Systematic Radioiodine Administration Versus Decision of Radioiodine Treatment Guided by a Post-operative Work-up

NCT ID: NCT04290663

Last Updated: 2025-10-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

476 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-02

Study Completion Date

2033-02-28

Brief Summary

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This trial is comparing two strategies in intermediate-risk differentiated thyroid cancer patients: Systematic radioiodine administration versus decision of radioiodine treatment guided by a post-operative work-up based on serum Tg values and diagnostic RAI scintigraphy

Detailed Description

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Conditions

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Thyroid Cancer Intermediate Risk

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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RAI group

Group Type ACTIVE_COMPARATOR

Systematic RAI-treatment

Intervention Type DRUG

Administration of 3.7 GBq (100 mCi) or 1,1 GBq (30 mCi) of I131 at the choice of the investigator after rhTSH-stimulation

GUIDED FOLLOW-UP group

Group Type EXPERIMENTAL

Decision of RAI-treatment guided by a post-operative assessment

Intervention Type OTHER

The decision-making for the administration of an adapted RAI-treatment will be taken according to the following criteria:

* No RAI treatment if Tg/LT4 ≤1 ng/mL and rhTSH-sTg ≤10 ng/mL and normal diagnostic RAI-scintigraphy
* 1.1 GBq after rhTSH if Tg/LT4\>1 ng/mL or rhTSH-sTg\>10 ng/mL and normal diagnostic RAI-scintigraphy.
* 3.7 GBq after rhTSH if metastatic lymph-node(s) detected on diagnostic RAI-scintigraphy without distant metastasis
* 3.7 GBq after hormone withdrawal if distant metastasis detected on diagnostic RAI-scintigraphy or on the hybrid CT scan of the SPECT-CT acquisition

Interventions

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Systematic RAI-treatment

Administration of 3.7 GBq (100 mCi) or 1,1 GBq (30 mCi) of I131 at the choice of the investigator after rhTSH-stimulation

Intervention Type DRUG

Decision of RAI-treatment guided by a post-operative assessment

The decision-making for the administration of an adapted RAI-treatment will be taken according to the following criteria:

* No RAI treatment if Tg/LT4 ≤1 ng/mL and rhTSH-sTg ≤10 ng/mL and normal diagnostic RAI-scintigraphy
* 1.1 GBq after rhTSH if Tg/LT4\>1 ng/mL or rhTSH-sTg\>10 ng/mL and normal diagnostic RAI-scintigraphy.
* 3.7 GBq after rhTSH if metastatic lymph-node(s) detected on diagnostic RAI-scintigraphy without distant metastasis
* 3.7 GBq after hormone withdrawal if distant metastasis detected on diagnostic RAI-scintigraphy or on the hybrid CT scan of the SPECT-CT acquisition

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Subgroup of patients with differentiated thyroid cancer and intermediate-risk defined as follows according to TNM 2017:

* Papillary thyroid cancer (PTC) without aggressive subtype, follicular thyroid cancer (FTC) (with \< 4 foci of vascular invasion) or Hürthle cell carcinoma (HCC)
* T1b or T2 with minimal extra-thyroid extension into the perithyroidal soft tissues and/or pN1 with largest nodal dimension between 2 and 10 mm, without extra-capsular invasion and with a number of metastatic nodes ≤ 10
* T1aN1 with largest nodal dimension between 2 and 10 mm, without extra-capsular invasion and with a number of metastatic nodes ≤ 10
* Patient treated by total thyroidectomy with macroscopically complete tumor resection (R0 or R1) ± neck dissection
* Total thyroidectomy performed within 6 to 14 10 weeks before randomization
* Patient with or without anti-thyroglobulin antibodies (TgAb)
* No known distant metastases
* Normal post-operative neck ultrasound (US) or if doubtful US, negative cytology and normal Tg value (\<10 ng/ml) in FNA washout fluid
* Post-operative LT4 treatment initiated at least 6 weeks before randomization
* Performance Status 0 or 1
* Patients aged 18 years or older
* Signed informed consent form
* Patient who agrees to be followed annually during 5 years
* Patient affiliated to the French social security system

Exclusion Criteria

* • Patients with:

* medullary or anaplastic thyroid cancer
* or poorly differentiated carcinoma
* or well differentiated FTC with at least more than 4 foci of vascular invasion
* or PTC with aggressive variants (tall cell or columnar cell carcinoma, diffuse sclerosing papillary, hobnail variant)
* NIFTP (Noninvasive follicular thyroid neoplasm with papillary-like nuclear features)

• Low-risk or high-risk DTC patients according to ATA 2015, and intermediate-risk patients with extra-thyroid extension into the perithyroidal muscles (pT3b according to pTNM 2017), and/or pN1 with nodal largest dimension \>10 mm or with extra-capsular invasion or more than 10 metastatic nodes. This excludes the following patients:
* All pT1a, pT3 or pT4
* pT1aN0/x with or without minimal extra-thyroid extension
* pT1bN0/x, pT2N0/Nx without minimal extra-thyroid extension
* pT1aN1 or pT1bN1 or pT2N1 without extra-thyroid extension and with nodal largest dimension \<2mm
* pT1aN1 or pT1bN1 or pT2N1 without extra-thyroid extension and with nodal largest dimension \>10mm
* pT2N0/Nx without extra-thyroid extension
* pT2N1 without extra-thyroid extension and with nodal largest dimension \<2mm
* pT2N1 without extra-thyroid extension and with nodal largest dimension \>10mm
* Surgery considered as macroscopically incomplete (R2)

* Patients who have undergone lobectomy only
* Post-operative neck US with metastatic lymph-nodes confirmed by cytology or by increased Tg (\>10 ng/ml) in FNA washout fluid
* Drugs affecting thyroid function including iodinated contrast agents in the 6 weeks prior to randomization. Amiodarone should have been stopped at least 1 year before randomization.
* Previous RAI treatment for thyroid cancer
* Pregnant or lactating women
* Any associated geographical, social or psychopathological condition that could compromise the patient's ability to participate in the study
* Patient deprived of liberty or placed under the authority of a tutor
* History of malignancy in the past 3 years, except skin cancer excluding melanoma, carcinoma in situ of the cervix. Any other solid tumor or lymphoma (without bone marrow involvement) must have been treated and not have shown signs of recurrence for at least 3 years
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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French cancer Institute INCa

UNKNOWN

Sponsor Role collaborator

Centre Francois Baclesse

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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CHU Pointe à pitre

Pointe à Pitre, Guadeloupe, France

Site Status NOT_YET_RECRUITING

Chu Angers

Angers, , France

Site Status RECRUITING

Institu de Cancérologie de l'Ouest - Site Angers

Angers, , France

Site Status RECRUITING

Bergonié

Bordeaux, , France

Site Status RECRUITING

Hôpital saint-André

Bordeaux, , France

Site Status RECRUITING

Chu Brest

Brest, , France

Site Status RECRUITING

Centre Francois Baclesse

Caen, , France

Site Status RECRUITING

Centre Hospitalier Métropôle Savoie

Chambéry, , France

Site Status RECRUITING

Centre Jean Perrin

Clermont-Ferrand, , France

Site Status RECRUITING

Centre Georges-François Leclerc

Dijon, , France

Site Status RECRUITING

Chu Martinique

Fort de France, , France

Site Status RECRUITING

Chu Grenoble

Grenoble, , France

Site Status RECRUITING

Chru Lille

Lille, , France

Site Status RECRUITING

Centre Léon Bérard

Lyon, , France

Site Status RECRUITING

Hospices Civils de Lyon

Lyon, , France

Site Status RECRUITING

CHU Timone

Marseille, , France

Site Status RECRUITING

Chu Nancy

Nancy, , France

Site Status RECRUITING

Chu Nantes

Nantes, , France

Site Status RECRUITING

Centre Antoine Lacassagne -

Nice, , France

Site Status RECRUITING

Chu Nimes

Nîmes, , France

Site Status RECRUITING

AP-HP Pitié Salpétrière

Paris, , France

Site Status RECRUITING

Centre Jean Godinot

Reims, , France

Site Status RECRUITING

Centre Henri Becquerel

Rouen, , France

Site Status RECRUITING

Institut CURIE, site Réné Huguenin

Saint-Cloud, , France

Site Status RECRUITING

Institu de Cancérologie de l'Ouest - Site St Herblain

Saint-Herblain, , France

Site Status RECRUITING

Centre Paul Strauss

Strasbourg, , France

Site Status RECRUITING

CHU TOULOUSE, Hôpital Larrey

Toulouse, , France

Site Status RECRUITING

IUCT Oncopole

Toulouse, , France

Site Status RECRUITING

Institut Gustave Roussy

Villejuif, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Stéphane BARDET, MD

Role: CONTACT

(33)231455050

Facility Contacts

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Suzy DUFLO, Prof

Role: primary

Patrice RODIEN, MD

Role: primary

Olivier MOREL, MD

Role: primary

Yann GODBERT, MD

Role: primary

Bogdan NICOLESCU-CATARGI, Prof

Role: primary

Nathalie ROUDAUT, MD

Role: primary

Stéphane BARDET, MD

Role: primary

Jean-Cyril BOURRE, MD

Role: primary

Clémence VALLA, MD

Role: primary

Inna DYGAI-COCHET, MD

Role: primary

Soizic MASSON, MD

Role: primary

Julie ROUX, MD

Role: primary

Christine DO CAO, MD

Role: primary

Anne-Laure GIRAUDET, MD

Role: primary

Solène CASTELLNOU, MD

Role: primary

David TAIEB, Prof

Role: primary

Perrine RAYMOND, prof

Role: primary

Catherine Ansquer, MD

Role: primary

Danielle BENISVY, MD

Role: primary

Olivier GILLY, MD

Role: primary

Charlotte LUSSEY-LEPOUTRE, MD

Role: primary

Mohamad ZALZALI, MD

Role: primary

Agathe EDET-SANSON, MD

Role: primary

RICHARD Capucine, MD

Role: primary

Danièla RUSU, MD

Role: primary

Olivier SCHNEEGANS, MD

Role: primary

Solange GRUNENWALD, MD

Role: primary

Camila NASCIMENTO, MD

Role: primary

Livia LAMARTINA, MD

Role: primary

Other Identifiers

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2019-002968-27

Identifier Type: -

Identifier Source: org_study_id

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