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Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy

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Abstract

Radiotheragnostics represents the systematic integration of diagnostic imaging and therapeutics using radionuclides targeting specific characteristics of tumor biology. Radioiodine (131I) is the classic radiotheragnostic agent used for the diagnosis and treatment of differentiated thyroid cancer based on sodium-iodine symporter expression in normal and neoplastic thyroid tissue. Application of radiotheragnostics principles in thyroid cancer involves using pre-ablation diagnostic scans (Dx Scans) for detection of iodine-avid regional and distant metastatic disease and patient-individualized targeted 131I therapy with goal of maximizing the benefits of the first therapeutic 131I administration. Clinically available nuclear medicine imaging technology has significantly evolved over the past 10 years with the introduction of hybrid SPECT/CT and PET/CT systems, as well as advances in iterative image reconstruction with modeling of image degrading physical factors. This progress makes possible the acquisition of accurate diagnostic radioiodine scintigraphy capable of identifying regional and distant metastatic disease, which can be used for 131I treatment planning and delivery of activity adjusted 131I therapy for achieving intended treatment goals (e.g., remnant ablation, adjuvant 131I treatment and targeted 131-I treatment). The overarching aim of thyroid cancer radiotheragnostics is to optimize the balance between 131I therapeutic efficacy and potential side-effects on non-target tissues.

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Abbreviations

Anti-Tg Ab:

Anti-thyroglobulin antibody

ATA:

American Thyroid Association

DTC:

Differentiated thyroid cancer

Dx Scan:

Diagnostic 131I scan with single-photon emission computer tomography (SPECT) with inline computed tomography (CT) SPECT/CT

ETE:

Extra-thyroidal extension

L-T4:

Levothyroxine

Post-Rx scan:

Post-therapy 131I scan

PTC:

Papillary thyroid cancer

Tg:

Thyroglobulin

THW:

Thyroid hormone withdrawal

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Funding

The authors have received funding support 2-R01-EB-001994 awarded by the National Institute of Biomedical Imaging and Bioengineering, National Institute of Health, U.S. Department of Health and Human Services.

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  1. Division of Nuclear Medicine, Department of Radiology, University of Michigan Medical Center, B1G505G University Hospital, 1500E. Medical Center Drive, Ann Arbor, MI, 48109-5028, USA

    Anca M. Avram & Yuni K. Dewaraja

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Avram, A.M., Dewaraja, Y.K. Thyroid cancer radiotheragnostics: the case for activity adjusted 131I therapy. Clin Transl Imaging 6, 335–346 (2018). https://doi.org/10.1007/s40336-018-0291-x

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