Polish Prospective Study by Piciu et al., Which Evaluated Long‑Term Outcomes of Different RAI Activities in Low‑ and Intermediate‑Risk Differentiated Thyroid Cancer (DTC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Study Overview:
    • Design:
      • Prospective, long-term study combining two RCTs conducted at a single center in Gliwice, Poland
    • Participants:
      • Low-risk group (n = 277):
        • Received 30, 60, or 100 mCi RAI
      • Intermediate-risk group (n = 46):
        • Randomized to 60 mCi (n = 20) vs 100 mCi (n = 26)
      • Follow-up duration:
        • Mean ~ 11 years (range 3 to 19 years) 
  • Key Findings:
    • Low-Risk Patients:
      • Excellent response rates:
        • 88% (30 mCi), 89% (60 mCi), 90% (100 mCi)
      • Incomplete structural response:
        • ~ 1% to 1.6%
      • Indeterminate response:
        • ~ 9%
    • Long-term outcomes were comparable across all doses:
      • Confirming adequacy of lower doses in low-risk cases
  • Intermediate-Risk Patients:
    • Excellent response (after first ablation):
      • 85% in both 60 mCi and 100 mCi groups 
    • Indeterminate response:
      • 6.5%
    • Incomplete structural response:
      • 6.5%
    • Incomplete biochemical response:
      • 2.2% (only in 100 mCi group)
  • Cumulative excellent response:
    • 72% after possible additional therapies
    • 11% of patients required further RAI
    • 4.3% required treatment for recurrence 
    • No significant differences were observed between the two dose levels in final therapeutic outcomes
  • Conclusions:
    • Low-Risk:
      • All three RAI doses 30, 60, and 100 mCi:
        • Achieve similar long-term disease response:
          • Supports use of lower-dose ablation
    • Intermediate‑Risk:
      • 60 mCi RAI appears sufficient:
        • No additional benefit shown with 100 mCi:
          • Based on long-term structural and biochemical outcomes
  • Clinical implication:
    • In intermediate-risk DTC:
      • A moderate 60 mCi RAI dose is a safe and effective option with favorable long-term results
  • Clinical Take‑Home:
    • Tailored approach:
      • For intermediate-risk patients, standardizing to 60 mCi avoids higher-dose exposure without compromising efficacy
      • Supports ATA and ETA guidance favoring risk-adapted dosing strategies:
        • Minimizes overtreatment while optimizing outcomes
  • Reference:
    • Kukulska et al. Arch Med Sci. 2022;18(5):1241–1247.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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