21
Recommendation 52
A. A decision to perform a therapeutic compartmental or focused
central and/or lateral neck operation in the re-operative setting
should be based on a combination of factors. These include extent of
prior operation(s), size and anatomic location of new disease, pace
of growth, patient factors and preference, and context to overall
disease management. (GPS)
B. Percutaneous ethanol ablation may be considered an alternative
therapy for recurrent or residual thyroid cancer, with greatest use in
patients at high-risk for complications from reoperation. (C-L)
C. Radiofrequency (RFA) may be considered an alternative therapy in
recurrent or residual thyroid cancer, with greatest use in patients at
high-risk for complications from reoperation. (C-L)
Recommendation 53
➤ Additional RAI therapy for identified isolated cervical lymph
node metastases may be considered after local therapy has been
performed or if local therapy is not feasible. (C-L)
Recommendation 54
➤ EBRT using modern techniques such as intensity-modulated radiation
therapy (IMRT) and stereotactic radiation may be considered for
locoregional recurrences that are not surgically resectable or when
there is extranodal extension or involvement of soft tissues. (C-L)
Recommendation 55
A. Empirically administered amounts of
131
I >5.5 GBq (150 mCi) that
have high potential to exceed toxicity parameters should be avoided
in patients >70 years or with renal failure. Such patients should be
evaluated with dosimetry to confirm safety prior to RAI administration
if doses >5.5 GBq (150 mCi) are being considered. (S-M)
B. Dosimetry-guided RAI (either lesional or maximum tolerated activity)
may be considered in patients with locoregional or metastatic disease
when administered activities >5.5 GBq (150 mCi) are considered. (C-M)
C. rhTSH-mediated elevation or levothyroxine withdrawal may be utilized
to prepare patients with distant metastatic disease who are being
treated with RAI. (C-L)
