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Lung only 44
Despite the generally good prognosis in most cases, ap-
Bone only 18 proximately 10% of the patients with DTC, some with an
Lung and bone 12 unexpectedly aggressive clinical course, die of their disease.
Lung and other 7 The indications and appropriate use of available treatment
Cervical 6 options (i.e., surgery, RAI treatment, and thyroid hormone)
Other 8
have been subjects of controversy for many decades. Be-
Tg
Patient Age Therapy Dose Dose to tumor or second Before After Cause of
no. (y) Met.* date GBq to BM organ at risk therapy therapy Surv. death
*Met. metastasis or metastases (1 lung, 2 bone, 3 other, 4 lymph nodes, 5 local recurrence).
Dose to tumor: calculated tumor dose; if mentioned, dose to second organ at risk or reason why no exact dose could be given. Met
metastasis or metastases.
Tg before and after (minimum) therapy: TSH 0.1; TSH 20 (italics).
Surv. survival (years after first curative-intent radioiodine therapy).
DTC or other (other than DTC).
cause of the protracted course of most thyroid carcinoma with RAI (10). The early results of the National Thyroid
cases, it is extremely difficult to design a prospective ran- Cancer Treatment Cooperative Study confirmed that post-
domized clinical trial evaluating the efficacy of RAI treat- operative RAI treatment was associated with improved can-
ment. Large retrospective series have clearly demonstrated cer-specific mortality rates and disease progression in both
a significant outcome benefit for both ablation and therapy papillary and follicular cancer (11).
maximizing the administered dose, one has a better chance pecially when a thyroid hormone withdrawal protocol is
of overcoming the anatomic and physiologic obstacles of applied) favorably affect the quality of life in patients
nonhomogeneous distribution. with DTC.
The potential impact of the stunning effect on the efficacy
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