LET TER T O TH E E D I TOR - RES P ONS E Response to Letter to the Editor: “Decreasing Use of Radioactive Iodine for Low-Risk Thyroid Cancer in California, 1999 to 2015” Masha Livhits Section of Endocrine Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095 y colleagues and I thank Dr. Wu and Dr. Guan for of RAI in individual cases. Given the clear trend in de- Mtheir interest in our work. Their letter focuses on creasing RAI for localized tumors ,2 cm following the our conclusion that many patients with low-risk differ- 2009 American Thyroid Association guidelines, we entiated thyroid cancers between 2 and 4 cm in size still would expect a similar trend in localized tumors between underwent potentially unnecessary radioactive iodine 2 and 4 cm. We believe that although some localized ablation (RAI). Dr. Wu and Dr. Guan correctly point out tumors between 2 and 4 cm may have warranted RAI on that some localized tumors between 2 and 4 cm in size the basis of other higher risk features, many of those may be higher risk on the basis of incomplete resection, patients potentially received unnecessary RAI. We local invasion, or more aggressive histologic subtypes. highlight this finding as an opportunity for further The California Cancer Registry defines localized tumors analysis and improvement in patient care. as those confined to the thyroid, without extrathyroidal We also agree with Dr. Wu and Dr. Guan that mo- extension or nodal metastasis. However, more granular lecular testing will be increasingly important in both data regarding the completeness of resection and detailed prognostication and treatment decisions for thyroid histopathology are not available in the database. cancer in the future. These data are not recorded in the There are certainly patients with localized tumors California Cancer Registry but should certainly be in- between 2 and 4 cm who would likely benefit from RAI cluded in future studies when available. ablation based on individual clinical factors and tumor histopathology. Our analysis of a state-wide cancer Acknowledgments registry evaluated real-world clinical practice trends on a population level. The limitations of such a database are Disclosure Summary: The author has nothing to the lack of granularity to determine the appropriateness disclose. ISSN Print 0021-972X ISSN Online 1945-7197 Abbreviation: RAI, radioactive iodine ablation. Printed in USA Copyright © 2018 Endocrine Society Received 27 February 2018. Accepted 7 March 2018. First Published Online 14 March 2018 doi: 10.1210/jc.2018-00476 J Clin Endocrinol Metab, May 2018, 103(5):2073 https://academic.oup.com/jcem 2073 Downloaded from https://academic.oup.com/jcem/article-abstract/103/5/2073/4935082 by Ed 'DeepDyve' Gillespie user on 20 June 2018
Journal of Clinical Endocrinology and Metabolism – Oxford University Press
Published: Mar 14, 2018
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