22
Treatment
Recommendation 56
A. Pulmonary micrometastases can be treated with RAI therapy, and
this may be repeated if the disease continues to concentrate RAI and
clinically respond. (C-L)
B. RAI dosing for pulmonary micrometastases should either be empiric
(3.7–7.4 GBq, 100–200 mCi, or 3.7–5.55 GBq, 100–150 mCi for
patients >70 years) or estimated by dosimetry to limit whole-body
retention to 2.96 GBq (80 mCi) at 48 hours with 200 cGy to the bone
marrow. (GPS)
C. Radioiodine-avid macronodular metastases can be treated with RAI,
and treatment can be repeated when objective benefit is demonstrated.
RAI dosing either may be empiric (3.7–7.4 GBq, 100–200 mCi, or
3.7–5.55 GBq, 100–150 mCi for patients >70 years) or informed by
whole-body dosimetry to limit whole-body retention to 2.96 GBq (80
mCi) at 48 hours with 200 cGy to the bone marrow. (C-L)
Recommendation 57
A. RAI for iodine-avid bone metastases has been associated with
improved survival and should be employed. (S-L)
B. The activity administered could be given either empirically (3.7–7.4
GBq, 100–200 mCi) or as determined by dosimetry. (C-VL)
Recommendation 58
A. In the absence of structurally demonstrable disease, patients with
stimulated serum Tg <10 ng/mL after thyroid hormone withdrawal or
<5 ng/mL with rhTSH (indeterminate response) can be followed with
thyroid hormone therapy alone, reserving additional treatment for
emergence of rising serum Tg levels over time or other evidence of
structural disease progression. (C-L)
B. Empiric (3.7–7.4 GBq, 100–200 mCi) or dosimetrically-determined
RAI therapy may be considered in patients with more significantly
elevated or rapidly rising serum Tg levels where imaging (e.g., cross
sectional imaging and/or
18
FDG-PET/CT) has failed to reveal tumor
amenable to directed therapy. (C-L)
C. If persistent nonresectable disease is localized after empiric
administration of RAI, and there is objective evidence of significant
tumor reduction, then repeated RAI therapy can be considered until
the tumor has been eradicated or the tumor no longer responds to
treatment. (C-L)
