Outcomes of surgery and radioiodine treatment for neck recurrence in papillary thyroid cancer.

PURPOSE: Persistent/recurrent disease in the neck is frequent in patients with papillary thyroid cancer (PTC). The goal of this study was to evaluate the efficacy of the reoperation and radioiodine (RAI) treatment for persistent/recurrent disease after the initial treatment. METHODS: A total of 30 patients (13 M/17 F) with PTC were enrolled in this study. All had been submitted to total thyroidectomy for PTC and subsequently to reoperation for local persistent/recurrent disease. All had received RAI, before and/or after reoperation. The mean age at initial thyroidectomy and cancer diagnosis was 41.4±15.2 years. Initial T status was T1 in 22 cases (73.3%), T2 in 4 cases (13.3%) and T3 in 4 cases (13.3%). Initial N status was N0 in 2 cases (6.6%), N1 in 15 cases (50%) and Nx in 13 cases (43.3%). RESULTS: Reoperation reduced the mean stimulated thyroglobulin (stimTg) serum concentration from 76.1±165.5 ng/mL to 20.1±28.8 ng/mL, p=0.002. The RAI treatment provided to 19 patients after reoperation reduced further the stimTg values from 28.6±32.4 ng/mL after reoperation, to 11.3±20.4 ng/mL, p=0.003. According to the dynamic risk stratification after the reoperation 7 patients (23.3%) had excellent response, 4 (13.3%) had biochemically incomplete response, 9 (30.0%) had indeterminate response and 10 (33.3%) had still structural incomplete response. CONCLUSION: Surgery for local persistent/recurrent disease in papillary thyroid carcinoma reduces tumor burden, improves the biochemical and structural disease. Administration of therapeutic RAI after lymph node resections appears to further improve biochemical disease.