Controversies, Consensus, and Collaboration in the Use of 131I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association.

MedStar author(s):
Citation: Thyroid. 29(4):461-470, 2019 04.PMID: 30900516Institution: MedStar Washington Hospital CenterDepartment: Medicine/Nuclear MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cell Differentiation | *Iodine Radioisotopes/tu [Therapeutic Use] | *Radiation Oncology/st [Standards] | *Radiopharmaceuticals/tu [Therapeutic Use] | *Thyroid Neoplasms/rt [Radiotherapy] | Consensus | Evidence-Based Medicine/st [Standards] | Humans | Iodine Radioisotopes/ae [Adverse Effects] | Radiopharmaceuticals/ae [Adverse Effects] | Thyroid Neoplasms/pa [Pathology]Year: 2019Local 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: Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (<sup>131</sup>I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues.CONCLUSION: By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique Principles) that (i) describe a commitment to proactive, purposeful, and inclusive interdisciplinary cooperation; (ii) define the goals of <sup>131</sup>I therapy as remnant ablation, adjuvant treatment, or treatment of known disease; (iii) describe the importance of evaluating postoperative disease status and multiple other factors beyond clinicopathologic staging in <sup>131</sup>I therapy decision making; (iv) recognize that the optimal administered activity of <sup>131</sup>I adjuvant treatment cannot be definitely determined from the published literature; and (v) acknowledge that current definitions of <sup>131</sup>I-refractory disease are suboptimal and do not represent definitive criteria to mandate whether <sup>131</sup>I therapy should be recommended.SUMMARY: To address some of the differences in opinion and controversies associated with the therapeutic uses of <sup>131</sup>I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for <sup>131</sup>I adjuvant treatment; (iii) define the optimal prescribed activity of <sup>131</sup>I for adjuvant treatment; and (iv) clarify the definition and classification of <sup>131</sup>I-refractory thyroid cancer.All authors: Ahuja S, Avram AM, Bernet VJ, Bourguet P, Daniels GH, Dillehay G, Draganescu C, Flux G, Fuhrer D, Giovanella L, Greenspan B, Hegedus L, Luster M, Muylle K, Smit JWA, Tuttle RM, Van Nostrand D, Verburg FAOriginally published: Thyroid. 29(4):461-470, 2019 Apr.Original year of publication: 2019Fiscal year: FY2019FY2019Digital Object Identifier: Date added to catalog: 2019-05-21
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 30900516

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

BACKGROUND: Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (<sup>131</sup>I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues.

CONCLUSION: By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique Principles) that (i) describe a commitment to proactive, purposeful, and inclusive interdisciplinary cooperation; (ii) define the goals of <sup>131</sup>I therapy as remnant ablation, adjuvant treatment, or treatment of known disease; (iii) describe the importance of evaluating postoperative disease status and multiple other factors beyond clinicopathologic staging in <sup>131</sup>I therapy decision making; (iv) recognize that the optimal administered activity of <sup>131</sup>I adjuvant treatment cannot be definitely determined from the published literature; and (v) acknowledge that current definitions of <sup>131</sup>I-refractory disease are suboptimal and do not represent definitive criteria to mandate whether <sup>131</sup>I therapy should be recommended.

SUMMARY: To address some of the differences in opinion and controversies associated with the therapeutic uses of <sup>131</sup>I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for <sup>131</sup>I adjuvant treatment; (iii) define the optimal prescribed activity of <sup>131</sup>I for adjuvant treatment; and (iv) clarify the definition and classification of <sup>131</sup>I-refractory thyroid cancer.

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