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Vol. 38. Issue 3.
Pages 195-203 (May - June 2019)
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Vol. 38. Issue 3.
Pages 195-203 (May - June 2019)
Continuing Education
DOI: 10.1016/j.remnie.2018.12.004
Radioiodine treatment of differentiated thyroid cancer related to guidelines and scientific literature
Tratamiento del cáncer diferenciado de tiroides con radioyodo a la luz de las guías y de la literatura científica
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M. Estorcha,
Corresponding author
mestorch@santpau.cat

Corresponding author.
, M. Mitjavilab, M.A. Murosc, E. Caballerod, on behalf of the Grupo de Trabajo de Endocrinología de la SEMNIM
a Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
c Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
d Servicio de Medicina Nuclear, Hospital Doctor Peset, Valencia, Spain
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Tables (4)
Table 1. 2017 TNM classification of the American Joint Committee on Cancer and the Union for International Cancer Control for differentiated thyroid cancer.
Table 2. Stratification of risk of persistence/recurrence of differentiated thyroid cancer according to the ATA 2015.
Table 3. Comparison between the 7th and 8th edition of the TNM Classification of the AJCC for differentiated thyroid cancer.
Table 4. Ablative treatment with 131I according to the ATA 2015.
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Abstract

In differentiated thyroid cancer (DTC), radioiodine is administered to eliminate residual normal thyroid tissue after thyroidectomy (ablative treatment), to treat residual microscopic disease (adjuvant treatment), and to treat macroscopic or metastatic disease. Currently, treatment of DTC with 131I is still a matter of controversy due to the absence of prospective clinical trials assessing its benefit in terms of overall survival and recurrence-free interval. The current recommendations of the experts are based on observational retrospective data and on their interpretation of the literature. Pending the results of the prospective trials that are currently underway, the use of 131I seems to be justified not only in high-risk patients, but also in intermediate-risk and low-risk patients. The guidelines of The American and British Thyroid Association, European and American Societies of Nuclear Medicine, The European Consensus Group and the latest edition of National Comprehensive Cancer Network (NCCN) were considered in drawing up this continuing education document, we also undertook a review of the related scientific literature.

Keywords:
Radioiodine treatment
131I
Differentiated thyroid cancer
Initial risk stratification
Dynamic risk stratification
Resumen

En el cáncer diferenciado de tiroides (CDT), el tratamiento con 131I se administra para eliminar tejido tiroideo residual sano postiroidectomía (tratamiento ablativo), para tratar enfermedad residual microscópica (tratamiento adyuvante) y para tratar enfermedad macroscópica o metastásica. A día de hoy, el tratamiento con 131I del CDT es todavía un tema de controversia debido a la ausencia de ensayos clínicos prospectivos que evalúen su beneficio en cuanto a supervivencia global e intervalo libre de recurrencia. Las recomendaciones actuales de los expertos se basan en datos retrospectivos observacionales y en su interpretación de la literatura. A la espera de los resultados de los ensayos prospectivos actualmente en marcha, la utilización del 131I parece estar justificada no solamente en los pacientes de alto riesgo, sino también en los de riesgo intermedio y bajo. Para la realización del presente documento de formación continuada se han considerado las guías de la Sociedad Americana y Británica de Tiroides, de las Sociedades Europea y Americana de Medicina Nuclear, el consenso del Grupo Europeo y la última edición del National Comprehensive Cancer Network (NCCN), así como se ha revisado la literatura científica relacionada.

Palabras clave:
Tratamiento con radioyodo
131I
Cáncer diferenciado de tiroides
Estratificación inicial de riesgo
Estratificación dinámica de riesgo

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