Strategy | Prescribed 131I activity | Clinical/pathologic context |
---|---|---|
Risk-adapted 131I therapy | 1.11–1.85 GBq (30–50 mCi) 131I* | Remnant ablation |
Risk-adapted 131I therapy | 1.85–3.7 GBq (50–100 mCi) 131I** | Adjuvant treatment |
Risk-adapted 131I therapy | 3.7–5.6 GBq (100–150 mCi) 131I | Treatment of small volume locoregional disease |
Risk-adapted 131I therapy | 5.6–7.4 GBq (150–200 mCi) 131I | Treatment of advanced locoregional disease and/or small volume distant metastatic disease |
Whole-body/-blood dosimetry | ≥7.4 GBq (≥200 mCi) 131I, maximum tolerable safe 131I activity | Treatment of diffuse distant metastatic disease |
*FDA approved the use of rhTSH in combination with 100 mCi 131I for remnant ablation in December 2007 (139,140).
**Some committee members recommend up to 5.6 GBq (150 mCi) without extant data regarding the effectiveness and toxicity profiles of 1.85 GBq (100 mCi) vs. 5.6 GBq (150 mCi) for adjuvant treatment. Current guidelines advise that frequency and severity of side effects are activity dependent, specifically, increased xerostomia risk for >3.7GBq (100 mCi) and sialadenitis risk for >5.6 GBq (150 mCi) (141).