ATA Guidelines Tools

DTC: Long-Term Management and Advanced Cancer Management 30 90. Men receiving cumulative radioiodine activities >400 mCi should be counseled on potential risk of infertility. (SR-M) 91. Radioiodine-refractory structurally-evident DTC is defined classified in patients with appropriate TSH stimulation and iodine preparation in four basic ways: A) The malignant/metastatic tissue does not ever concentrate radioiodine (no uptake outside the thyroid bed at the first diagnostic or therapeutic WBS). B) The tumor tissue loses the ability to concentrate radioiodine after previous evidence of RAI-avid disease (in the absence of stable iodine contamination). C) Radioiodine is concentrated in some lesions but not in others. D) Metastatic disease progresses despite significant concentration of radioiodine. When a patient with DTC is classified as refractory to radioiodine, there is no indication for further radioiodine treatment. (WR-L) 92. A) Patients with 131 I refractory metastatic DTC that is asymptomatic, stable or minimally progressive, not likely to develop rapidly progressive, clinically significant complications, and do not have indications for directed therapy can be monitored on TSH- suppressive thyroid hormone therapy with serial radiographic imaging every 3–12 months. (WR-L) B) BRAF or other mutational testing is not routinely recommended for prognostic purposes in patients with radioiodine-refractory, progressive, locally advanced or metastatic DTC. (WR-M) 93. A) Both stereotactic radiation and thermal ablation (RFA and cryoablation) show a high efficacy in treating individual distant metastases with relatively few side effects and may be considered as valid alternatives to surgery. (WR-M) B) Stereotactic radiation or thermal ablation should be considered prior to initiation of systemic treatment when individual distant metastases are symptomatic or at high risk of local complications. (SR-M) 94. While surgical resection and stereotactic external beam radiotherapy are the mainstays of therapy for CNS metastases, RAI can be considered if CNS metastases concentrate RAI. If RAI is being considered, stereotactic external beam radiotherapy and concomitant glucocorticoid therapy are recommended prior to RAI therapy to minimize the effects of a potential TSH-induced increase in tumor size and RAI-induced inflammatory response. (WR-L)

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