ArticleFrontiers in endocrinology2026
Limited effectiveness of radioiodine therapy for residual cervical lymph node metastases in radioiodine-naïve papillary thyroid cancer.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Radioiodine (RAI) therapy is frequently used to treat suspected or documented cervical lymph node metastases in papillary thyroid carcinoma (PTC), although its effectiveness for structurally documented residual nodal disease remains uncertain. Methods: This retrospective analysis of a prospectively followed cohort included RAI-naïve patients with PTC who had structurally confirmed cervical nodal metastases identified after surgery. Patients with documented metastatic lymph nodes in recently operated compartments, or those declining immediate reoperation, received upfront RAI therapy. Treatment response was evaluated at both lymph-node and patient levels using serial ultrasonography and biochemical follow-up. Results: A total of 146 cervical lymph node metastases in 71 patients were analyzed. Of these, 39 (26.7%) were RAI-avid, 89 (61%) were RAI-non-avid, and 18 (12.3%) were indeterminate due to remnant interference. Among RAI-avid nodes, complete and partial responses were observed in 38.5% and 20.5%, respectively. Across all nodes, complete and partial responses were seen in 10.3% and 6.2%, while no objective response occurred in 83.5%. RAI-non-avid disease was frequent among aggressive histologic subtypes; however, most non-avid metastases arose from tumors with otherwise indolent histology. At the patient level, a complete response was achieved in 11% (8/71). All responders remained in the excellent response category at a median follow-up of 77 months (range 32-156), indicating a durable treatment effect. Conclusion: RAI-non-avid nodal metastases were common and represented the primary determinant of treatment failure. Even among RAI-avid lesions, response rates were modest. These findings suggest that lesion-level RAI-avidity is the principal determinant of therapeutic benefit and support a more selective, biology-guided approach to RAI therapy in patients with residual nodal disease.
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