Endocrinol Metab.  2014 Sep;29(3):233-239. 10.3803/EnM.2014.29.3.233.

Radioiodine Therapy in Differentiated Thyroid Cancer: The First Targeted Therapy in Oncology

• Chung JK
• Cheon GJ

• KMID: 2169458
• DOI: http://doi.org/10.3803/EnM.2014.29.3.233

Abstract

Iodide uptake across the membranes of thyroid follicular cells and cancer cells occurs through an active transport process mediated by the sodium-iodide symporter (NIS). The rat and human NIS-coding genes were cloned and identified in 1996. Evaluation of NIS gene and protein expression is critical for the management of thyroid cancer, and several approaches to increase NIS levels have been tried. Identification of the NIS gene has provided a means of expanding its role in radionuclide therapy and molecular target-specific theragnosis (therapy and diagnosis using the same molecular target). In this article, we describe the relationship between NIS expression and the thyroid carcinoma treatment using I-131 and alternative therapeutic approaches.

Keyword

Differentiated thyroid cancer; Radioiodine therapy; Sodium-iodide symporter; Target-specific therapy; Theranosis

MeSH Terms

Animals
Biological Transport, Active
Clone Cells
Diagnosis
Humans
Ion Transport
Membranes
Rats
Thyroid Gland
Thyroid Neoplasms*

Figure

• 

  Fig. 1 (A-C) A 62-year-old male postthyroidectomy papillary cancer patient with lymph node and lung metastases. After serial I-131 treatment (200 mCi), the metastatic lesions disappeared gradually, resulting in complete remission. Adapted from Chung et al. Nucl Med Mol Imaging 2010;44:4-14, with permission from Springer [4].

• 

  Fig. 2 (A-C) Iodine scan-negative and fluorodeoxyglucose positron emission tomography (FDG PET)-positive metastasis. A patient with DTC had bone pain in the back after total thyroidectomy. An iodine scan was negative. By contrast, on an fluorine-18 FDG PET (F-18 FDG PET) scan, there was a focal hypermetabolic bone lesion, suggesting malignant tumors. I-124, a PET radiotracer iodine isotope, demonstrated faint iodine uptake on PET scans. This discrepancy between the I-131 scan and I-124 PET may have been caused by a difference in the resolution of the instruments. The patient underwent high-dose radioiodine treatment, and the bone pain improved. WBS, whole body scan. Adapted from Cheon, Korean J Endocr Surg 2011:11:139-45 [9].

• 

  Fig. 3 Comparison of I-131 treatment outcomes according to human sodium-iodide symporter (NIS) expression. Adapted from Min et al. Eur J Nucl Med 2001;28:639-45, with permission from Springer [18].

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