ECE2018 Poster Presentations: Thyroid Thyroid cancer (88 abstracts)
Changing treatment trends with radioiodine in thyroid carcinoma at the beginning of 21st century in Castilla-La Mancha (Spain)
Manuel Delgado 1 , Julia Sastre 2 , Ivan Quiroga 3 , Javier Gonzalez 4 , Belvis Torres 5 , Silvia Aznar 6 , Visitación Alvarez 7 , Sandra Herranz 7 , Jesús Moreno 1 & Paz Gómez 1
1Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 2Complejo Hospitalario de Toledo, Toledo, Spain; 3Hospital General Nuestra Señora del Prado, Talavera de la Reina, Spain; 4Hospital Virgen de la Luz, Cuenca, Spain; 5Hospital General La Mancha Centro, Alcázar de San Juan, Spain; 6Complejo Hospitalario Universitario de Albacete, Albacete, Spain; 7Hospital Universitario de Guadalajara, Guadalajara, Spain.
Background and objective: The incidence of differentiated thyroid carcinoma (DTC) is increasing worldwide. Radioiodine (RAI) ablation is one of the main elements in the therapy of DTC after surgical removal of the gland. This study aims to compare the use of I131 in a Spanish Cohort of DTC before and after the American Thyroid Association (ATA) 2009 guidelines.
Patients and methods: The Cadit-CAM study was designed to evaluate retrospectively characteristics of patients diagnosed of DTC in Castilla-La Mancha (CAM), a region in the central part of Spain, from 2001 to 2015. The cohort in Cadit-CAM study included 1434 patients from seven hospitals. We studied the use of RAI ablation therapy n this cohort. Patient recurrence risk was assessed using ATA risk stratification system (Low, Intermediate and High risk).
Results: 1426 patients were analyzed (77% women, 92% papillary carcinomas). 1183 of them received RAI ablation (83.4%). The mean initial activity of I131 was 101.3 mCi. The mean accumulated activity was 148.7 mCi, only 21.7% of the patients received more than one RAI ablation therapy. Before 2010, RAI was used in 565 of 639 patients (88.4%). Between 2010 and 2015, 618 of the 779 patients diagnosed with DTC received RAI ablation therapy (79.3%, P<0.01). 81.1% of patients in the Low Risk category received I131 before 2010 and after this year only 66.5% were submitted to RAI (P<0.01). In Intermediate and High risk patients there were no differences in RAI therapy (99.0% vs 97.8% and 98.3% vs 90.7%, respectively) between the two periods. In microcarcinomas I131 was used in 65.9% before 2010 and in 46.7% after (P<0.01). Mean initial activity in low risk patients was significantly different before and after 2010 (99.3 vs 68.9 mCi, P<0.01). The recurrence rate of microcarcinomas and low-risk DTC was less than 1.5% in patients without RAI therapy in this Spanish Cohort.
Conclusion: There is a trend in using less RAI ablation in low-risk DTC after the 2009 ATA guidelines. In our cohort the prognosis of microcarcinoma and low-risk DTC was excellent in patients treated and not treated with RAI ablation therapy. We recommend risk-based selection of patients candidates for RAI, according to international guidelines.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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