Tailoring the approach to radioactive iodine treatment in thyroid cancer

Abstract

The treatment of differentiated thyroid cancer continues to move away from a ‘one size fits all’ approach to a process of tailored therapeutic decision-making that incorporates disease-specific factors and individual patient preferences. Management options range from active surveillance to thyroid lobectomy to total thyroidectomy with or without the use of postoperative radioactive iodine (RAI). RAI may be administered for one or more reasons: Thyroid remnant ablation, adjuvant therapy, or therapy for persistent structural disease. It is important to be cognizant of the therapeutic intent of RAI and weigh the risks and benefits of treatment for each individual patient. Risk stratification should be used to identify those patients who are most likely to benefit from RAI and guide therapeutic choices. Available data suggest that RAI can be safely deferred for most patients considered at low risk for structural recurrence, while adjuvant RAI is associated with improved disease-free survival in patients with higher risk disease. Although progress has been made, many areas of uncertainty related to the use of RAI remain. These include: 1) The appropriate selection of intermediate risk patients to receive adjuvant RAI, 2) the superiority or inferiority of different RAI dosing activities, 3) the optimal approach to the use of RAI in special populations, including patients with ESRD and children and 4) the management of patients with RAI-refractory disease.

Strategies for Radioiodine Treatment: What’s New

“…In these cases, a stable or decreasing trend is associated with remission, while a rising trend is highly suspicious of persistent/recurrent disease [ 14 ]. The same consideration can be made for TgAb, as we observe in most cases a spontaneous decline [ 2 , 38 , 39 ]. Nonetheless, at least half of patients will already have an undetectable Tg after 12 months of follow-up [ 32 , 36 , 37 ], particularly when surgery is performed in an experienced center.…”

Bambus[4,6]urils as Dual Scaffolds for Multivalent Iminosugar Presentation and Ion Transport: Access to Unprecedented Glycosidase-Directed Anion Caging Agents

“…Moreover, the fact that activity is not influenced by anion binding opens the way to potential therapeutic applications by inducing accumulation of the encaged anion, and potentially radioactive iodide, in a glycosidase rich environment. It is, for example, well-known that β-glucuronidases are present at high concentration in the microenvironment of most solid tumours [ 44 ] and that radioactive iodine is used for the treatment of cancers, including thyroid cancers [ 45 , 46 , 47 ].…”

Radioactive iodine in low- to intermediate-risk papillary thyroid cancer

“…The difficulty in performing RAI is to identify patients who are most likely to benefit from RAI therapy while avoiding unnecessary exposure to ionizing radiation in the majority of low- to intermediate-risk thyroid cancer patients ( 6 ). Except for the strong recommendation for RAI treatment in patients with gross tumor extension and distant metastases and non-recommendation for RAI in PTMC patients without risk clinicopathologic features, RAI use remains controversial in most cases ( 7 ). Consistent with the ATA recommendation, our study found that PTMC patients did not benefit from RAI administration, while patients with extrathyroidal extension had better OS with the addition of RAI.…”