Hung ML, et al. - Whether or not receipt of radioactive iodine (RAI) after reoperation for recurrent papillary thyroid cancer (PTC) is associated with improved outcomes was investigated. Patients received RAI after reoperation and patients who underwent reoperation alone had similar outcomes. No significant clinical benefit was gained in relation to RAI after reoperation in this limited series.

Methods

• Researchers performed a retrospective cohort study including electronic health record data from 102 patients who underwent neck reoperation for persistent or recurrent PTC at a tertiary referral center from April 2006 to January 2016.
• In this study, 50 patients received RAI after reoperation and 52 patients underwent reoperation alone.
• From September 1, 2017 to December 1, 2017, they performed data analysis.
• Patients who underwent reoperation and received RAI and patients who underwent reoperation alone were compared regarding suppressed thyroglobulin (Tg) levels at the following time points: before reoperation (Tg0), after reoperation (Tg1), and after RAI or a comparable time interval among patients whose cases were managed without RAI (Tg2).
• Biochemical response and structural recurrence after reoperation were the outcomes assessed.

Results

• Neck reoperation for persistent or recurrent PTC was performed on 102 patients (median age, 44 years [interquartile range, 33-54 years; SD, 14 years]; 67 [66%] female), 50 of whom received treatment with RAI after reoperation.
• The reoperation with RAI group and the reoperation without RAI group were similar in terms of clinicopathologic characteristics of the patients at the time of the initial surgical procedure except for tumor (T) stage (T3 and T4, 28 of 50 [56%] vs 19 of 52 [37%]).
• The reoperation with RAI group and the reoperation without RAI group were similar regarding median Tg levels (Tg0, 3.3 ng/mL vs 2.4 ng/mL; Tg1, 0.6 ng/mL vs 0.2 ng/mL; and Tg2, 0.5 ng/mL vs 0.2 ng/mL; all differences were nonsignificant), but the reoperation with RAI group displayed lower rate of excellent response at Tg1 (4 of 33 [12%] vs 24 of 51 [47%];P=.007).
• The reoperation with RAI group and the reoperation without RAI group had structural recurrence after reoperation in 18 of 50 patients (36%) and 10 of 52 patients (19%), respectively.
• As per multivariable analysis accounting for clinicopathologic characteristics and Tg0, no association of receipt of RAI after reoperation with the rate of a second structural recurrence was evident.
• Subset analyses limiting to patients with incomplete response to reoperation and patients with T3 or T4 tumors showed no correlation between receipt of RAI and the risk of a second recurrence.