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Variations in Radioiodine Therapy in Europe: Decision-Making after Total Thyroidectomy
Flavio Forrer1, Galina Farina Fischer1,2, Ole Maas1
1Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Oncology
|November 17, 2021
Summary
Radioiodine therapy for differentiated thyroid cancer shows variability among European experts, especially for low-risk cases. Dosing and preparation methods differ, highlighting a need for clearer guidelines.
Area of Science:
- Nuclear Medicine
- Oncology
- Endocrinology
Background:
- Radioiodine therapy (RIT) following thyroidectomy for differentiated thyroid cancer (DTC) has evolving recommendations.
- Discrepancies exist between American Thyroid Association (ATA) and European Association of Nuclear Medicine (EANM) guidelines.
- Previous studies indicated variability in RIT practice within Swiss centers.
Purpose of the Study:
- To assess the variability in RIT practices among European experts in managing DTC.
- To map current expert practices regarding RIT administration, decision criteria, and treatment details.
- To compare European expert consensus with existing guidelines and previous national findings.
Main Methods:
- Decision-tree-based analysis of management strategies from EANM thyroid committee members.
- Data collection on RIT administration, decision-making criteria, treatment activities (I-131 doses), and patient preparation (rhTSH vs. hormone withdrawal).
- Analysis of expert agreement levels across different risk stratifications of DTC.
Main Results:
- Significant discrepancies observed in RIT use for low-risk DTC, with some experts recommending 'follow-up only' and others administering RIT.
- Agreement on RIT use for pT1b tumors without metastases was as low as 50%.
- I-131 activities ranged from 1.1 GBq to 3.0 GBq when RIT was administered.
- Experts diverged from guidelines in some cases (e.g., pT1a), with up to 75% administering RIT.
- Dosing and preparation methods varied distinctly for intermediate and high-risk patients.
- Overall agreement among European experts was higher than in the Swiss study.
Conclusions:
- Considerable variability exists in European expert management of RIT for DTC, particularly in low-risk patients.
- Divergence from current guidelines and significant differences in practice highlight the need for updated recommendations.
- Emerging approaches and ongoing studies may help reduce uncertainty in RIT treatment decisions.
- Consensus among European experts could inform future guideline development for RIT in DTC.
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