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Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma.
Thyroid. 2017 07; 27(7):944-952.T

Abstract

BACKGROUND

There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery.

METHODS

In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors.

RESULTS

The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HRPTC Stage IV-A = 2.12 [confidence interval (CI) 1.79-2.52]; HRPTC Stage IV-B = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TRPTC Stage IV-B = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HRFTC Stage IV-C = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TRFTC Stage IV-C = 1.98 [CI 1.31-3.00]).

CONCLUSIONS

Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC.

Authors+Show Affiliations

1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana.2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.3 Department of Radiation Oncology, Willis-Knighton Cancer Center , Shreveport, Louisiana.1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana.1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28446057

Citation

Yang, Zao, et al. "Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma." Thyroid : Official Journal of the American Thyroid Association, vol. 27, no. 7, 2017, pp. 944-952.
Yang Z, Flores J, Katz S, et al. Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. Thyroid. 2017;27(7):944-952.
Yang, Z., Flores, J., Katz, S., Nathan, C. A., & Mehta, V. (2017). Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. Thyroid : Official Journal of the American Thyroid Association, 27(7), 944-952. https://doi.org/10.1089/thy.2016.0650
Yang Z, et al. Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. Thyroid. 2017;27(7):944-952. PubMed PMID: 28446057.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. AU - Yang,Zao, AU - Flores,Jose, AU - Katz,Sanford, AU - Nathan,Cherie-Ann, AU - Mehta,Vikas, Y1 - 2017/05/17/ PY - 2017/4/28/pubmed PY - 2018/4/24/medline PY - 2017/4/28/entrez KW - differentiated thyroid carcinoma KW - external beam radiation therapy KW - follicular thyroid carcinoma KW - papillary thyroid carcinoma KW - radioactive iodine KW - stage IV SP - 944 EP - 952 JF - Thyroid : official journal of the American Thyroid Association JO - Thyroid VL - 27 IS - 7 N2 - BACKGROUND: There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery. METHODS: In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors. RESULTS: The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HRPTC Stage IV-A = 2.12 [confidence interval (CI) 1.79-2.52]; HRPTC Stage IV-B = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TRPTC Stage IV-B = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HRFTC Stage IV-C = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TRFTC Stage IV-C = 1.98 [CI 1.31-3.00]). CONCLUSIONS: Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC. SN - 1557-9077 UR - https://www.unboundmedicine.com/medline/citation/28446057/Comparison_of_Survival_Outcomes_Following_Postsurgical_Radioactive_Iodine_Versus_External_Beam_Radiation_in_Stage_IV_Differentiated_Thyroid_Carcinoma_ L2 - https://www.liebertpub.com/doi/full/10.1089/thy.2016.0650?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -