2008; 249(2): 429 - 444. [Abstract] [Full Text] [PDF]

				I. D. Hay, I. R. McDougall, and J. C. Sisson Perspective: The Case Against Radioiodine Remnant Ablation in Patients with Well-Differentiated Thyroid Carcinoma J. Nucl. Med., August 1, 2008; 49(8): 1395 - 1397. [Abstract] [Full Text] [PDF]

				R. M. Tuttle, M. Brokhin, G. Omry, A. J. Martorella, S. M. Larson, R. K. Grewal, M. Fleisher, and R. J. Robbins Recombinant Human TSH-Assisted Radioactive Iodine Remnant Ablation Achieves Short-Term Clinical Recurrence Rates Similar to Those of Traditional Thyroid Hormone Withdrawal J. Nucl. Med., May 1, 2008; 49(5): 764 - 770. [Abstract] [Full Text] [PDF]

				S. Bardet, E. Malville, J.-P. Rame, E. Babin, G. Samama, D. De Raucourt, J.-J. Michels, Y. Reznik, and M. Henry-Amar Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma. Eur. J. Endocrinol., April 1, 2008; 158(4): 551 - 560. [Abstract] [Full Text] [PDF]

				T. Pilli, E. Brianzoni, F. Capoccetti, M. G. Castagna, S. Fattori, A. Poggiu, G. Rossi, F. Ferretti, E. Guarino, L. Burroni, et al. A Comparison of 1850 (50 mCi) and 3700 MBq (100 mCi) 131-Iodine Administered Doses for Recombinant Thyrotropin-Stimulated Postoperative Thyroid Remnant Ablation in Differentiated Thyroid Cancer J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3542 - 3546. [Abstract] [Full Text] [PDF]

				P. Z. Pace-Asciak, R. J. Payne, S. J. Eski, P. Walfish, M. Damani, and J. L. Freeman Cost Savings of Patients With a MACIS Score Lower Than 6 When Radioactive Iodine Is Not Given Arch Otolaryngol Head Neck Surg, September 1, 2007; 133(9): 870 - 873. [Abstract] [Full Text] [PDF]

				D. Handkiewicz-Junak, J. Wloch, J. Roskosz, J. Krajewska, A. Kropinska, L. Pomorski, A. Kukulska, A. Prokurat, Z. Wygoda, and B. Jarzab Total Thyroidectomy and Adjuvant Radioiodine Treatment Independently Decrease Locoregional Recurrence Risk in Childhood and Adolescent Differentiated Thyroid Cancer J. Nucl. Med., June 1, 2007; 48(6): 879 - 888. [Abstract] [Full Text] [PDF]

				G. Chiappetta, M. Ammirante, A. Basile, A. Rosati, M. Festa, M. Monaco, E. Vuttariello, R. Pasquinelli, C. Arra, M. Zerilli, et al. The Antiapoptotic Protein BAG3 Is Expressed in Thyroid Carcinomas and Modulates Apoptosis Mediated by Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 1159 - 1163. [Abstract] [Full Text] [PDF]

				A. Hackshaw, C. Harmer, U. Mallick, M. Haq, and J. A. Franklyn 131I Activity for Remnant Ablation in Patients with Differentiated Thyroid Cancer: A Systematic Review J. Clin. Endocrinol. Metab., January 1, 2007; 92(1): 28 - 38. [Abstract] [Full Text] [PDF]

				D. W. Kim, Y. S. Jo, H. S. Jung, H. K. Chung, J. H. Song, K. C. Park, S. H. Park, J. H. Hwang, S. Y. Rha, G. R. Kweon, et al. An Orally Administered Multitarget Tyrosine Kinase Inhibitor, SU11248, Is a Novel Potent Inhibitor of Thyroid Oncogenic RET/Papillary Thyroid Cancer Kinases J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 4070 - 4076. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Schlumberger, H. Dralle, R. Elisei, J. W A Smit, W. Wiersinga, and the European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur. J. Endocrinol., June 1, 2006; 154(6): 787 - 803. [Full Text] [PDF]

				E. Roti, R. Rossi, G. Trasforini, F. Bertelli, M. R. Ambrosio, L. Busutti, E. N. Pearce, L. E. Braverman, and E. C. degli Uberti Clinical and Histological Characteristics of Papillary Thyroid Microcarcinoma: Results of a Retrospective Study in 243 Patients J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2171 - 2178. [Abstract] [Full Text] [PDF]

				F. Pacini, P. W. Ladenson, M. Schlumberger, A. Driedger, M. Luster, R. T. Kloos, S. Sherman, B. Haugen, C. Corone, E. Molinaro, et al. Radioiodine Ablation of Thyroid Remnants after Preparation with Recombinant Human Thyrotropin in Differentiated Thyroid Carcinoma: Results of an International, Randomized, Controlled Study J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 926 - 932. [Abstract] [Full Text] [PDF]

				B Jarzab, D Handkiewicz-Junak, and J Wloch Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review Endocr. Relat. Cancer, December 1, 2005; 12(4): 773 - 803. [Abstract] [Full Text] [PDF]

				F. Pacini, M. Schlumberger, C. Harmer, G. G Berg, O. Cohen, L. Duntas, F. Jamar, B. Jarzab, E. Limbert, P. Lind, et al. Post-surgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report Eur. J. Endocrinol., November 1, 2005; 153(5): 651 - 659. [Abstract] [Full Text] [PDF]

				E. L. Mazzaferri Empirically Treating High Serum Thyroglobulin Levels J. Nucl. Med., July 1, 2005; 46(7): 1079 - 1088. [Full Text] [PDF]

				F. A Verburg, B. de Keizer, C. J M Lips, P. M J Zelissen, and J. M H de Klerk Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients Eur. J. Endocrinol., January 1, 2005; 152(1): 33 - 37. [Abstract] [Full Text] [PDF]

				R. J. Robbins and M. J. Schlumberger The Evolving Role of 131I for the Treatment of Differentiated Thyroid Carcinoma J. Nucl. Med., January 1, 2005; 46(1_suppl): 28S - 37S. [Abstract] [Full Text] [PDF]

				E. Mazzaferri A Randomized Trial of Remnant Ablation--In Search of an Impossible Dream? J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3662 - 3664. [Full Text] [PDF]

				B. R. Haugen Patients with Differentiated Thyroid Carcinoma Benefit from Radioiodine Remnant Ablation J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3665 - 3667. [Full Text] [PDF]