Int J Thyroidol.  2024 May;17(1):111-114. 10.11106/ijt.2024.17.1.111.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 7. Adjuvant External Beam Radiotherapy and Systemic Chemotherapy Following Thyroidectomy 2024

• Moon SJ
• Kang HC
• Kim SW
• Kim WG
• Na DG
• Park YJ
• Song YS
• Lee EK
• Lim DJ
• Chung YJ
• Shin DY
• Korean Thyroid Association Guideline Committee on the Managements of Thyroid Nodule and Cancer

• KMID: 2556509
• DOI: http://doi.org/10.11106/ijt.2024.17.1.111

Abstract

Surgical resection is typically the primary treatment for differentiated thyroid cancer (DTC), followed by radioactive iodine (RAI) and thyroid-stimulating hormone suppression therapies based on the cancer stage and risk of recurrence. Nevertheless, further treatment may be necessary for patients exhibiting persistent disease following RAI therapy, residual disease refractory to RAI, or unresectable locoregional lesions. This guideline discusses the role of external beam radiotherapy and chemotherapy following surgical resection in patients with DTC. External beam radiotherapy is ineffective if DTC has been entirely excised (Grade 2). Adjuvant external beam radiotherapy may be optionally performed in patients with incomplete surgical resection or frequently recurrent disease (Grade 2). In patients at high risk of recurrence following surgery and RAI therapy, adjuvant external beam radiotherapy may be optionally considered (Grade 3). However, external beam radiotherapy may increase the risk of serious adverse events after tyrosine kinase inhibitor therapy. Therefore, careful consideration is needed when prescribing external beam radiotherapy for patients planning to undergo tyrosine kinase inhibitor therapy. There is no evidence supporting the benefits of the routine use of adjuvant chemotherapy for DTC treatment (Grade 2).

Keyword

Advanced differentiated thyroid carcinoma; External beam radiation therapy; Concurrent chemoradiation; Adjuvant chemotherapy; Korean Thyroid Association; Guideline

Reference

References

1. Haddad RI, Bischoff L, Salgado SA, Applewhite M, Bernet V, Blomain E, et al. NCCN clinical practice guidelines in oncology (NCCN Guidelines®): thyroid carcinoma. version 1.2024. cited May 8, 2024. Available from: URL: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.

2. Kiess AP, Agrawal N, Brierley JD, Duvvuri U, Ferris RL, Genden E, et al. 2016; External-beam radiotherapy for differentiated thyroid cancer locoregional control: a statement of the American Head and Neck Society. Head Neck. 38(4):493–8. DOI: 10.1002/hed.24357. PMID: 26716601. PMCID: PMC4975923.

3. Ford D, Giridharan S, McConkey C, Hartley A, Brammer C, Watkinson JC, et al. 2003; External beam radiotherapy in the management of differentiated thyroid cancer. Clin Oncol (R Coll Radiol). 15(6):337–41. DOI: 10.1016/S0936-6555(03)00162-6.

4. Terezakis SA, Lee KS, Ghossein RA, Rivera M, Tuttle RM, Wolden SL, et al. 2009; Role of external beam radiotherapy in patients with advanced or recurrent nonanaplastic thyroid cancer: Memorial Sloan-kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 73(3):795–801. DOI: 10.1016/j.ijrobp.2008.05.012. PMID: 18676097.

5. Valerio L, Giani C, Agate L, Molinaro E, Viola D, Bottici V, et al. 2021; Prevalence and risk factors of developing fistula or organ perforation in patients treated with lenvatinib for radioiodine- refractory thyroid cancer. Eur Thyroid J. 10(5):399–407. DOI: 10.1159/000514182. PMID: 34540710. PMCID: PMC8406256.

6. Blevins DP, Dadu R, Hu M, Baik C, Balachandran D, Ross W, et al. 2014; Aerodigestive fistula formation as a rare side effect of antiangiogenic tyrosine kinase inhibitor therapy for thyroid cancer. Thyroid. 24(5):918–22. DOI: 10.1089/thy.2012.0598. PMID: 24635127. PMCID: PMC4026371.

7. Ryu H, Wu HG, Lee KE, Chung EJ, Ahn SH, Park YJ, et al. 2023; Effect of postoperative radiotherapy for patients with differentiated thyroid cancer. Clin Endocrinol (Oxf). 98(6):803–12. DOI: 10.1111/cen.14865. PMID: 36535908.

8. Lee EK, Lee YJ, Jung YS, Ryu J, Kim TH, Lee CY, et al. 2015; Postoperative simultaneous integrated boost-intensity modulated radiation therapy for patients with locoregionally advanced papillary thyroid carcinoma: preliminary results of a phase II trial and propensity score analysis. J Clin Endocrinol Metab. 100(3):1009–17. DOI: 10.1210/jc.2014-3242. PMID: 25581596.

9. Romesser PB, Sherman EJ, Shaha AR, Lian M, Wong RJ, Sabra M, et al. 2014; External beam radiotherapy with or without concurrent chemotherapy in advanced or recurrent non-anaplastic non-medullary thyroid cancer. J Surg Oncol. 110(4):375–82. DOI: 10.1002/jso.23656. PMID: 24961938. PMCID: PMC10152973.

10. Tulloch-Reid M, Skarulis MC, Sherman SI, Sarlis NJ, Santarpia L. 2009; Long-term eradication of locally recurrent invasive follicular thyroid carcinoma after taxane-based concomitant chemoradiotherapy. Anticancer Res. 29(11):4665–71.