The “reset button” revisited: why high activity ¹³¹I therapy of advanced differentiated thyroid cancer after dosimetry is advantageous for patients

Excerpt

The treatment of advanced differentiated thyroid cancer (DTC) remains challenging. In spite of our best efforts, about 15% of patients with high-risk DTC have a significantly reduced life expectancy as many do not respond sufficiently to ¹³¹I therapy to prevent recurrence and progression of DTC, or even death [1]. Furthermore, it has been firmly established that the more advanced the DTC, the worse will be the prognosis [1]. Therefore, there is an ongoing quest to optimize ¹³¹I therapy in patients with locally advanced or metastatic disease. Although at the other end of the disease spectrum, the discussion on optimization of ¹³¹I therapy in advanced DTC essentially comes down to the same point as is currently debated extensively in low-risk and intermediate-risk DTC: what ¹³¹I activity is “best” or “better” [2‐4]? However, in contrast to the discussion in patients at the lower end of the risk spectrum, in patients with advanced DTC, the scientific debate is not about a “low”, a “lower” or “no” ¹³¹I activity, but instead about a “high” or a “higher” ¹³¹I activity [5, 6]. …