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Selective use of RAI for ablation and adjuvant therapy after total thyroidectomy for differentiated thyroid cancer: a practical approach to clinical decision making.
Oral Oncol 2013; 49(7):676-83OO

Abstract

OBJECTIVES

For the past 40 years, many clinicians have recommended RAI remnant ablation for essentially all differentiated thyroid cancer patients with a primary tumor size greater than 1.5 cm or with any evidence of even microscopic disease outside the thyroid capsule. This "one size fits all" approach exposes many low risk thyroid cancer patients to the risks of ionizing radiation with little potential benefit. Current thyroid cancer management guidelines call for a far more risk adapted approach to the selection of patients for post-operative RAI treatment.

MATERIALS AND METHODS

We will review the current selective use of RAI ablation recommendations and provide a practical approach to implementation of a risk adapted approach to post-operative RAI administration.

RESULTS AND CONCLUSIONS

We will show how thoughtful integration of pre-operative, intra-operative, and post-operative clinico-pathologic factors allows the clinician to accurately identify patients most likely to benefit from RAI administration. This approach ensures that patients most likely to experience a clinical benefit are selected for RAI ablation while avoiding unnecessary exposure to ionizing radiation in the majority of low to intermediate risk thyroid cancer patients.

Authors+Show Affiliations

Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. tuttlem@mskcc.orgNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23601564

Citation

Tuttle, R Michael, and Mona M. Sabra. "Selective Use of RAI for Ablation and Adjuvant Therapy After Total Thyroidectomy for Differentiated Thyroid Cancer: a Practical Approach to Clinical Decision Making." Oral Oncology, vol. 49, no. 7, 2013, pp. 676-83.
Tuttle RM, Sabra MM. Selective use of RAI for ablation and adjuvant therapy after total thyroidectomy for differentiated thyroid cancer: a practical approach to clinical decision making. Oral Oncol. 2013;49(7):676-83.
Tuttle, R. M., & Sabra, M. M. (2013). Selective use of RAI for ablation and adjuvant therapy after total thyroidectomy for differentiated thyroid cancer: a practical approach to clinical decision making. Oral Oncology, 49(7), pp. 676-83. doi:10.1016/j.oraloncology.2013.03.444.
Tuttle RM, Sabra MM. Selective Use of RAI for Ablation and Adjuvant Therapy After Total Thyroidectomy for Differentiated Thyroid Cancer: a Practical Approach to Clinical Decision Making. Oral Oncol. 2013;49(7):676-83. PubMed PMID: 23601564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selective use of RAI for ablation and adjuvant therapy after total thyroidectomy for differentiated thyroid cancer: a practical approach to clinical decision making. AU - Tuttle,R Michael, AU - Sabra,Mona M, Y1 - 2013/04/16/ PY - 2013/4/23/entrez PY - 2013/4/23/pubmed PY - 2014/1/15/medline SP - 676 EP - 83 JF - Oral oncology JO - Oral Oncol. VL - 49 IS - 7 N2 - OBJECTIVES: For the past 40 years, many clinicians have recommended RAI remnant ablation for essentially all differentiated thyroid cancer patients with a primary tumor size greater than 1.5 cm or with any evidence of even microscopic disease outside the thyroid capsule. This "one size fits all" approach exposes many low risk thyroid cancer patients to the risks of ionizing radiation with little potential benefit. Current thyroid cancer management guidelines call for a far more risk adapted approach to the selection of patients for post-operative RAI treatment. MATERIALS AND METHODS: We will review the current selective use of RAI ablation recommendations and provide a practical approach to implementation of a risk adapted approach to post-operative RAI administration. RESULTS AND CONCLUSIONS: We will show how thoughtful integration of pre-operative, intra-operative, and post-operative clinico-pathologic factors allows the clinician to accurately identify patients most likely to benefit from RAI administration. This approach ensures that patients most likely to experience a clinical benefit are selected for RAI ablation while avoiding unnecessary exposure to ionizing radiation in the majority of low to intermediate risk thyroid cancer patients. SN - 1879-0593 UR - https://www.unboundmedicine.com/medline/citation/23601564/Selective_use_of_RAI_for_ablation_and_adjuvant_therapy_after_total_thyroidectomy_for_differentiated_thyroid_cancer:_a_practical_approach_to_clinical_decision_making_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1368-8375(13)00520-4 DB - PRIME DP - Unbound Medicine ER -