A Systematic Review and Metaanalysis of the Effectiveness of Radioactive Iodine Remnant Ablation for Well-Differentiated Thyroid Cancer
Anna M. Sawka,
Kullathorn Thephamongkhol,
Melissa Brouwers,
Lehana Thabane,
George Browman and
Hertzel C. Gerstein
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 thyroidtissue after surgical resection of papillary or follicular thyroidcancer. We systematically reviewed 1543 English references todetermine whether remnant ablation decreases the risk of thyroidcancer-related death or recurrence after bilateral thyroidectomyfor papillary or follicular thyroid cancer. In 13 cohort studiesin which the analysis of thyroid cancer-related outcomes wasstatistically adjusted to a variable degree for prognostic factorsor cointerventions, rates of recurrences of thyroid cancer-relatedoutcomes were significantly decreased in the following: oneof seven studies examining thyroid cancer-related mortality,three of six studies examining any tumor recurrence, three ofthree studies examining locoregional recurrence, and two ofthree studies examining distant metastases. Thyroid hormonesuppressive therapy was not adjusted for in the majority ofthese analyses. In 18 cohort studies not adjusted for prognosticfactors or interventions, the benefit of radioactive iodineablation in decreasing the thyroid cancer-related mortalityand any recurrence at 10 yr was inconsistent among centers.However, pooled analyses were suggestive of a statisticallysignificant treatment effect of ablation for the following 10-yroutcomes: locoregional recurrence (relative risk of 0.31, 95%confidence interval, 0.2, 0.49) and distant metastases (absolutedecrease in risk 3%, 95% confidence interval, risk decreases1–4%). In conclusion, radioactive iodine ablation maybe beneficial in decreasing recurrence of well-differentiatedthyroid cancer; however, results are inconsistent among centersfor some outcomes, and the incremental benefit of remnant ablationin low-risk patients treated with bilateral thyroidectomy andthyroid hormone suppressive therapy is unclear.
This review was supported, in part, by the Program in Evidence-BasedCare, Cancer Care Ontario. H.C.G. holds the McMaster UniversityPopulation Health Institute Chair in Diabetes Research (sponsoredby Aventis).
This review will serve as the basis of the practice guidelineon radioactive iodine ablation for well-differentiated thyroidcancer being developed by the Radiopharmaceutical GuidelinesGroups of the Program in Evidence-Based Care, Cancer Care Ontario.
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