title: Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer.
abstract: OBJECTIVE
  The goal was to determine if there was a relation between the introduction of evidence-based radioactive iodine (RAI) treatment guidelines for differentiated thyroid cancer (DTC) at Cedars-Sinai Medical Center (CSMC) and subsequent RAI use. In addition, we compared RAI treatment rates for DTC at CSMC to data from the National Cancer Database (NCDB) to see if the trends in RAI use at CSMC differed from the national trends.
  
  
  METHODS
  RAI data from the CSMC Thyroid Cancer Center were reviewed to determine if RAI treatment was given appropriately. Kaplan-Meier curves were used to estimate disease-free survival for patients who received or did not receive treatment. RAI data from the NCDB were also used to compare how CSMC treatment rates compare nationally.
  
  
  RESULTS
  There were 444 CSMC patients identified with DTC between 2009 and 2012. Approximately 95% of the patients had papillary thyroid cancer (n=423) with 65% in the stage I risk group (n=290). Kaplan-Meier curves for stages I-III show that those who did not receive RAI treatment had 100% disease-free survival, which was better than those who had received RAI. However, given that the total population in both stages II and III is quite small, having received RAI ablation was not found to be statistically significant. Stage I patients who received RAI had a significantly increased incidence of recurrent disease. The NCDB RAI rates for all DTC stages in each year have consistently been over 50% with an overall treatment rate of 57%. There were significant differences in the treatment rates between CSMC and NCDB, with a decrease in the use of RAI in low-risk patients with stage I tumors at CSMC following institution of the guidelines.
  
  
  CONCLUSIONS
  Prudent use of RAI treatment should be considered for low-risk patients. Ablation rates have been decreasing steadily at CSMC, particularly among low-risk patients, with the adoption of more stringent RAI treatment guidelines. It is apparent from our data that physician practices can change with the implementation and dissemination of evidence-based guidelines for the treatment of DTC with RAI.
authors.affiliation: 1 Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.
authors.forename: Wendy
authors.initials: W
authors.lastname: Sacks
authors.forename: Ronnie Meiyi
authors.initials: RM
authors.lastname: Wong
authors.forename: Catherine
authors.initials: C
authors.lastname: Bresee
authors.forename: Glenn D
authors.initials: GD
authors.lastname: Braunstein
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002291:Carcinoma, Papillary; D002454:Cell Differentiation; D016208:Databases, Factual; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015397:Program Evaluation; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals