Surgery Versus 131I Versus External Beam Radiotherapy EBRT Therapy Versus No Therapy

Patients with high serum Tg levels should be treated with surgery, whenever possible (Figure 20.3). Patients should not be treated with 131I if they have any of the following five conditions: (1) HAB Tg interference; (2) after adequate preparation, there is no 131I uptake on RxWBS; (3) there is no fall in Tg within a year after 131I therapy; (4) there is intense uptake of 18FDG-PET by metastases; or (5) anatomical imaging such as ultrasonography reveals tumor deposits amenable to surgery. EBRT should be considered in patients over 45 years who have locally invasive (pT4 tumors), unresectable regional

PET Results and Therapeutic Response to 131I Among Patients with Distant metastases and positive or negative FDG-PET Scans

Figure 20.4 The relationship of the therapeutic response to 131I is related to 18FDG-PET results. When there is avid uptake of 18FDG, subsequent 131I treatment was largely ineffective in 25 patients in the study group, in which there was a 32% increase in serum Tg over time (right bar) while a negative 18FDG-PET scan was associated with a 62% decline in serum Tg concentrations after 131I therapy in the control group. (Drawn from the data of Wang et al. [59].)

Figure 20.4 The relationship of the therapeutic response to 131I is related to 18FDG-PET results. When there is avid uptake of 18FDG, subsequent 131I treatment was largely ineffective in 25 patients in the study group, in which there was a 32% increase in serum Tg over time (right bar) while a negative 18FDG-PET scan was associated with a 62% decline in serum Tg concentrations after 131I therapy in the control group. (Drawn from the data of Wang et al. [59].)

Negative Positive

18FDG-PET Results tumor that does not concentrate 131I (Figure 20.3).

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