title: A new appraisal of iodine refractory thyroid cancer.
abstract: Thyroid cancer incidence is increasing all over the world - mostly due to an increase in the detection of small tumors that were previously undetected. A small percentage of these tumors lose the ability to uptake and/or to respond to radioiodine (RAI) therapy, especially in metastatic patients. There are several new therapeutic options that have emerged in the last 5 years to treat RAI refractory thyroid cancer patients, however, it is very important to properly identify RAI refractory patients and to clarify those appropriate for these treatments. In this review, we discuss the RAI refractory definitions and the criteria that have been suggested based on RAI uptake in the post therapy scan, as well as the response after RAI therapy and the possible molecular mechanisms involved in this process. We offer a review of the therapeutic options available at the moment and the therapeutic considerations based on a patient's individualized personal characteristics, primary tumor histology, tumor burden and location and velocity of lesion growth.
authors: Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.
authors: Fernanda
authors: F
authors: Vaisman
authors: Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.
authors: Denise P
authors: DP
authors: Carvalho
authors: Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil vaisman@hucff.ufrj.br mario.vaisman@globo.com.
authors: Mario
authors: M
authors: Vaisman
mesh_terms: D055372:AMP-Activated Protein Kinases / Q000502:physiology; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001693:Biological Transport, Active; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm / Q000502:physiology; D019788:Fluorodeoxyglucose F18; D005544:Forecasting; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007457:Iodine Radioisotopes / Q000493:pharmacokinetics / Q000627:therapeutic use; D058990:Molecular Targeted Therapy; D064847:Multimodal Imaging; D009362:Neoplasm Metastasis / Q000628:therapy*; D009363:Neoplasm Proteins / Q000037:antagonists & inhibitors / Q000235:genetics / Q000502:physiology; D019869:Phosphatidylinositol 3-Kinases / Q000502:physiology; D049268:Positron-Emission Tomography; D011379:Prognosis; D048493:Proto-Oncogene Proteins B-raf / Q000037:antagonists & inhibitors / Q000235:genetics / Q000502:physiology; D015398:Signal Transduction; D015996:Survival Rate; D027981:Symporters / Q000172:deficiency / Q000502:physiology; D058570:TOR Serine-Threonine Kinases / Q000502:physiology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D000099209:Sodium-Iodide Symporters
chemical_list: D055372:AMP-Activated Protein Kinases; D000970:Antineoplastic Agents; D019788:Fluorodeoxyglucose F18; D007457:Iodine Radioisotopes; D009363:Neoplasm Proteins; D019869:Phosphatidylinositol 3-Kinases; D048493:Proto-Oncogene Proteins B-raf; D027981:Symporters; D058570:TOR Serine-Threonine Kinases; D000099209:Sodium-Iodide Symporters; C546842:MTOR protein, human; C482119:BRAF protein, human
keywords: iodine refractory; metastatic; thyroid cancer; tyrosine kinase inhibitors