Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm?
To evaluate tumor recurrence after total thyroidectomy in patients with single papillary carcinoma with size <or= 2 cm and restricted to the thyroid, we studied 136 consecutive patients divided into two groups according to postoperative management: no ablative therapy (n = 42) (group 1) and ablation with 1.1 GBq (n = 36) or 3.7 GBq (131)I (n = 58) (group 2). None of the patients were submitted to central-compartment (VI level) neck dissection. Thyroid-stimulating hormone (TSH) levels were > 0.5 mIU/L in >or=50% of the measurements in all patients. Complete remission (stimulated thyroglobulin (Tg) <or= 1 ng/mL, undetectable antithyroglobulin antibodies (TgAb), and negative imaging methods) was observed in 83% of the patients in group 1 and in 89% in group 2 (p = 0.4), and none of the patients presented apparent disease during follow-up (mean: 6 years). Posttherapy whole-body scanning was available in 74 patients, and none of them showed ectopic uptake. TgAb were still present in 7.1% of the patients in group 1 and in 8.5% in group 2 (p > 0.05). Six patients who still had stimulated Tg > 1 ng/mL (<5 ng/mL) showed a >50% decrease in comparison with Tg measured 12-24 months earlier. In conclusion, we suggest a more conservative approach with respect to central-compartment neck dissection, postoperative (131)I, and suppressive therapy in patients with small tumors restricted to the thyroid.
Rosário
Pedro W S
PW
Department of Thyroid, Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil.
Borges
Michelle A R
MA
Valadão
Maristane M A
MM
Vasconcelos
Flávio P J
FP
Rezende
Leonardo L
LL
Padrão
Eduardo L
EL
Barroso
Alvaro L
AL
Purisch
Saulo
S
D000328:Adult; D001706:Biopsy; D002291:Carcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D018714:Radiotherapy, Adjuvant; D013961:Thyroid Gland / Q000473:pathology; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D051598:Whole Body Imaging
D007457:Iodine Radioisotopes