From the Research
Adjuvant radiotherapy has a limited role in the management of papillary thyroid carcinoma (PTC), and its use should be reserved for specific high-risk situations, such as gross residual disease that cannot be surgically removed and is not responsive to radioactive iodine (RAI) therapy, locally advanced disease with invasion into surrounding structures, or recurrent disease that is not amenable to surgery or RAI therapy. For most patients with PTC, surgery (total thyroidectomy or lobectomy) followed by RAI ablation is the standard treatment approach. The limited use of adjuvant radiotherapy in PTC is based on the generally excellent prognosis of this cancer with standard treatment and the potential for radiation to cause significant acute and late toxicities. Additionally, the presence of microscopic disease is usually well-addressed by RAI, making external beam radiation therapy (EBRT) unnecessary in most cases.
Some key points to consider in the management of PTC include:
- The role of RAI therapy in reducing the risk of recurrence and improving overall survival, particularly in intermediate-risk and high-risk patients 1, 2
- The importance of individualizing treatment decisions based on the patient's specific disease characteristics, risk factors, and overall health status
- The potential benefits and risks of EBRT, including its effectiveness in improving local control in patients with gross postoperative residual disease, but also its potential to cause significant side effects 3
- The need for a multidisciplinary team approach to treatment decisions, involving endocrinologists, surgeons, radiation oncologists, and other specialists as needed.
In terms of specific treatment recommendations, the use of high-dose RAI therapy (median 150 mCi) is associated with a lower risk of recurrence compared to intermediate-dose RAI therapy (median 100 mCi) in high-risk patients 2. Additionally, EBRT should be considered for patients with gross residual disease that cannot be surgically removed and is not responsive to RAI therapy, with a typical radiation dose ranging from 60-70 Gy delivered over 6-7 weeks. However, treatment decisions should always be individualized and based on the latest available evidence, including the results of studies such as those published in 1, 2, and 3.