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CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(02): 123-126
DOI: 10.4103/wjnm.wjnm_117_18
Editorial

The World Association of Radiopharmaceutical and Molecular Therapy position statement on the initial radioiodine therapy for differentiated thyroid carcinoma

S Dizdarevic
1   Department of Imaging and Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, UK
,
M Tulchinsky
2   Radiology Department, Nuclear Medicine Section, Penn State University, Milton S. Hershey Medical Center, USA
,
V McCready
1   Department of Imaging and Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, UK
,
J Mihailovic
3   Department of Nuclear Medicine, Oncology Institute of Vojvodina, Sremska Kamenica, University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
,
S Vinjamuri
4   Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool
,
J Buscombe
5   Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge, UK
,
S Lee
6   Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Australia
7   Olivia Newton-John Cancer Research Institute, Heidelberg, Australia School of Cancer Medicine, La Trobe University, Heidelberg, Australia
,
S Frangos
8   Department of Nuclear Medicine, Bank of Cyprus Oncology Center, Nicosia, Cyprus
,
M Sathekge
9   Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
,
Q Siraj
10   Department of Nuclear Medicine, Farwania Hospital, Kuwait
,
P Choudhury
11   Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
,
H Bom
12   Department of Nuclear Medicine, Asian Regional Cooperative Council for Nuclear Medicine (ARCCNM), Chonnam National University Medical School, Gwangju, South Korea
,
M Franceschi
13   Department of Oncology and Nuclear Medicine, Sestre Milosrdnice, UHC, Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia, Faculty of Medicine, University of Osijek, Osijek, Croatia
,
A Ugrinska
14   Institute of Pathophysiology and Nuclear Medicine, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
,
D Paez
15   Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
,
R Hussain
16   Nuclear Medicine and Molecular Imaging, Apollo Hospitals Dhaka, Society of Nuclear Medicine, Bangladesh (SNMB)
,
J Mailman
17   World Association of Radiopharmaceutical and Molecular Therapy (WARMTH), Oakland, CA, USA
,
M Luster
18   Department of Nuclear Medicine, University Hospital Marburg, Marburg
,
I Virgolini
19   Department of Nuclear Medicine, Medical University of Innsbruck, Austria
,
On behalf of the WARMTH Thyroid Group › Author Affiliations
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Introduction

The World Association of Radiopharmaceutical and Molecular Therapy (WARMTH) is a worldwide nonprofit organization, which is dedicated to educating medical professionals in the use of radionuclide therapies based on the theragnostic principles and to harmonizing appropriate evidence-based practices worldwide.

Radionuclide therapy with radioiodine for thyroid conditions has been utilized for over 77 years since the first use of radioiodine (RAI) in a patient by Saul Hertz.[1] Over the years, new radionuclides of iodine have been introduced, which have improved diagnostic imaging quality. However, the basic concept of using a radiopharmaceutical to interrogate its affinity for a molecular target, in this case the sodium–iodide symporter, and later use of a biosimilar or identical agent formulated to deliver a radiation-absorbed dose to achieve a therapeutic effect remains the most enduring example of an optimal theragnostic approach.[2] Radiotheragnostic approach takes advantage of using a targeted radiopharmaceutical that demonstrates avidity to the disease-affected organ(s) or cells in an orderly manner. First, the avidity of the theragnostic radiopharmaceutical to the target is tested by administration of a diagnostic activity of the agent or its biosimilar analog labeled with the same or a radioisotope with optimal imaging characteristics. Second, the therapeutic activity of the theragnostic radiopharmaceutical is selected based on the information obtained from the diagnostic radiopharmaceutical, as well as taking into consideration ancillary diagnostic factors, such as other diagnostic imaging modalities, laboratory markers of the disease process as well as relevant physical and functional patients' characteristics. Since the introduction of RAI, there have been many attempts to discover and develop another “magic bullet” for diagnosis and therapy using a variety of radiopharmaceuticals that only recently began to bear fruit in cancer management.[3]

There are many international guidelines addressing RAI therapy in the differentiated thyroid cancer (DTC), such as from the European Association of Nuclear Medicine (EANM),[4] the Society of Nuclear Medicine and Molecular Imaging,[5] the American Thyroid Association (ATA),[6] as well as many national guidelines. They all differ significantly in principles and recommendations, for example, European panelists suggested modifications to approximately one-third of ATA 2015 recommendations. Those varying perspectives stimulated continuing debates, and the stakeholders concede that additional research is needed to resolve discrepant recommendations and potentially improve patient outcomes.[7] The WARMTH is a key stakeholder organization that is inherently enabled to facilitate a worldwide outreach to all professionals authorized in safe and effective administration of RAI therapy. Hence, in this introductory position statement, the WARMTH will channel its collective understanding of the first or initial RAI (iRAI) administration post total or near-total thyroidectomy for DTC and goals for the future investigations. The statement is also aimed to facilitate understanding of the key issues and homogenize the appropriate use of terminology in the memberships' countries of practice. The WARMTH will also seek to issue further position statements on the various key matters, including, but not limited to the need for preablation scans, the need for single-photon emission computed tomography-computed tomography (SPECT-CT) in addition to whole-body (WB) scans, the role of thyroglobulin (Tg) measurement, the use of hormone withdrawal versus recombinant human thyroid-stimulating hormone (rhTSH) stimulation, the role of fluorine-18-fluorodeoxyglucose-positron emission tomography-CT (18F-FDG-PET-CT), optimum treatment and follow-up regime, role of dosimetry, role of tyrosine kinase inhibitors, and when to discharge patients to community care.



Publication History

Received: 00 00 2019

Accepted: 00 00 2019

Article published online:
22 April 2022

© 2019. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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