Radioiodine Refractory Differentiated Thyroid Cancer: Time to Update the Classifications.

MedStar author(s):
Citation: Thyroid. 28(9):1083-1093, 2018 Sep.PMID: 30105931Institution: MedStar Washington Hospital CenterDepartment: Medicine/Nuclear MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Adenocarcinoma/cl [Classification] | *Iodine Radioisotopes/tu [Therapeutic Use] | *Thyroid Neoplasms/cl [Classification] | Adenocarcinoma/pa [Pathology] | Adenocarcinoma/rt [Radiotherapy] | Humans | Thyroid Neoplasms/pa [Pathology] | Thyroid Neoplasms/rt [Radiotherapy]Year: 2018Local holdings: Available online from MWHC library: August 2000 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 1050-7256
Name of journal: Thyroid : official journal of the American Thyroid AssociationAbstract: BACKGROUND: The management of aggressive and progressing metastatic differentiated thyroid cancer (DTC) is very difficult, and the determination as to when such patients are refractory to <sup>131</sup>I therapy (e.g., radioiodine refractory) is problematic and controversial.CONCLUSION: Classifications to help determine radioiodine refractory disease will continue to evolve as (i) more studies are published, (ii) managing physicians better understand the limitations and confounding factors of present classifications, and (iii) new agents either increase or reestablish <sup>131</sup>I uptake.OBJECTIVE: The objective of this review is to discuss (i) the present major classifications of radioiodine refractory disease in DTC, (ii) factors that should be considered before designating a patient's DTC as radioiodine refractory, (iii) potential approaches and caveats to help manage and minimize a patient's exclusion from an <sup>131</sup>I therapy that may have potential benefit in patients with aggressive and progressing metastatic DTC, (iv) next steps for revision of the classifications of radioiodine refractory DTC, and (v) areas for future research.SUMMARY: To date, the classifications of radioiodine refractory DTC, although very useful, are not sacrosanct especially in the context of individualized patient management, and merely because a patient meets one or more of the various classifications, one should not consider by definition, fiat, or de facto that that a patient's DTC is radioiodine refractory. Rather, each patient should be individually managed with a good understanding of the limitations of the various classifications and potential approaches to help manage that patient. With awareness of the suggestions and caveats discussed herein and with assessment of the many other factors that affect the patient's specific clinical situation, the managing physician can deliver appropriate individualized patient care. A multi-organizational committee should be established as a standing committee to supervise and assist in the update of the classifications of radioiodine refractory DTC, including discussions of their limitations.All authors: Van Nostrand DFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-09-28
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30105931 Available 30105931

Available online from MWHC library: August 2000 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: The management of aggressive and progressing metastatic differentiated thyroid cancer (DTC) is very difficult, and the determination as to when such patients are refractory to <sup>131</sup>I therapy (e.g., radioiodine refractory) is problematic and controversial.

CONCLUSION: Classifications to help determine radioiodine refractory disease will continue to evolve as (i) more studies are published, (ii) managing physicians better understand the limitations and confounding factors of present classifications, and (iii) new agents either increase or reestablish <sup>131</sup>I uptake.

OBJECTIVE: The objective of this review is to discuss (i) the present major classifications of radioiodine refractory disease in DTC, (ii) factors that should be considered before designating a patient's DTC as radioiodine refractory, (iii) potential approaches and caveats to help manage and minimize a patient's exclusion from an <sup>131</sup>I therapy that may have potential benefit in patients with aggressive and progressing metastatic DTC, (iv) next steps for revision of the classifications of radioiodine refractory DTC, and (v) areas for future research.

SUMMARY: To date, the classifications of radioiodine refractory DTC, although very useful, are not sacrosanct especially in the context of individualized patient management, and merely because a patient meets one or more of the various classifications, one should not consider by definition, fiat, or de facto that that a patient's DTC is radioiodine refractory. Rather, each patient should be individually managed with a good understanding of the limitations of the various classifications and potential approaches to help manage that patient. With awareness of the suggestions and caveats discussed herein and with assessment of the many other factors that affect the patient's specific clinical situation, the managing physician can deliver appropriate individualized patient care. A multi-organizational committee should be established as a standing committee to supervise and assist in the update of the classifications of radioiodine refractory DTC, including discussions of their limitations.

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