Nuclear Medicine Research, MedStar Health Research Institute and Washington Hospital Center , Washington, DC.
Thyroid. 2018 Sep;28(9):1083-1093. doi: 10.1089/thy.2018.0048.
The management of aggressive and progressing metastatic differentiated thyroid cancer (DTC) is very difficult, and the determination as to when such patients are refractory to I therapy (e.g., radioiodine refractory) is problematic and controversial.
The objective of this review is to discuss (i) the present major classifications of radioiodine refractory disease in DTC, (ii) factors that should be considered before designating a patient's DTC as radioiodine refractory, (iii) potential approaches and caveats to help manage and minimize a patient's exclusion from an I therapy that may have potential benefit in patients with aggressive and progressing metastatic DTC, (iv) next steps for revision of the classifications of radioiodine refractory DTC, and (v) areas for future research.
To date, the classifications of radioiodine refractory DTC, although very useful, are not sacrosanct especially in the context of individualized patient management, and merely because a patient meets one or more of the various classifications, one should not consider by definition, fiat, or de facto that that a patient's DTC is radioiodine refractory. Rather, each patient should be individually managed with a good understanding of the limitations of the various classifications and potential approaches to help manage that patient. With awareness of the suggestions and caveats discussed herein and with assessment of the many other factors that affect the patient's specific clinical situation, the managing physician can deliver appropriate individualized patient care. A multi-organizational committee should be established as a standing committee to supervise and assist in the update of the classifications of radioiodine refractory DTC, including discussions of their limitations.
Classifications to help determine radioiodine refractory disease will continue to evolve as (i) more studies are published, (ii) managing physicians better understand the limitations and confounding factors of present classifications, and (iii) new agents either increase or reestablish I uptake.
侵袭性和进展性转移性分化型甲状腺癌（DTC）的治疗极具挑战性，确定此类患者是否对碘治疗（如放射性碘治疗）产生耐药性非常困难且颇具争议。
本综述旨在讨论：（i）DTC 放射性碘难治性疾病的现行主要分类；（ii）在指定患者的 DTC 为放射性碘难治性之前应考虑的因素；（iii）潜在的方法和注意事项，以帮助管理和尽量减少因碘治疗而被排除在外的患者数量，而这种治疗对侵袭性和进展性转移性 DTC 患者可能具有潜在益处；（iv）修订 DTC 放射性碘难治性分类的下一步措施；（v）未来的研究领域。
迄今为止，DTC 放射性碘难治性的分类虽然非常有用，但并非不可更改，特别是在个体化患者管理的背景下，仅仅因为患者符合一种或多种不同的分类，就不应根据定义、假设或事实上认为患者的 DTC 对放射性碘具有耐药性。相反，应根据各种分类的局限性和潜在的治疗方法，对每个患者进行个体化管理。只有了解了这些建议和注意事项，并评估影响患者具体临床情况的诸多其他因素，临床医生才能为患者提供适当的个体化治疗。应成立一个多组织委员会作为常设委员会，监督和协助修订 DTC 放射性碘难治性的分类，并讨论其局限性。
有助于确定放射性碘难治性疾病的分类将继续发展，因为：（i）更多的研究将发表；（ii）临床医生更好地了解现有分类的局限性和混杂因素；（iii）新的治疗药物要么增加，要么重新建立碘的摄取。
