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Second Primary Malignancy After Radioiodine Therapy in Thyroid Cancer Patient: A Nationwide Study

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Abstract

Objective

This study aimed to investigate the risk of second primary malignancy after radioiodine (RAI) therapy in patients with thyroid cancer, using the National Health Insurance Service (NHIS) database.

Methods

We extracted data from the NHIS database of South Korea, which covers the entire population of the nation. Risk of second primary malignancy in the thyroid cancer patients who received RAI therapy were compared with the thyroid cancer patients who received surgery only.

Results

Between January 1, 2004, and December 31, 2018, we identified 363,155 patients who underwent thyroid surgery due to thyroid cancer for analysis. The surgery only cohort was 215,481, and the RAI cohort was 147,674 patients. A total of 19,385 patients developed second primary malignancy (solid cancer, 18,285; hematologic cancer, 1,100). There was no significant increase in the risk of second primary malignancy in patients who received a total cumulative dose of 100 mCi or less (hazard ratio [HR], 1.013; 95% confidence interval [CI], 0.979–1.049). However, a statistically significant increase in the risk of second primary malignancy was observed in patients who received 101–200 mCi (HR, 1.214; 95% CI, 1.167–1.264), 201–300 mCi (HR, 1.422; 95% CI, 1.258–1.607), and > 300 mCi (HR, 1.693; 95% CI, 1.545–1.854).

Conclusion

Total cumulative doses of 100 mCi or less of RAI can be safely administered without concerns about second primary malignancy. However, the risk of second primary malignancy increases in a dose-dependent manner, and the risk–benefit needs to be considered for doses over 100 mCi of RAI therapy.

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Data Availability

The data that support the findings of this study are available from the corresponding author (J.L.) upon reasonable request.

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Acknowledgements

This study was performed based on memorandum of understanding (MOU) between Korean Thyroid Association and National Health Insurance Service.

Funding

Korean Thyroid Association supported this study.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, 41944, Daegu, Republic of Korea

    Chae Moon Hong & Jaetae Lee

  2. Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea

    Chae Moon Hong, Junik Son & Jaetae Lee

  3. Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea

    Min Kyung Hyun & Jang Won Lee

Authors
  1. Chae Moon Hong
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  2. Junik Son
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Contributions

J Lee and CM Hong participated in the study design, drafting of the manuscript, and data acquisition and analysis. MK Hyun and JW Lee participated in data acquisition and data analysis. J Son participated in data analysis, manuscript revision, and approval of the final content of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jaetae Lee.

Ethics declarations

Ethics Approval and Consent to Participate

The institutional review board of Kyungpook National University Hospital approved this retrospective study with waiver of the need for informed consent (KNUH 2019–06-030–011). And this study was conducted in accordance with the Declaration of Helsinki.

Consent for Publication

The institutional review board at our institution approved this retrospective study, and the requirement to obtain informed consent was waived.

Conflict of Interest

Chae Moon Hong, Junik Son, Min Kyung Hyun, Jang Won Lee, and Jaetae Lee declare that they have no conflict of interest.

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Hong, C.M., Son, J., Hyun, M.K. et al. Second Primary Malignancy After Radioiodine Therapy in Thyroid Cancer Patient: A Nationwide Study. Nucl Med Mol Imaging 57, 275–286 (2023). https://doi.org/10.1007/s13139-023-00818-1

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  • DOI: https://doi.org/10.1007/s13139-023-00818-1

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