Differentiated thyroid cancer theranostics: radioiodine and beyond

Area of Science:

• Nuclear Medicine
• Oncology
• Molecular Imaging

Background:

• Theranostics integrates diagnostic and therapeutic modalities for personalized disease management.
• Radioactive iodine (RAI) therapy, established in 1946 for thyroid cancer, is a foundational example of theranostics.
• Differentiated thyroid cancer (DTC) management has evolved using a multimodality approach centered on RAI therapy.

Purpose of the Study:

• To review the role of sodium iodide symporter (NIS) in the theranostic management of DTC with RAI.
• To discuss the current status of NIS in theranostics and explore molecular approaches for RAI-refractory disease.

Main Methods:

• Utilizing NIS expression in DTC cells for targeted RAI uptake and treatment.
• Employing diagnostic imaging like whole body iodine scintigraphy (WBS) and FDG-PET-CT to assess NIS status.
• Leveraging SPECT-CT for enhanced precision in localizing iodine-avid and non-avid disease foci.

Main Results:

• NIS expression is crucial for successful RAI trapping in DTC, enabling treatment of residual and metastatic disease.
• NIS status, assessed via WBS or PET-CT, guides personalized theranostic strategies.
• SPECT-CT improves the accuracy of disease localization, refining treatment personalization.

Conclusions:

• NIS plays a key role in the theranostic approach to DTC management with RAI.
• The theranostic strategy, guided by NIS status, remains a cornerstone for curing most DTC patients.
• Future directions include molecular approaches for managing RAI-refractory DTC.