Second primary malignancies induced by radioactive iodine treatment of differentiated thyroid carcinoma - a critical review and evaluation of the existing evidence.
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ICR Authors
Authors
Reinecke, MJ
Ahlers, G
Burchert, A
Eilsberger, F
Flux, GD
Marlowe, RJ
Mueller, H-H
Reiners, C
Rohde, F
van Santen, HM
Luster, M
Ahlers, G
Burchert, A
Eilsberger, F
Flux, GD
Marlowe, RJ
Mueller, H-H
Reiners, C
Rohde, F
van Santen, HM
Luster, M
Document Type
Journal Article
Date
2022-03-23
Date Accepted
2022-03-11
Abstract
PURPOSE: Concern is growing about long-term side effects of differentiated thyroid cancer treatment, most notably radioactive iodine (RAI) therapy. However, published studies on the subject have had heterogeneous cohorts and conflicting results. This review seeks to provide an updated evaluation of published evidence, and to elucidate the risk of second primary malignancies (SPMs), especially secondary hematologic malignancies (SHMs), attributable to RAI therapy. METHODS: An extensive literature search was performed in Ovid MEDLINE, Ovid MEDLINE and In-Process & Other Non-Indexed Citations, Ovid MEDLINE Epub Ahead of Print, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. Studies regarding RAI-induced SPMs or a dose-response relationship between RAI therapy and SPMs were identified, 10 of which were eligible for the analysis. We evaluated risk of bias in each study and judged quality of evidence (QOE) across all studies using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS: For the outcome "SPM", the relative effect (relative risk, hazard ratio, or odds ratio) of RAI vs. no RAI ranged from 1.14 to 1.84 across studies, but most results were not statistically significant. For the outcome "SHM", reported relative effects ranged from 1.30 to 2.50, with 2/3 of the studies presenting statistically significant results. In 7/8 of the studies, increased risk for SPM was shown with increasing cumulative RAI activity. QOE was "very low" regarding SPM after RAI and regarding a dose-response relationship, and "low" for SHM after RAI. CONCLUSION: Based on low quality evidence, an excess risk for the development of SPM cannot be excluded but is expected to be small.
Citation
European Journal of Nuclear Medicine and Molecular Imaging, 2022, 49 (9), pp. 3247 - 3256
Source Title
European Journal of Nuclear Medicine and Molecular Imaging
Publisher
SPRINGER
ISSN
1619-7070
eISSN
1619-7089
1619-7089
1619-7089
Collections
Research Team
Radioisotope Physics