Radioiodine-131 therapy for well-differentiated thyroid cancer--a quantitative radiation dosimetric approach: outcome and validation in 85 patients.

TLDR

For five decades, 131I therapy of thyroid cancer relied on empiric activity dosing until 1983 when dose thresholds for successful treatment were defined. This study validates those dose thresholds in 85 patients. Standardizing to a minimum dose of 30,000 cGy achieved ablation in 84 % of inpatients and 79 % of outpatients, while lymph node metastases were successfully treated in 74 % of patients with ≥8,500 cGy and in 86 % of athyrotic nodal cases with ≥14,000 cGy, matching or exceeding empiric outcomes and enabling selective outpatient therapy in 47 % of cases.

Abstract

For almost five decades, 131I treatment of thyroid cancer has been based empirically on administered activity rather than on actual radiation doses delivered. In 1983, we defined radiation dose thresholds for successful treatment. This report is concerned with the subsequent validation of those thresholds in 85 patients. The successful ablation of thyroid remnants occurred after a single initial 131I administration in 84% of inpatients and in 79% of outpatients when treatment was standardized to a radiation dose of at least 30,000 cGy (rad). Administered activities low enough to permit outpatient therapy could be used in 47% of the patients. Lymph node metastases were treated successfully in 74% of patients with a single administration of 131I calculated to deliver at least 8,500 cGy (rad). For athyrotic patients with nodal metastases only, success was achieved in 86% of patients at tumor doses of at least 14,000 cGy (rad). These success rates are equal to or better than those reported with empiric methods of 131I administration. The individualized treatment planning selectively allocates hospitalization and higher exposures to 131I to those patients who require them.