Controversies in primary treatment of low-risk papillary thyroid cancer

• Published in: The Lancet (British edition) 2013-03, Vol.381 (9871), p.1046-1057
• Main Authors: McLeod, Donald SA, FRACP, Sawka, Anna M, MD, Cooper, David S, Prof
• Format: Article
• Language: English
• Subjects: Age; Biological and medical sciences; blood serum; Cancer therapies; Carcinoma - diagnosis; Carcinoma - therapy; Carcinoma, Papillary; Clinical medicine; Contraindications; disease control; disease incidence; Endocrinopathies; Epidemiology; Fathers; Female; General aspects; guidelines; Health risks; Histology; Humans; Internal Medicine; Iodine radioisotopes; Iodine Radioisotopes - therapeutic use; L-thyroxine; Lymph Node Excision - methods; Lymphatic Metastasis; Male; Malignant tumors; Medical sciences; Mortality; Multivariate analysis; neck; Non tumoral diseases. Target tissue resistance. Benign neoplasms; patients; Pregnancy; Pregnancy Complications - chemically induced; Pregnancy Complications - prevention & control; professional societies; Radiation; Radiation Protection; Radiopharmaceuticals - therapeutic use; randomized clinical trials; relapse; risk; Risk Assessment; Risk Factors; Studies; Surgery; Surgical outcomes; Thyroid; Thyroid cancer; Thyroid Cancer, Papillary; Thyroid gland; thyroid neoplasms; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - therapy; Thyroid. Thyroid axis (diseases); Thyroidectomy - methods; thyrotropin; Thyrotropin - antagonists & inhibitors; Tumors
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(12)62205-3

In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.