Differentiated Thyroid Cancer: Management of Patients with Radioiodine Nonresponsive Disease

Table 2

Therapeutic modalities for RAI-refractory recurrent disease.

	Indication	Pros	Cons
Surgery	Surgically resectable local recurrences; metastasectomy	Potential for cure	Potential significant morbidity
External beam radiation	Adjuvant: neck Therapeutic and palliative: metastatic sites	Decrease in recurrence, progression, and pain	May preclude future neck surgery; dysphagia and xerostomia; secondary malignancies
PEIT	Locally recurrent disease in patients at high risk for morbidity and mortality from surgical resection	Potential for avoidance of surgery	Local pain; injury to local structures; unknown effect on survival and recurrence
Systemic chemotherapy (including TKIs)	Unresectable, RAI-refractory, metastatic disease	May slow progression of disease; may alleviate disease symptoms	Significant adverse events; unknown effect on survival

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