Controversies, Consensus, and Collaboration in the Use of ¹³¹I Therapy in Differentiated Thyroid Cancer: A Joint Statement from the American Thyroid Association, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association

Abstract

Background: Publication of the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer was met with disagreement by the extended nuclear medicine community with regard to some of the recommendations related to the diagnostic and therapeutic use of radioiodine (131 I). Because of these concerns, the European Association of Nuclear Medicine and the Society of Nuclear Medicine and Molecular Imaging declined to endorse the ATA guidelines. As a result of these differences in opinion, patients and clinicians risk receiving conflicting advice with regard to several key thyroid cancer management issues. Summary: To address some of the differences in opinion and controversies associated with the therapeutic uses of 131 I in differentiated thyroid cancer constructively, the ATA, the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the European Thyroid Association each sent senior leadership and subject-matter experts to a two-day interactive meeting. The goals of this first meeting were to (i) formalize the dialogue and activities between the four societies; (ii) discuss indications for 131 I adjuvant treatment; (iii) define the optimal prescribed activity of 131 I for adjuvant treatment; and (iv) clarify the definition and classification of 131 I-refractory thyroid cancer. Conclusion: By fostering an open, productive, and evidence-based discussion, the Martinique meeting restored trust, confidence, and a sense of collegiality between individuals and organizations that are committed to optimal thyroid disease management. The result of this first meeting is a set of nine principles (The Martinique

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

“…However, the European Association of Nuclear Medicine (EANM) has not endorsed this recommendation [45], mainly because prospective RCT data showing that surveillance is non-inferior to RAI administration are lacking. The ATA, the EANM, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Thyroid Association (ETA) have recently published a joint statement acknowledging the absence of high-quality evidence either for or against the postoperative use of 131 I in lowrisk patients [46]. They conclude that decisions should be taken on an individual basis, depending on tumour features (e.g.…”

MANAGEMENT OF ENDOCRINE DISEASE: The role of rhTSH in the management of differentiated thyroid cancer: pros and cons

“…The adoption of a nomenclature that uses 'I-131 therapy' as the broad term encompassing the three primary goals associated with an administered activity of I-131 was recently proposed (9). a.…”

“…Admittedly, previous literature is severely hampered by the retrospective design of most studies, the inclusion of patients treated with mixed ablation and adjuvant intents and the use of different stimulation protocols and RAI-administered activities. Accordingly, an international multidiciplinary panel recently stated that 'until the results of prospective multicenter studies centering on relevant outcomes of adjuvant postoperative RAI treatment, including disease-specific survival and disease-free survival as well as the incidence of side effects, are available, the stimulation method and the activity to be prescribed for adjuvant treatment of DTC remains a question best answered on an individual basis in a multidisciplinary setting' (9). Interestingly, advantages of rhTSH in terms of QoL and side effects were evaluated using prolonged THW periods (i.e.…”

No time like the present: time to re-think our habits in science and continuous medical education?

“…It will also make sure that we as physicians are away from the daily grind and can fully focus on either presenting or attending presentations and continuous medical education, without being unduly disturbed for the business of the day. Furthermore, as is for instance very well illustrated by the inter-societal meeting of the European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, European Thyroid Association and American Thyroid Association: in person meetings of top-level experts at a secluded location, again without the distractions of everyday life and the chance to socialise outside of the meeting room, can be the only way forward in resolving professional differences [3,4].…”