Combined radioiodine (I131) treatment and radio-guided surgery for recurrent cervical well-differentiated thyroid cancer

Local recurrence and cervical lymph node involvement are relatively common in patients with well-differentiated thyroid carcinoma. Since these patients are young and have a good prognosis, their treatment is challenging. Therapeutic doses of radioiodine (I131) are seldom curative and include a long period of discomfort - stopping the replacement therapy. Most patients will require surgery to eradicate the recurrent disease. However, when performed, excision of all involved tissue should be complete and accomplished in a single procedure since repeated cervical surgery is technically difficult, carries a high morbidity rate and yields bad cosmetic results. This study aims to combine radioiodine (I131) treatment and radio-guided surgery to improve the completeness of surgical excision without wide resections of cervical tissues. The combined treatment protocol was described previously and includes preparation of the patient for radioiodine (I131) treatment, administration of a therapeutic dose of 3.7 GBq of radioiodine (I131) in the hypothyroid state and using the radioactivity as a marker for identifying tumor aggregates intraoperatively using a hand held gamma probe. Both patients treated show complete removal of all neoplastic foci with radioiodine uptake. Moreover, in both patients the intraoperative probe identified additional metastatic foci that were not shown by the preoperative scan. Although our experience is limited (only two patients), and a larger series with a longer follow-up period is needed, we believe radio-guided surgery for recurrent or persistent cervical well-differentiated thyroid cancer offers an important therapeutic tool.