title: The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification.
abstract: BACKGROUND
  The American Thyroid Association guidelines recommend the routine use of radioactive iodine for remnant ablation (RRA) in all T3 or greater primary tumors, and selective use in patients with intrathyroidal disease >1 cm, or evidence of nodal metastases. The guidelines recognize that there is conflicting and inadequate data to make firm recommendations for most patients. The aim of this study was to analyze our institutional experience of the use of RRA in the management of papillary thyroid cancer, with a particular focus on outcomes for those patients selected not to receive RRA.
  
  
  METHODS
  We retrospectively reviewed 1129 consecutive patients who underwent total thyroidectomy at the Memorial Sloan-Kettering Cancer Center between 1986 and 2005. Of these, 490 were pT1-2 N0, 193 pT1-2 N1, and 444 pT3-4. Details on recurrence and disease-specific survival were recorded by the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  The five-year disease-specific survival and recurrence-free survival in the pT1/T2 N0, pT1-2 N1, and pT3-4 were 100% and 92%, 100% and 92%, and 98% and 87% respectively. Low-risk patients who were managed without RRA (who tended to have limited primary disease, pT1-2, and low-volume metastatic disease in the neck, pT1-2 N1-fewer than five nodes, all <1 cm greatest dimension) had five-year recurrence-free survival of >97%. In the group with advanced local tumors (pT3-4), those patients who did not receive RRA (who tended to have pT3 N0 disease) had five-year recurrence-free survival of >90%.
  
  
  CONCLUSIONS
  Following appropriate surgical management, the majority of patients with low-risk local disease and even some patients with more advanced-stage (pT3) tumors or regional metastases have low rates of recurrence and high rates of survival when managed without RRA.
authors.affiliation: Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Nixon
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Frank L
authors.initials: FL
authors.lastname: Palmer
authors.forename: Monica M
authors.initials: MM
authors.lastname: Di Lorenzo
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Grewal
authors.forename: Steven M
authors.initials: SM
authors.lastname: Larson
authors.forename: R Michael
authors.initials: RM
authors.lastname: Tuttle
authors.forename: Ashok
authors.initials: A
authors.lastname: Shaha
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000368:Aged; D002173:Cancer Care Facilities; D002277:Carcinoma / Q000175:diagnosis / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000556:secondary; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000556:secondary; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009519:New York City; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery*; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals