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Meta-Analysis
. 2021 Dec;48(13):4437-4444.
doi: 10.1007/s00259-021-05440-x. Epub 2021 Jun 18.

Ablation rate after radioactive iodine therapy in patients with differentiated thyroid cancer at intermediate or high risk of recurrence: a systematic review and a meta-analysis

Michele Klain  1 , Carmela Nappi  1 , Emilia Zampella  1 , Valeria Cantoni  1 , Roberta Green  1 , Leandra Piscopo  1 , Fabio Volpe  1 , Mariarosaria Manganelli  1 , Elisa Caiazzo  1 , Mario Petretta  2 , Martin Schlumberger  1 , Alberto Cuocolo  3
Affiliations
Meta-Analysis

Ablation rate after radioactive iodine therapy in patients with differentiated thyroid cancer at intermediate or high risk of recurrence: a systematic review and a meta-analysis

Michele Klain et al. Eur J Nucl Med Mol Imaging. 2021 Dec.

Abstract

Purpose: We performed a systematic review and a meta-analysis to investigate the successful ablation rate after radioiodine (RAI) administration in patients with differentiated thyroid cancer (DTC) at intermediate-high risk of recurrence.

Methods: A comprehensive literature search of the PubMed, Scopus, and Web of Science databases was conducted according to the PRISMA statement.

Results: The final analysis included 9 studies accounting for 3103 patients at intermediate-high risk of recurrence. In these patients, the successful ablation rates ranged from 51 to 94% with a 71% pooled successful ablation and were higher in intermediate (72%) than in high (52%)-risk patients. Despite the rigorous inclusion standards, a significant heterogeneity among the evaluated studies was observed. Higher administered RAI activities are associated with a lower successful ablation rate in the whole population and in the subgroup of high-risk patients. Furthermore, pooled recurrence rate in intermediate-risk patients achieving successful ablation was only 2% during the subsequent 6.4-year follow-up while the pooled recurrence rate was 14% in patients who did not achieve a successful ablation.

Conclusion: In a large sample of 3103 patients at intermediate-high risk of persistent/recurrent disease, 71% of patients achieved a successful ablation. In these intermediate-risk patients, the probability of subsequent recurrence is low and most recurrence occurred in those with already abnormal findings at the first control.

Keywords: 131I; Differentiated thyroid cancer; High risk; Intermediate risk; Meta-analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart illustrating the study selection process
Fig. 2
Fig. 2
Methodological quality of the included studies assessed with JBI tool for risk of bias and applicability concerns. The green circle represents low risk of bias, the yellow circle unclear risk of bias, and the red circle high risk of bias
Fig. 3
Fig. 3
Forest plot for the successful ablation rate after RAI therapy. Horizontal lines represent 95% confidence interval of the point estimates. The diamond represents the pooled estimate (size of the diamond = 95% confidence interval). The solid vertical line represents the reference of no increased risk and the dashed vertical line represents the overall point estimate
Fig. 4
Fig. 4
Forest plot for the persistent/recurrent disease rate at late follow-up in patients who achieved SA. Horizontal lines represent 95% confidence interval of the point estimates. The diamond represents the pooled estimate (size of the diamond = 95% confidence interval). The solid vertical line represents the reference of no increased risk and the dashed vertical line represents the overall point estimate
See this image and copyright information in PMC

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