**4. Future directions**

EBRT is the treatment of choice for iodine refractory DTC recurrence. A pilot study conducted on F18 FDG PET guided EBRT showed promising results [42]. PETCT identifies relapsed sites and allows dose escalation to sites of recurrence. It helps in reducing treatment volumes, thereby reducing adverse effects. Initial experience on Intensity Modulated Proton Therapy (IMPT) from Mayo Clinic has been published and showed promising loco-regional control for recurrent iodine refractory DTC [43, 44]. The long term efficacy and safety of proton beam therapy are yet to be proven.
