Appropriate dosing of adjuvant radioactive iodine for differentiated thyroid cancer.
OBJECTIVE
The incidence of well differentiated thyroid cancer (WDTC) is increasing in the US population and is now a major public health concern. Although surgery is the mainstay of treatment, radioactive iodine (RAI) is routinely used for adjuvant therapy, remnant ablation, and for the treatment of metastatic disease. Despite excellent prognosis and stable mortality rates, the use of RAI is increasing in many low and intermediate risk WDTC patients without clear indication that it changes the outcome. As a result, the current treatment paradigm has shifted towards a risk-stratified approach.


RESULTS
Although there is widespread acceptance that RAI improves overall and recurrence-free survival in patients with metastatic disease, controversy remains regarding radioactive remnant ablation use in low and intermediate risk patients. Additional studies have shown that reduced doses of RAI can provide similar rates of remnant ablation and adjuvant therapy in low and intermediate risk patients without adversely affecting the recurrence rates and mortality.


CONCLUSIONS
Recent studies suggest potential new paradigms in radioactive remnant ablation dosing and indications for use. Risk stratification is important in determining the proper use and dosing of RAI.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Brittany N
BN
Bohinc
Jennifer M
JM
Perkins
D055011:Ablation Techniques; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery
D007457:Iodine Radioisotopes