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This Week in NEJM: May 3, 2012

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In NEJM this week, researchers in France report on different strategies of radioiodine ablation in patients with low-risk thyroid cancer. In a randomized phase III trial, the team compared two thyrotropin-stimulation methods — thyroid hormone withdrawal and use of recombinant human thyrotropin — and two radioiodine doses. They enrolled 752 patients and assigned them to receive the treatments — in total, 92 percent of the patients had complete thyroid ablation. "The ablation rate was equivalent between the [radioiodine] doses and between the thyrotropin-stimulation methods," the authors write. "The use of recombinant human thyrotropin and low-dose postoperative radioiodine ablation may be sufficient for the management of low-risk thyroid cancer."

Also in NEJM this week, researchers in the UK report their study comparing various combination therapies for patients with thyroid cancer. The team conducted a randomized noninferiority trial, comparing low-dose and high-dose radioiodine, each with either thyrotropin alfa or thyroid hormone withdrawal in 438 patients with thyroid cancer with possible spread to the lymph nodes, but no metastasis. The group receiving low-dose radioiodine had an ablation rate of 85 percent, compared with 88.9 percent in the group receiving high-dose radioiodine, the team found. Further, the patients receiving thyrotropin alfa had an ablation rate of 87.1 percent versus 86.7 percent in the thyroid hormone withdrawal group. "Similar results were found for low-dose radioiodine plus thyrotropin alfa (84.3 percent) versus high-dose radioiodine plus thyroid hormone withdrawal (87.6 percent) or high-dose radioiodine plus thyrotropin alfa (90.2 percent)," the authors write. "Low-dose radioiodine plus thyrotropin alfa was as effective as high-dose radioiodine, with a lower rate of adverse events."

Finally in NEJM this week, an international team of researchers reports its study of different combination chemotherapies for patients with advanced adrenocortical carcinoma. The team randomly assigned 304 patients to receive mitotane with either streptozocin or a combination of etoposide, doxorubicin, and cisplatin. They found that patients in the EDP-mitotane group had a significantly higher response rate and longer median progression-free survival than the patients in the streptozocin-mitotane group. However, there was no significant difference in overall survival between the two groups, the team adds.

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