Guidelines for radioiodine therapy of differentiated thyroid cancer

Abstract

For this purpose, recommendations have been formulated based on recent literature and expert opinion regarding the rationale, indications and contraindications for these procedures, as well as the radioiodine activities and the administration and patient preparation techniques to be used. Recommendations also are provided on pre-RAIT history and examinations, patient counselling and precautions that should be associated with (131)I iodine ablation and treatment. Furthermore, potential side effects of radioiodine therapy and alternate or additional treatments to this modality are reviewed. Appendices furnish information on dosimetry and post-therapy scintigraphy.

An update on molecular biology of thyroid cancers

“…The overall 5 and 10-year survival rates for follicular thyroid cancer are 91% and 85%, respectively. Treatment strategy is thyroidectomy followed by ablative or metastatic doses of radioiodine therapy [12,13,18,19]. Approximately 50% of FTC patients have mutations in RAS family genes or PAX-PPAR␥ rearrangements [14,20,21].…”

Whither peptide receptor radionuclide therapy for neuroendocrine tumors: an Einsteinian view of the facts and myths

“…In metastasized differentiated thyroid cancers, two thirds of which exhibit radioiodine uptake following thyroid-stimulating hormone (TSH) stimulation, radioiodine therapy can achieve a complete remission in at least one third [44]. Radioimmunotherapy with anti-CD20 antibodies in B-cell non-Hodgkin's lymphomas also achieves complete responses in 75 % of patients [45].…”

Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma

“…In accordance with the recent EANM guidelines [5], radioiodine ablation is therefore to be regarded as a standard treatment in all patients except those with unifocal PTC ≤1 cm in diameter who lack evidence of metastasis, thyroid capsule invasion, a history of radiation exposure or unfavourable histological typing (tall-cell, columnar cell or diffuse sclerosing subtypes).…”

“…For example, in a survey from North America [2] the majority of physicians are convinced that RRA decreases DTC-related mortality and recurrence, and facilitates DTC follow-up with a low risk of adverse effects. RRA has been adopted as an integral part of several recent international guidelines for the treatment of DTC, such as those of the American Thyroid Association [3], the European Thyroid Association [4], and the European Association of Nuclear Medicine [5], as well as several national guidelines in countries such as the UK, Germany [6,7], the Netherlands and Austria.…”