Table 2: Therapeutic modalities for RAI-refractory recurrent disease.

IndicationProsCons

SurgerySurgically resectable local recurrences; metastasectomyPotential for curePotential significant morbidity
External beam radiationAdjuvant: neck Therapeutic and palliative: metastatic sitesDecrease in recurrence, progression, and painMay preclude future neck surgery; dysphagia and xerostomia; secondary malignancies
PEITLocally recurrent disease in patients at high risk for morbidity and mortality from surgical resectionPotential for avoidance of surgeryLocal pain; injury to local structures; unknown effect on survival and recurrence
Systemic chemotherapy (including TKIs)Unresectable, RAI-refractory, metastatic diseaseMay slow progression of disease; may alleviate disease symptomsSignificant adverse events; unknown effect on survival

PEIT: percutaneous ethanol injection therapy; TKI: tyrosine kinase inhibitors.