A new nationwide trial has launched in the UK for patients with low-risk thyroid cancer. The study aims to compare recurrence rates among patients who undergo two different types of thyroid surgery following diagnosis.
The HoT trial ('Hemithyroidectomy or Total Thyroidectomy in ‘low-risk’ thyroid cancers') is a major project funded by the National Institute of Health Research Health Technology Assessment (NIHR HTA). The trial is being coordinated by the Cancer Research UK & UCL Cancer Trials Centre and plans to recruit 456 patients from 30 hospitals across the UK over a period of four years.
Low-risk thyroid cancers are highly curable, with figures showing that disease returns in just 7 out of every 100 patients in the 8 years after surgery. These low-risk cancers are also associated with a high long-term survival rate, with 99 out of every 100 patients surviving at least 10 years after diagnosis.
The current standard of care for these patients involves complete removal of the thyroid gland (total thyroidectomy, or TT). Clinical guidelines in the US and UK introduced in 2015 suggest that a less invasive procedure, where patients have only the cancerous part of their thyroid gland removed (hemithyroidectomy, or HT; also referred to as a ‘lobectomy’), is adequate treatment for this low risk group. Furthermore, patients can avoid lifelong dependence on thyroid hormone tablets with the HT procedure, whilst also experiencing fewer side effects.
Both surgeries are now performed in the NHS, however there is uncertainty amongst surgeons, and anxiety amongst patients - as to which procedure to have. The HoT trial is the first randomised trial to compare both types of surgery – patients who join will be randomly allocated to receive either a total thyroidectomy or a hemithyroidectomy.
Professor Dae Kim, chief investigator for the trial and a consultant ENT & thyroid surgeon at the Royal Marsden Hospital, had this to say about the importance of the study: ‘Let’s help patients make the right decision for them: please get involved in the HoT trial and help us give our patients the true answers’.
Kate Farnell, director of Butterfly Thyroid Cancer Trust, has also highlighted the impact the trial will have for future cancer patients: ‘Butterfly Thyroid Cancer Trust is delighted that this clinical trial is going ahead. It will lead to more clarity for patients in their decision making about the way forward after having a thyroid cancer diagnosis’.
The HoT Trial will aim to provide definitive evidence comparing the recurrence rate of both surgeries, and thus resolve the controversy among surgeons, endocrinologists and patients. The trial has now opened to recruitment at Lister Hospital in Stevenage, and is supported by the British Association of Endocrine & Thyroid Surgeons (BAETS), ENT UK's Head & Neck Society, and Butterfly Thyroid Cancer Trust.