Although surgery has been the mainstay of treatment for patients with well-differentiated
thyroid cancer, the extents of thyroid resection and
lymph node dissection adopted in Japan differ from those in other countries. Furthermore, regarding the indications for postoperative
radiation therapy and hormonal
therapy, and treatment modalities for
cancer recurrence, there are marked discrepancies between Japan and other countries. A questionnaire survey was thus conducted among domestic and overseas thyroid surgeons to ascertain the actual treatment policy for well-differentiated
thyroid cancer in Japan and various foreign countries. For small
papillary carcinomas of 2.0 cm or less (T1), thyroid resection was more extensive in foreign countries than in Japan, although the extent of
lymph node dissection was limited in the former. For large
papillary carcinomas exceeding 3.0 cm (T2), on the other hand, total
thyroidectomy was the treatment of first choice for all overseas respondents, but of only 20% in Japan, despite
lymph node dissection being more extensive in Japan than in other countries. Overseas surgeons were much more likely to favor postoperative TSH suppression
therapy and high-dose (131)I
therapy. For recurrence following surgery for
papillary thyroid cancer, both domestic and overseas respondents indicated surgical resection to be the most common treatment option, and favored high-dose (131)I
therapy as well. In Japan, however, high-dose (131)I
therapy is available only in a few institutions. Such limited indications for high-dose (131)I
therapy in Japan may reflect a discrepancy in the frequency of total
thyroidectomy, a prerequisite for postoperative high-dose (131)I
therapy, between Japan and other countries. This is the first questionnaire study conducted in both Japan and other countries in relation to treatment modalities for
thyroid cancer. The results reveal that there is a clear disparity in treatment policies between Japan and foreign countries.