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Radioactive iodine (131I) therapy for differentiated thyroid cancer in Japan: current issues with historical review and future perspective

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Abstract

Radioactive iodine (RAI, 131I) has been used as a therapeutic agent for differentiated thyroid cancer (DTC) with over 50 years of history. Recently, it is now attracting attention in medical fields as one of the molecular targeting therapies, which is known as targeted radionuclide therapy. Radioactive iodine therapy (RIT) for DTC, however, is now at stake in Japan, because Japan is confronting several problems, including the recent occurrence of the Great East Japan Disaster (GEJD) in March 2011. RIT for DTC is strictly limited in Japan and requires hospitalization. Because of strict regulations, severe lack of medical facilities for RIT has become one of the most important medical problems, which results in prolonged waiting time for Japanese patients with DTC, including those with distant metastasis, who wish to receive RIT immediately. This situation is also due to various other factors, such as prolonged economic recession, super-aging society, and subsequent rapidly changing medical environment. In addition, due to the experience of atomic bombings in Hiroshima and Nagasaki, Japanese people have strong feeling of “radiophobia”. There is fear that GEJD and related radiation contamination may worsen this feeling, which might be reflected in more severe regulation of RIT. To overcome these difficulties, it is essential to collect and disclose all information about the circumstances around this therapy in Japan. In this review, we would like to look at this therapy through several lenses, including historical, cultural, medical, and socio-economic points of view. We believe that clarifying the problems is sure to lead to the resolution of this complicated situation. We have also included several recommendations for future improvements.

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Acknowledgments

The authors wish to thank the members of STRT of JSNM, editorial committee of JSNM, and the members of Task Force of Clinical Practice Guidelines for Thyroid Tumors in Japan. We also would like to thank JSNM, JRIA, and the National Institute of Radiological Science for their assistance. We would like to express our gratitude to the Nagasaki Atomic Bomb Museum and the Nagasaki National Peace Memorial Hall for the Atomic Bomb Victims for their help in acquisition of library material, the Memorial Museum of Taro Okamoto, and Mr. Akiomi Hirano, the director of the Museum, for the permission for the usage of Taro Okamoto’s works. We also would like to thank Prof. Takahiro Higuchi, University of Wuerzburg, for his assistance in the use of the pictures of RIT wards. I, Tatsuya Higashi, would like to thank Mr. Hidetoshi Yukawa of Nihon Hoso Kyokai (NHK) for his help in developing concept of this paper. I would also like to thank Takako Higashi, my wife, for her great help in English proof reading.

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Authors and Affiliations

  1. Shiga Medical Center Research Institute, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan

    Tatsuya Higashi

  2. Department of Radioisotope Medicine, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Nagasaki, 852-8523, Japan

    Takashi Kudo

  3. Department of Nuclear Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 950-8640, Japan

    Seigo Kinuya

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Correspondence to Tatsuya Higashi.

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Higashi, T., Kudo, T. & Kinuya, S. Radioactive iodine (131I) therapy for differentiated thyroid cancer in Japan: current issues with historical review and future perspective. Ann Nucl Med 26, 99–112 (2012). https://doi.org/10.1007/s12149-011-0553-4

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