Results of a clinical trial led by Newcastle Hospitals could mean patients with thyroid cancer are safely spared radioactive iodine treatment and its associated side effects.
The results of the trial have now been published in renowned medical journal, The Lancet.
The thyroid is a butterfly-shaped gland in the neck that produces hormones to help regulate metabolism and energy levels.
Thyroid cancer affects a high proportion of young people compared to most cancers and is three times more common in women than men.
The Iodine or Not (IoN) clinical trial, funded by Cancer Research UK, aimed to determine whether patients with low-risk thyroid cancer could safely forego radioactive iodine treatment following surgery to remove the thyroid (thyroidectomy).
Radioactive iodine is considered for most patients following a thyroidectomy. The treatment is given in hospital and is usually followed by one to three days’ isolation in a radiation-protected room to avoid contact with people.
Safety precautions need to be followed for several days after leaving hospital to make sure others aren’t exposed to radiation, including babies, young children, and pets.
Patients on the trial had a low chance of their thyroid cancer returning. Half of these patients were randomly assigned to receive radioactive iodine treatment, which is designed to destroy any remaining cancer cells following surgery. The other half received surgery only
The IoN trial involved 504 patients from 33 UK cancer centres. It was led by Dr Ujjal Mallick, an oncologist at the Freeman Hospital and chief investigator for the trial.
The trial reviews were led by thyroid cancer nurse specialist Nicola Armstrong, who works at the Freeman Hospital, and Irene Jobson in cancer trials.
Following Dr Mallick’s retirement, Mr Peter Truran took over as CI.
Dr Mallick said:
“This study represents a major improvement to how thousands of thyroid cancer patients might be treated worldwide. They can avoid the risk of side effects of radioactive iodine treatment such as changes in taste, salivary gland problems, dry mouth, lacrimal gland problems, and also the very small risk of a new and different cancer in the future.”
Positive impact on quality of life
The patients were assessed regularly for at least five years. By the end of the study, 98% of patients who did not have radioactive iodine were still free from thyroid cancer, compared to 96% who did receive it (though the latter number is lower, the authors say that this is likely down to chance rather than any clinically significant factor).
Professor Allan Hackshaw, one of the trial’s investigators from University College London Cancer Institute, said:
“Our results show that radioactive iodine represents over-treatment in these particular patients and is not required to improve their outcomes. The only impact of not receiving this radiotherapy was a positive one on people’s quality of life.
“This is particularly important because around a third of patients in the study were aged 40 years or less, and many would have children to care for. Not having physical contact can be quite hard for them.
“Being spared radioactive iodine therapy means they will be able to get back to a near normal life much more quickly, as well as receiving the emotional and physical support of their families in the weeks after their operation.”
The authors estimate that 2,500 patients in the UK and 400,000 patients worldwide could potentially avoid radioiodine treatment each year.
Wider benefits
As well as the benefits for patients, foregoing radioactive iodine treatment would mean lower healthcare costs, reducing the pressure on clinical staff and hospital beds.
Dr Kate Newbold, consultant clinical oncologist at The Royal Marsden NHS Foundation Trust and co-investigator of the study, said:
“IoN is an exemplar study that shows that the UK can successfully run major practice-changing clinical trials in cancer – with impacts for patients and healthcare systems internationally.”
Kate Farnell, CEO of Butterfly Thyroid Cancer Trust, added:
“On behalf of thyroid cancer patients, we are delighted. Many tell us that having radiation treatment in isolation away from their family is perhaps the hardest part of their cancer journey. This trial has shown that in many patients this will no longer be necessary.”
Karen’s story
55-year-old Karen Miller from Sunderland recalls feeling like she was in “another world” when she was told she had thyroid cancer.
The mum-of-two was 43 when she spotted a lump on her neck. She saw her GP and was quickly referred for further tests with a biopsy later confirming that she had thyroid cancer.
Karen, who works as a teacher, underwent two thyroidectomies, a procedure that involves removing part or all of the thyroid. Recalling the time when she received her diagnosis, she said:
“I remember being told I had cancer and feeling as though it wasn’t real. It was the last thing I expected to hear and all I could think about was my husband and two kids who were six and nine at the time.”
Following her operation, Karen’s consultant at Sunderland Royal Hospital mentioned that the Freeman Hospital was looking for people to take part in a clinical trial that compared treatments for thyroid cancer.
An assessment confirmed she was eligible, and she was assigned to radioactive iodine treatment.
Treatment involved taking the iodine in tablet form, followed by a two-night stay at the Freeman Hospital where her radiation levels were monitored. Once home, Karen had to isolate herself to protect her family from radiation.
Karen added:
“It was difficult being away from my kids, but at the time you do what’s best for yourself and family. We were fortunate that grandparents were able to look after them, which hopefully helped to keep things as normal as possible.
“I know first-hand what it is like to go through cancer, so I’m really pleased to see the results of the trial knowing it could help others.
“I can’t fault the care I’ve received and am so grateful to be well again.”
Rebecca’s story
41-year-old Rebecca Griffin, who lives in Northumberland, was diagnosed with thyroid cancer in 2018 when she was just 35.
Rebecca, who is originally from Greater Manchester but has lived in Northumberland since 2010, visited her GP after finding a small lump on her neck.
Rebecca says she wasn’t particularly concerned about the lump and assumed it would be something harmless:
“At the time, I didn’t think the lump was anything to worry about. I was working in a busy job, my son was 18 months old and my daughter five, so I didn’t really have time to worry.”
Rebecca’s GP decided to send her for further tests, however a biopsy proved inconclusive. In 2019, Rebecca had a partial thyroidectomy at the Freeman Hospital and tests confirmed that the lump was cancerous.
Rebecca adds:
“It was a huge shock when I was told I had thyroid cancer as it hadn’t crossed my mind. My first thought went to my children and how they would be when I went in for surgery.
“Following surgery, I had to make a decision about whether I had radioactive iodine. My main concern was that I would have to stay away from my kids who were so young at the time and wouldn’t understand why they couldn’t be near me.
“I was then told about the IoN trial and I was pleased to have the opportunity to take part. I know it can feel overwhelming making such a significant decision about treatment, so anything that helps people in a similar situation to me is a positive step.”
Rebecca is keeping well and continues to have regular check-ups at the Freeman Hospital.
- The IoN clinical trial was developed by expert UK oncologists, clinical trial specialists and Butterfly Thyroid Cancer Trust, involving over 30 NHS centres. The trial was conducted by the Cancer Research UK & University College London Cancer Trials Centre, and funded by Cancer Research UK.
