SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Head and Neck Cancer
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1670978
This article is part of the Research TopicReviews in Head and Neck CancersView all 4 articles
Is Radioiodine Necessary for patients with Low-Risk Differentiated Thyroid Cancer After Thyroidectomy: A Pooled Analysis of ESTIMABL2 and IoN trials
Provisionally accepted
- 1Ganzhou People's Hospital, Ganzhou, China
- 2Gannan Healthcare Vocational College, Ganzhou, China
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Background: The clinical utility of postoperative radioiodine therapy in patients with low-risk differentiated thyroid cancer (DTC) remains a subject of ongoing debate. Although radioiodine has been widely employed to reduce the risk of recurrence, its necessity in low-risk populations is increasingly questioned, given the favorable outcomes observed with surgery alone. To address this issue, we conducted a meta-analysis exclusively based on randomized controlled trials (RCTs) to comprehensively evaluate the efficacy and safety of radioiodine therapy in this specific patient population. Methods: We systematically searched 6 databases for eligible phase 3 RCTs comparing surgery with or without radioiodine in patients with low-risk DTC. Primary outcomes included recurrence and recurrence-free survival (RFS); secondary outcomes included adverse events (AEs), structural events, and biological events. Risk ratios (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled and analyzed. Results: Two phase 3 RCTs (the ESTIMABL2 and IoN trials), encompassing 1280 patients, were included. Compared to the non-radioiodine group, radioiodine therapy did not significantly reduce recurrence rates (RR: 0.78 [0.36-1.70], P = 0.53) or improve RFS (HR: 0.96 [0.80-1.15], P = 0.68). The total number of structural events (RR: 0.83 [0.68-1.02], P = 0.07) and biological events (RR: 0.88 [0.71-1.08], P = 0.23) were also similar between the two groups. In the safety analysis, the two groups exhibited comparable rates of AEs (RR: 0.97 [0.79-1.20], P = 0.80), grade 3-5 AEs (RR: 0.25 [0.03-2.20], P = 0.21), death (RR: 1.28 [0.48-3.41], P = 0.62), and second primary cancers (RR: 1.26 [0.58-2.73], P = 0.55). Conclusion: Radioiodine therapy did not confer significant benefits in reducing recurrence or improving RFS in patients with low-risk DTC after thyroidectomy, and the safety profiles were comparable between the two groups.
Keywords: radioiodine, Low-risk differentiated thyroid cancer, Thyroidectomy, Meta-analysis, randomized controlled trials
Received: 22 Jul 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 Yang, Luo, Xie, Zou, Chen, Yang, Zeng and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jing Liu, ljky2026@126.com
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