Skip to main content

Advertisement

SpringerLink
Log in

Propensity score matching analysis of adjuvant external-beam radiotherapy for the treatment of papillary thyroid carcinoma with other organ invasions

  • Original Paper
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

The role of adjuvant external-beam radiotherapy (EBRT) in the treatment of locally advanced papillary thyroid carcinoma (PTC) remains controversial due to the lack of prospective data and the conflicting retrospective data. This study aimed to determine the benefits of adjuvant EBRT in patients with PTC and other organ invasions using propensity score matching to reduce the heterogeneity of the patient population.

Methods

Data from patients with PTC with other organ invasions but no distant metastases who underwent surgery and adjuvant radioactive iodine (RAI) alone (Non-EBRT group) or adjuvant EBRT plus RAI (EBRT group) were retrospectively reviewed. Propensity matching was used to reduce heterogeneity. Survival outcomes and toxicities associated with EBRT were evaluated.

Results

Between January 2005 and December 2019, 102 patients in the Non-EBRT group and 26 patients in the EBRT group were evaluated. In the 48 propensity score-matched patients, no significant differences in baseline characteristics between the Non-EBRT and EBRT groups were detected. The locoregional recurrence-free survival (LRRFS) and recurrence-free survival (RFS) rates were significantly higher in the EBRT group compared with the rates in the Non-EBRT group (5y-LRRFS: 100% vs. 74%, p = 0.003, 5y-RFS: 91% vs. 74%, p = 0.035). EBRT was well-tolerated, with no grade ≥ 3 toxicity, and all patients completed the therapy as planned.

Conclusion

Adjuvant EBRT plus RAI exhibited acceptable toxicity and improved LRRFS and RFS in patients with PTC with other organ invasions compared with RAI alone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ATA:

American Thyroid Association

CI:

confidence interval

CT:

computed tomography

DSS:

disease-specific survival

DTC:

differentiated thyroid carcinoma

EBRT:

external-beam radiotherapy

ECE:

extra-capsular extension

HR:

hazard ratio

LRRFS:

locoregional recurrence-free survival

OS:

overall survival

PTC:

papillary thyroid carcinoma

QOL:

quality of life

RAI:

radioactive iodine

RFS:

recurrence-free survival

Tg:

thyroglobulin

TSH:

thyroid-stimulating hormone

References

  1. G. Pellegriti, F. Frasca, C. Regalbuto, S. Squatrito, R. Vigneri, Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J. Cancer Epidemiol. 2013, 965212 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  2. M. Hori, T. Matsuda, A. Shibata, K. Katanoda, T. Sobue, H. Nishimoto, Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J. Clin. Oncol. 45, 884–891 (2015)

    Article  PubMed  Google Scholar 

  3. B.R. Haugen, E.K. Alexander, K.C. Bible, G.M. Doherty, S.J. Mandel, Y.E. Nikiforov, F. Pacini, G.W. Randolph, A.M. Sawka, M. Schlumberger, K.G. Schuff, S.I. Sherman, J.A. Sosa, D.L. Steward, R.M. Tuttle, L. Wartofsky, 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid.: Off. J. Am. Thyroid. Assoc. 26, 1–133 (2016)

    Article  Google Scholar 

  4. M.L. Shindo, S.M. Caruana, E. Kandil, J.C. McCaffrey, L.A. Orloff, J.R. Porterfield, A. Shaha, J. Shin, D. Terris, G. Randolph, Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head. Neck 36, 1379–1390 (2014)

    PubMed  Google Scholar 

  5. S.M. Chow, S. Yau, C.K. Kwan, P.C. Poon, S.C. Law, Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th edition. Endocr. Relat. Cancer 13, 1159–1172 (2006)

    Article  PubMed  Google Scholar 

  6. J. Brierley, R. Tsang, T. Panzarella, N. Bana, Prognostic factors and the effect of treatment with radioactive iodine and external beam radiation on patients with differentiated thyroid cancer seen at a single institution over 40 years. Clin. Endocrinol. 63, 418–427 (2005)

    Article  CAS  Google Scholar 

  7. K.C. Keum, Y.G. Suh, W.S. Koom, J.H. Cho, S.J. Shim, C.G. Lee, C.S. Park, W.Y. Chung, G.E. Kim, The role of postoperative external-beam radiotherapy in the management of patients with papillary thyroid cancer invading the trachea. Int. J. Radiat. Oncol., Biol., Phys. 65, 474–480 (2006)

    Article  PubMed  Google Scholar 

  8. N.K. Lee, C.Y. Kim, S.K. Baek, K.Y. Jung, The role of adjuvant radiation therapy for locoregionally advanced papillary thyroid carcinoma. Oncology 90, 209–214 (2016)

    Article  CAS  PubMed  Google Scholar 

  9. Y.S. Kim, J.H. Choi, K.S. Kim, G.C. Lim, J.H. Kim, J.W. Kang, H.S. Song, S.A. Lee, C.L. Hyun, Y. Choi, G.E. Kim, The role of adjuvant external beam radiation therapy for papillary thyroid carcinoma invading the trachea. Radiat. Oncol. J. 35, 112–120 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  10. S. Tam, M. Amit, M. Boonsripitayanon, M.E. Cabanillas, N.L. Busaidy, G.B. Gunn, S.Y. Lai, N.D. Gross, E.M. Sturgis, M.E. Zafereo, Adjuvant external beam radiotherapy in locally advanced differentiated thyroid cancer. JAMA Otolaryngol. Head. Neck Surg. 143, 1244–1251 (2017)

    Article  PubMed  PubMed Central  Google Scholar 

  11. M. Biermann, M. Pixberg, B. Riemann, A. Schuck, A. Heinecke, K.W. Schmid, N. Willich, H. Dralle, O. Schober, Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer - results after 874 patient-years of follow-up in the MSDS-trial. Nuklearmedizin. Nucl. Med. 48, 89–98 (2009).

    Google Scholar 

  12. E.K. Lee, Y.J. Lee, Y.S. Jung, J. Ryu, T.H. Kim, C.Y. Lee, C.H. Ryu, T.S. Kim, S.K. Kim, K.W. Chung, S.S. Kim, D.Y. Kim, J.Y. Kim, K.H. Cho, 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, 1009–1017 (2015)

    Article  CAS  PubMed  Google Scholar 

  13. P.V. Chen, R. Osborne, E. Ahn, S. Avitia, G. Juillard, Adjuvant external-beam radiotherapy in patients with high-risk well-differentiated thyroid cancer. Ear Nose Throat J. 88, E01 (2009)

    PubMed  Google Scholar 

  14. J. Brierley, M.K. Gospodarowicz, C. Wittekind, TNM classification of malignant tumours. Eighth edition. ed. John Wiley & Sons, Inc., Chichester, West Sussex, UK; Hoboken, NJ (2017)

  15. Y. Ito, N. Onoda, T. Okamoto, The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr. J. 67, 669–717 (2020)

    Article  PubMed  Google Scholar 

  16. National Cancer Institute: Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf.

  17. P.C. Austin, An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar. Behav. Res. 46, 399–424 (2011)

    Article  Google Scholar 

  18. T. Kawamoto, N. Shikama, T. Fukumori, M. Hoshi, T. Yamada, Long-term clinical outcomes and prognostic factors for patients with papillary thyroid carcinoma with other organ invasions after adjuvant radioactive iodine. Endocrine https://doi.org/10.1007/s12020-022-03251-0 (2022)

  19. Y. Kanda, Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 48, 452–458 (2013)

    Article  CAS  Google Scholar 

  20. A.P. Kiess, N. Agrawal, J.D. Brierley, U. Duvvuri, R.L. Ferris, E. Genden, R.J. Wong, R.M. Tuttle, N.Y. Lee, G.W. Randolph, External-beam radiotherapy for differentiated thyroid cancer locoregional control: a statement of the American Head and Neck Society. Head. Neck 38, 493–498 (2016)

    Article  PubMed  Google Scholar 

  21. W.M. McConahey, I.D. Hay, L.B. Woolner, J.A. van Heerden, W.F. Taylor, Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970: initial manifestations, pathologic findings, therapy, and outcome. Mayo Clin. Proc. 61, 978–996 (1986)

    Article  CAS  PubMed  Google Scholar 

  22. M. Schlumberger, M. Tahara, L.J. Wirth, B. Robinson, M.S. Brose, R. Elisei, M.A. Habra, K. Newbold, M.H. Shah, A.O. Hoff, A.G. Gianoukakis, N. Kiyota, M.H. Taylor, S.B. Kim, M.K. Krzyzanowska, C.E. Dutcus, B.de las Heras, J.Zhu, S.I.Sherman, Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. N. Engl. J. Med. 372, 621–630 (2015).

    Article  PubMed  Google Scholar 

  23. M. Tahara, N. Kiyota, A.O. Hoff, C. Badiu, T.K. Owonikoko, C.E. Dutcus, T. Suzuki, M. Ren, L.J. Wirth, Impact of lung metastases on overall survival in the phase 3 SELECT study of lenvatinib in patients with radioiodine-refractory differentiated thyroid cancer. Eur. J. Cancer 147, 51–57 (2021)

    Article  CAS  PubMed  Google Scholar 

  24. L. Lamartina, S. Ippolito, M. Danis, F. Bidault, I. Borget, A. Berdelou, A. Al Ghuzlan, D. Hartl, P. Blanchard, M. Terroir, D. Deandreis, M. Schlumberger, E. Baudin, S. Leboulleux, Antiangiogenic tyrosine kinase inhibitors: occurrence and risk factors of hemoptysis in refractory thyroid cancer. J. Clin. Endocrinol. Metab. 101, 2733–2741 (2016)

    Article  CAS  PubMed  Google Scholar 

  25. C. Hedman, T. Djärv, P. Strang, C.I. Lundgren, Determinants of long-term quality of life in patients with differentiated thyroid carcinoma—a population-based cohort study in Sweden. Acta Oncol. 55, 365–369 (2016)

    Article  PubMed  Google Scholar 

  26. N. Otsuki, H. Shimoda, N. Morita, T. Furukawa, M. Teshima, H. Shinomiya, K.I. Nibu, Salvage surgery for structural local recurrence of papillary thyroid cancer: recurrence patterns and surgical outcome. Endocr. J. 67, 949–956 (2020)

    Article  PubMed  Google Scholar 

  27. H.C. Grillo, H.C. Suen, D.J. Mathisen, J.C. Wain, Resectional management of thyroid carcinoma invading the airway. Ann. Thorac. Surg. 54, 3–9 (1992).

    Article  CAS  PubMed  Google Scholar 

  28. H.S. Lee, J.L. Roh, G. Gong, K.J. Cho, S.H. Choi, S.Y. Nam, S.Y. Kim, Risk factors for re-recurrence after first reoperative surgery for locoregional recurrent/persistent papillary thyroid carcinoma. World J. Surg. 39, 1943–1950 (2015)

    Article  PubMed  Google Scholar 

  29. D.L. Schwartz, M.J. Lobo, K.K. Ang, W.H. Morrison, D.I. Rosenthal, A. Ahamad, D.B. Evans, G. Clayman, S.I. Sherman, A.S. Garden, Postoperative external beam radiotherapy for differentiated thyroid cancer: outcomes and morbidity with conformal treatment. Int. J. Radiat. Oncol., Biol., Phys. 74, 1083–1091 (2009)

    Article  PubMed  Google Scholar 

  30. P.B. Romesser, E.J. Sherman, K. Whiting, M.L. Ho, A.R. Shaha, M.M. Sabra, N. Riaz, T.E. Waldenberg, C.R. Sabol, I. Ganly, S.M. McBride, J.A. Fagin, Z. Zhang, R.M. Tuttle, R.J. Wong, N.Y. Lee, Intensity-modulated radiation therapy and doxorubicin in thyroid cancer: a prospective phase 2 trial. Cancer 127, 4161–4170 (2021)

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Tokyo, Japan

    Terufumi Kawamoto & Naoto Shikama

  2. Department of Radiology, Kanaji Thyroid Hospital, Tokyo, Japan

    Terufumi Kawamoto

  3. Department of Surgery, Kanaji Thyroid Hospital, Tokyo, Japan

    Tatsuya Fukumori, Masae Hoshi & Tetsu Yamada

Authors
  1. Terufumi Kawamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoto Shikama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tatsuya Fukumori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masae Hoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsu Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T.K. prepared the manuscript and conducted the literature search; T.K. reviewed and edited the manuscript; and T.K., N.S., T.F., M.H., and T.Y. reviewed the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Terufumi Kawamoto.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval

All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients before participating in the study. The study protocol was approved by the participating centers’ institutional review boards.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawamoto, T., Shikama, N., Fukumori, T. et al. Propensity score matching analysis of adjuvant external-beam radiotherapy for the treatment of papillary thyroid carcinoma with other organ invasions. Endocrine 80, 589–599 (2023). https://doi.org/10.1007/s12020-023-03300-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-023-03300-2

Keywords

Search

Navigation