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. 2025 Jul 9.
doi: 10.1007/s40618-025-02644-y. Online ahead of print.

Role of Volumetric Modulated Arc radioTherapy (VMAT) in the adjuvant treatment of locally advanced differentiated thyroid cancer: single institution experience

Chiara Mura  1   2 , Bruno Fionda  3 , Carlo Antonio Rota  1 , Francesco Pastore  4 , Marcella Bugani  5 , Luca Zagaria  6 , Martina De Angeli  4 , Antonella Loperfido  7 , Germano Perotti  6 , Giovanni Schinzari  8 , Esther Diana Rossi  9 , Maria Antonietta Gambacorta  4 , Marco Raffaelli  10 , Luca Tagliaferri #  4 , Alfredo Pontecorvi #  1
Affiliations

Role of Volumetric Modulated Arc radioTherapy (VMAT) in the adjuvant treatment of locally advanced differentiated thyroid cancer: single institution experience

Chiara Mura et al. J Endocrinol Invest. .

Abstract

Purpose: The optimal management of locally advanced differentiated thyroid cancer (DTC) remains a topic of debate, and the adoption of adjuvant external beam radiotherapy (EBRT) is discussed. This study aimed to evaluate the efficacy of EBRT with volumetric modulated arc radiotherapy (VMAT) in improving locoregional relapse-free survival (LRFS) in addition to surgery and radioiodine therapy (RAI). Secondary objective was to assess the tolerability of EBRT with VMAT.

Methods: This monocentric, retrospective study included patients with locally advanced DTC, positive resection margins (R1) or lymph node metastases with extra-nodal extension who underwent total thyroidectomy and RAI. Patients were grouped based on whether they received adjuvant EBRT after surgery and RAI, and outcomes were compared.

Results: Overall, 25 patients were included. EBRT group comprised 10 patients and non-EBRT group 15 patients. In the EBRT group, none experienced locoregional recurrence, compared to 60% in the non-EBRT group. Comparison of the survival curves showed a statistically significant difference (p = 0.043). Additionally, no severe treatment-related adverse effects were reported, indicating good tolerability of EBRT. Distant Disease-Free Survival (DDFS) was similar between the groups.

Conclusion: Adjuvant EBRT using VMAT improves LRFS in patients with locally advanced DTC, without adding significant toxicity. Locoregional control potentially avoid repeated neck surgeries and their associated side effects. Despite some limitations, our findings support the integration of EBRT into treatment protocols for selected high-risk patients. Further studies are needed to confirm these results and to evaluate the long-term impact of EBRT on survival and quality of life.

Keywords: Differentiated thyroid cancer; Follicular; Papillary; Radiotherapy.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors have no conflicts of interest to declare that are relevant to the content of this article. Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and ethical review and approval were provided (Prot. N. 0012205/15); this retrospective study was conducted according to the principles of good clinical practice and in accordance with GDPR regulations for privacy. Informed consent: Informed consent was obtained from all subjects involved in the study.

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