Zeenat Jabin1, Seong Young Kwon1, Hee-Seung Bom1, Yansong Lin2, Ke Yang3, Anri Inaki4, Ayu Rosemeilia Dewi5, Akram N Al-Ibraheem6, Batool Al Balooshi7, Teofilo O L San Luis8. 1. Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea. 2. Department of Nuclear Medicine, Peking Union Medical College Hospital. 3. Department of Nuclear Medicine, Chinese Academy of Medical Sciences, Beijing, China. 4. Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan. 5. Department of Nuclear Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia. 6. Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan. 7. Department of Nuclear Medicine, Dubai hospital, Dubai, United Arab Emirates. 8. Department of Nuclear Medicine, St Luke's Medical Center, Quezon City, Philippines.
Abstract
OBJECTIVE: This survey was designed to investigate the practice of radioactive iodine (RAI) therapy and clinico-social factors related to RAI dose in differentiated thyroid cancer (DTC) patients among Asian countries. MATERIALS AND METHODS: A survey questionnaire was mailed to Asian Nuclear Medicine physicians that addressed the infrastructure, general regulations on RAI therapy, adherence to recommendations, RAI dose selection, factors to elevate RAI dose, and follow-up protocols in DTC patients. Contrived RAI practice recommendations were based on key international guidelines. RESULTS: A total of 38 institutes from 20 Asian countries were enrolled. Dose administration criterion was 30 mCi, but release criterion was variable (5-70 μSv/h). When the administered RAI dose was classified according to three risk stratifications, RAI dose distribution was variable, especially in the low-risk group. In this group, 14.0% of respondents preferred no ablation, 54.5% were treated with 0-30 mCi, 21.5% were treated with 30-50 mCi, and 10.0% were administered even higher doses of 80-100 mCi. The major factors that influenced the elevated RAI doses in the respondents included high serum thyroglobulin (Tg), inadequate information on lymph node involvement, and histopathology reporting. Although serum Tg measurement is included in most of the institutes as a follow-up tool, neck ultrasound was omitted in 25% and in another 25% a whole-body scan was not included. CONCLUSION: Different RAI dose ranges are used in the low-risk group probably because the enrolled physicians consider RAI dose elevation on the basis of clinico-social factors beyond pre-existed guidelines. Our study may enable closer harmonization of RAI therapy practice in Asian countries.
OBJECTIVE: This survey was designed to investigate the practice of radioactive iodine (RAI) therapy and clinico-social factors related to RAI dose in differentiated thyroid cancer (DTC) patients among Asian countries. MATERIALS AND METHODS: A survey questionnaire was mailed to Asian Nuclear Medicine physicians that addressed the infrastructure, general regulations on RAI therapy, adherence to recommendations, RAI dose selection, factors to elevate RAI dose, and follow-up protocols in DTC patients. Contrived RAI practice recommendations were based on key international guidelines. RESULTS: A total of 38 institutes from 20 Asian countries were enrolled. Dose administration criterion was 30 mCi, but release criterion was variable (5-70 μSv/h). When the administered RAI dose was classified according to three risk stratifications, RAI dose distribution was variable, especially in the low-risk group. In this group, 14.0% of respondents preferred no ablation, 54.5% were treated with 0-30 mCi, 21.5% were treated with 30-50 mCi, and 10.0% were administered even higher doses of 80-100 mCi. The major factors that influenced the elevated RAI doses in the respondents included high serum thyroglobulin (Tg), inadequate information on lymph node involvement, and histopathology reporting. Although serum Tg measurement is included in most of the institutes as a follow-up tool, neck ultrasound was omitted in 25% and in another 25% a whole-body scan was not included. CONCLUSION: Different RAI dose ranges are used in the low-risk group probably because the enrolled physicians consider RAI dose elevation on the basis of clinico-social factors beyond pre-existed guidelines. Our study may enable closer harmonization of RAI therapy practice in Asian countries.