Is adjuvant therapy useful in patients with papillary carcinoma smaller than 2 cm?

ABSTRACT

To evaluate tumor recurrence after total thyroidectomy in patients with single papillary carcinoma with size thyroid, we studied 136 consecutive patients divided into two groups according to postoperative management no ablative therapy (n = 42) (group 1) and ablation with 1.1 GBq (n = 36) or 3.7 GBq (131)I (n = 58) (group 2). None of the patients were submitted to central-compartment (VI level) neck dissection. Thyroid-stimulating hormone (TSH) levels were > 0.5 mIU/L in >or=50% of the measurements in all patients. Complete remission (stimulated thyroglobulin (Tg) antibodies (TgAb), and negative imaging methods) was observed in 83% of the patients in group 1 and in 89% in group 2 (p = 0.4), and none of the patients presented apparent disease during follow-up (mean 6 years). Posttherapy whole-body scanning was available in 74 patients, and none of them showed ectopic uptake. TgAb were still present in 7.1% of the patients in group 1 and in 8.5% in group 2 (p > 0.05). Six patients who still had stimulated Tg > 1 ng/mL (<5 ng/mL) showed a >50% decrease in comparison with Tg measured 12-24 months earlier. In conclusion, we suggest a more conservative approach with respect to central-compartment neck dissection, postoperative (131)I, and suppressive therapy in patients with small tumors restricted to the thyroid.