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Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer.
Thyroid. 2015 Apr; 25(4):377-85.T

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.

CONCLUSION

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+Show Affiliations

1 Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

25578116

Citation

Sacks, Wendy, et al. "Use of Evidence-based Guidelines Reduces Radioactive Iodine Treatment in Patients With Low-risk Differentiated Thyroid Cancer." Thyroid : Official Journal of the American Thyroid Association, vol. 25, no. 4, 2015, pp. 377-85.
Sacks W, Wong RM, Bresee C, et al. Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid. 2015;25(4):377-85.
Sacks, W., Wong, R. M., Bresee, C., & Braunstein, G. D. (2015). Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid : Official Journal of the American Thyroid Association, 25(4), 377-85. https://doi.org/10.1089/thy.2014.0298
Sacks W, et al. Use of Evidence-based Guidelines Reduces Radioactive Iodine Treatment in Patients With Low-risk Differentiated Thyroid Cancer. Thyroid. 2015;25(4):377-85. PubMed PMID: 25578116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. AU - Sacks,Wendy, AU - Wong,Ronnie Meiyi, AU - Bresee,Catherine, AU - Braunstein,Glenn D, Y1 - 2015/02/06/ PY - 2015/1/13/entrez PY - 2015/1/13/pubmed PY - 2016/1/5/medline SP - 377 EP - 85 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 25 IS - 4 N2 - 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. CONCLUSION: 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. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/25578116/Use_of_evidence_based_guidelines_reduces_radioactive_iodine_treatment_in_patients_with_low_risk_differentiated_thyroid_cancer_ L2 - https://www.liebertpub.com/doi/10.1089/thy.2014.0298?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -