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Shaha AR. Thyroid surgery during COVID-19 pandemic: Principles and philosophies. Head Neck 2020; 42:1322-1324. [PMID: 32338793 PMCID: PMC7267442 DOI: 10.1002/hed.26198] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
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Sanabria A, Shah JP, Medina JE, Olsen KD, Robbins KT, Silver CE, Rodrigo JP, Suárez C, Coca-Pelaz A, Shaha AR, Mäkitie AA, Rinaldo A, de Bree R, Strojan P, Hamoir M, Takes RP, Sjögren EV, Cannon T, Kowalski LP, Ferlito A. Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review. Cancers (Basel) 2020; 12:cancers12041059. [PMID: 32344717 PMCID: PMC7225965 DOI: 10.3390/cancers12041059] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
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Rodrigo JP, Hernandez-Prera JC, Randolph GW, Zafereo ME, Hartl DM, Silver CE, Suárez C, Owen RP, Bradford CR, Mäkitie AA, Shaha AR, Bishop JA, Rinaldo A, Ferlito A. Parathyroid cancer: An update. Cancer Treat Rev 2020; 86:102012. [PMID: 32247225 DOI: 10.1016/j.ctrv.2020.102012] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Parathyroid cancer (PC) is a rare malignant tumor which comprises 0.5-5% of patients with primary hyperparathyroidism (PHPT). Most of these cancers are sporadic, although it may also occur as a feature of various genetic syndromes including hyperparathyroidism-jaw tumor syndrome (HPT-JT) and multiple endocrine neoplasia (MEN) types 1 and 2A. Although PC is characterized by high levels of serum ionized calcium (Ca) and parathyroid hormone (PTH), the challenge to the clinician is to distinguish PC from the far more common entities of parathyroid adenoma (PA) or hyperplasia, as there are no specific clinical, biochemical, or radiological characteristic of PC. Complete surgical resection is the only known curative treatment for PC with the surgical approach during initial surgery strongly influencing the outcome. In order to avoid local recurrence, the lesion must be removed en-bloc with clear margins. PC has high recurrence rates of up to 50% but with favorable long-term survival rates (10-year overall survival of 60-70%) due to its slow-growing nature. Most patients die not from tumor burden directly but from uncontrolled severe hypercalcemia. In this article we have updated the information on PC by reviewing the literature over the past 10 years and summarizing the findings of the largest series published in this period.
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Núñez DA, Lu Y, Paudyal R, Hatzoglou V, Moreira AL, Oh JH, Stambuk HE, Mazaheri Y, Gonen M, Ghossein RA, Shaha AR, Tuttle RM, Shukla-Dave A. Quantitative Non-Gaussian Intravoxel Incoherent Motion Diffusion-Weighted Imaging Metrics and Surgical Pathology for Stratifying Tumor Aggressiveness in Papillary Thyroid Carcinomas. ACTA ACUST UNITED AC 2020; 5:26-35. [PMID: 30854439 PMCID: PMC6403039 DOI: 10.18383/j.tom.2018.00054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We assessed a priori aggressive features using quantitative diffusion-weighted imaging metrics to preclude an active surveillance management approach in patients with papillary thyroid cancer (PTC) with tumor size 1-2 cm. This prospective study enrolled 24 patients with PTC who underwent pretreatment multi-b-value diffusion-weighted imaging on a GE 3 T magnetic resonance imaging scanner. The apparent diffusion coefficient (ADC) metric was calculated from monoexponential model, and the perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), and diffusion kurtosis coefficient (K) metrics were estimated using the non-Gaussian intravoxel incoherent motion model. Neck ultrasonography examination data were used to calculate tumor size. The receiver operating characteristic curve assessed the discriminative specificity, sensitivity, and accuracy between PTCs with and without features of tumor aggressiveness. Multivariate logistic regression analysis was performed on metrics using a leave-1-out cross-validation method. Tumor aggressiveness was defined by surgical histopathology. Tumors with aggressive features had significantly lower ADC and D values than tumors without tumor-aggressive features (P < .05). The absolute relative change was 46% in K metric value between the 2 tumor types. In total, 14 patients were in the critical size range (1-2 cm) measured by ultrasonography, and the ADC and D were significantly different and able to differentiate between the 2 tumor types (P < .05). ADC and D can distinguish tumors with aggressive histological features to preclude an active surveillance management approach in patients with PTC with tumors measuring 1-2 cm.
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Nixon IJ, Shah JP, Zafereo M, Simo RS, Hay ID, Suárez C, Zbären P, Rinaldo A, Sanabria A, Silver C, Mäkitie A, Vander Poorten V, Kowalski LP, Shaha AR, Randolph GW, Ferlito A. The role of radioactive iodine in the management of patients with differentiated thyroid cancer - An oncologic surgical perspective. Eur J Surg Oncol 2020; 46:754-762. [PMID: 31952928 DOI: 10.1016/j.ejso.2020.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/16/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
With improved understanding of the biology of differentiated thyroid carcinoma its management is evolving. The approach to surgery for the primary tumour and elective nodal surgery is moving from a "one-size-fits-all" recommendation to a more personalised approach based on risk group stratification. With this selective approach to initial surgery, the indications for adjuvant radioactive iodine (RAI) therapy are also changing. This selective approach to adjuvant therapy requires understanding by the entire treatment team of the rationale for RAI, the potential for benefit, the limitations of the evidence, and the potential for side-effects. This review considers the evidence base for the benefits of using RAI in the primary and recurrent setting as well as the side-effects and risks from RAI treatment. By considering the pros and cons of adjuvant therapy we present an oncologic surgical perspective on selection of treatment for patients, both following pre-operative diagnostic biopsy and in the setting of a post-operative diagnosis of malignancy.
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Underwood HJ, Shaha AR, Patel KN. Variable response to radioactive iodine treatment in poorly differentiated thyroid carcinoma. Gland Surg 2019; 8:589-590. [PMID: 32042662 DOI: 10.21037/gs.2019.10.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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82
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Coca-Pelaz A, Rodrigo JP, Suárez C, Nixon IJ, Mäkitie A, Sanabria A, Quer M, Strojan P, Bradford CR, Kowalski LP, Shaha AR, de Bree R, Hartl DM, Rinaldo A, Takes RP, Ferlito A. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck 2019; 42:456-466. [PMID: 31750595 DOI: 10.1002/hed.26016] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Second primary tumors (SPTs) are a common cause of reduced life expectancy in patients treated for head and neck cancer (HNC). This phenomenon forms an area to be addressed during posttreatment follow-up. METHODS We conducted a systematic review of literature following PRISMA guidelines, from 1979 to 2019, to investigate incidence of SPTs, synchronous, and metachronous, in HNC population. RESULTS Our review includes data of 456 130 patients from 61 articles. With a minimum follow-up of 22 months, mean incidence of SPTs was 13.2% (95% CI: 11.56-14.84): 5.3% (95% CI: 4.24-6.36) for synchronous SPTs and 9.4% (95% CI: 7.9-10.9) for metachronous SPTs. The most frequent site for SPTs was head and neck area, followed by the lungs and esophagus. CONCLUSION Although with wide variations between studies, the rate of SPTs in HNC patients is high. Given the impact in the prognosis, we must develop strategies for the early diagnosis of SPTs.
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Bichakjian CK, Olencki T, Aasi SZ, Alam M, Andersen JS, Blitzblau R, Bowen GM, Contreras CM, Daniels GA, Decker R, Farma JM, Fisher K, Gastman B, Ghosh K, Grekin RC, Grossman K, Ho AL, Lewis KD, Loss M, Lydiatt DD, Messina J, Nehal KS, Nghiem P, Puzanov I, Schmults CD, Shaha AR, Thomas V, Xu YG, Zic JA, Hoffmann KG, Engh AM. Merkel Cell Carcinoma, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:742-774. [PMID: 29891526 DOI: 10.6004/jnccn.2018.0055] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This selection from the NCCN Guidelines for Merkel Cell Carcinoma (MCC) focuses on areas impacted by recently emerging data, including sections describing MCC risk factors, diagnosis, workup, follow-up, and management of advanced disease with radiation and systemic therapy. Included in these sections are discussion of the new recommendations for use of Merkel cell polyomavirus as a biomarker and new recommendations for use of checkpoint immunotherapies to treat metastatic or unresectable disease. The next update of the complete version of the NCCN Guidelines for MCC will include more detailed information about elements of pathology and addresses additional aspects of management of MCC, including surgical management of the primary tumor and draining nodal basin, radiation therapy as primary treatment, and management of recurrence.
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84
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Fan D, Ma J, Bell AC, Groen AH, Olsen KS, Lok BH, Leeman JE, Anderson E, Riaz N, McBride S, Ganly I, Shaha AR, Sherman EJ, Tsai CJ, Kang JJ, Lee NY. Outcomes of multimodal therapy in a large series of patients with anaplastic thyroid cancer. Cancer 2019; 126:444-452. [PMID: 31593317 DOI: 10.1002/cncr.32548] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/15/2019] [Accepted: 09/11/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The role of radiotherapy (RT) in the treatment of patients with anaplastic thyroid cancer (ATC) for local tumor control is critical because mortality often is secondary to complications of tumor volume rather than metastatic disease. Herein, the authors report the long-term outcomes of RT for patients with ATC. METHODS A total of 104 patients with histologically confirmed ATC were identified who presented to the study institution between 1984 and 2017 and who received curative-intent or postoperative RT. Locoregional progression-free survival (LPFS), overall survival (OS), and distant metastasis-free survival were assessed. RESULTS The median age of the patients was 63.5 years. The median follow-up was 5.9 months (interquartile range, 2.7-17.0 months) for the entire cohort and 10.6 months (interquartile range, 5.3-40.0 months) for surviving patients. Thirty-one patients (29.8%) had metastatic disease prior to the initiation of RT. Concurrent chemoradiation was administered in 99 patients (95.2%) and 53 patients (51.0%) received trimodal therapy. Systemic therapy included doxorubicin (73.7%), paclitaxel with or without pazopanib (24.3%), and other systemic agents (2.0%). The 1-year OS and LPFS rates were 34.4% and 74.4%, respectively. On multivariate analysis, RT ≥60 Gy was associated with improved LPFS (hazard ratio [HR], 0.135; P = .001) and improved OS (HR, 0.487; P = .004), and trimodal therapy was associated with improved LPFS (HR, 0.060; P = .017). The most commonly observed acute grade 3 adverse events included dermatitis (20%) and mucositis (13%), with no grade 4 subacute or late adverse events noted (adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). CONCLUSIONS RT appears to demonstrate a dose-dependent, persistent LPFS and OS benefit in patients with locally advanced ATC with an acceptable toxicity profile. Aggressive RT should be strongly considered for the treatment of patients with ATC as part of a trimodal treatment approach.
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Wu J, Hanson M, Lohia S, Li H, Wang L, Shaha AR, Ganly I. Anatomical Study of Insertion of Recurrent Laryngeal Nerve into Larynx. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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86
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Zbären P, Shah JP, Randolph GW, Silver CE, Olsen KD, Shaha AR, Zafereo M, Kowalski LP, Suarez C, Sanabria A, Vander Poorten V, Nixon I, Rinaldo A, Ferlito A. Thyroid Surgery: Whose Domain Is It? Adv Ther 2019; 36:2541-2546. [PMID: 31401787 PMCID: PMC6822823 DOI: 10.1007/s12325-019-01048-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Indexed: 12/02/2022]
Abstract
In the United States of America (US), most departments of otorhinolaryngology head and neck surgery have been performing thyroid surgery for many years. In contrast to the US, thyroid surgery is still dominated by general surgeons in most European countries. In numerous university centers, there continues to be friction regarding thyroid surgery. The focus of this editorial is to demonstrate that there is objective data in the literature to suggest that otorhinolaryngologists with appropriate training in head and neck surgery are well suited to perform the entire spectrum of thyroid surgery. The question of who is qualified to perform thyroid surgery is not determined by the basic specialty certification of the surgeon—general or otolaryngology; rather it depends on the training, skill and experience in surgery of the neck, of post-surgical and post-irradiated necks, and of neighboring structures.
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Spanheimer PM, Ganly I, Chou J, Capanu M, Ghossein RA, Tuttle RM, Wong RJ, Shaha AR, Untch BR. Long-Term Oncologic Outcomes After Curative Resection of Familial Medullary Thyroid Carcinoma. Ann Surg Oncol 2019; 26:4423-4429. [PMID: 31549322 DOI: 10.1245/s10434-019-07869-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Long-term outcomes after curative resection in patients with germline RET mutations and medullary thyroid cancer (MTC) are highly variable and mutation-specific oncologic outcomes are not well-described. METHODS Sixty-six patients identified from 1986 to 2017 from a single-institution cancer database were assessed for recurrence and survival using Kaplan-Meier estimates, and correlated with clinicopathologic features using log-rank or Cox proportional hazards. RESULTS Median follow-up was 9.3 years (range 0.3-31.5), median tumor diameter was 1.5 cm (range 0.1-7.5), and preoperative calcitonin was known in 41 patients [median 636 (range 0-9600)]. Overall survival (OS) of the cohort was 94% at 10 years, the cumulative incidence of locoregional recurrence was 38% at 10 years, and 19/24 (79%) patients underwent repeat neck operation. The cumulative incidence of distant recurrence was 27% at 10 years. Predictors of distant recurrence were tumor size, positive lymph nodes, and pre- and postoperative carcinoembryonic antigen, but not calcitonin. M918T mutation-bearing patients had 10-year distant recurrence-free survival of 0%, compared with 83% in all other patients (p < 0.001), and equivalent 10-year OS (100% vs. 92%; p = 0.49). CONCLUSIONS Structural and metastatic recurrence is common in patients with germline RET mutations, and MTC and can occur 20 years after initial treatment, however survival remains high. Management should focus on optimal surveillance strategies and long-term control of structural disease.
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Harries V, Wang LY, McGill M, Xu B, Tuttle RM, Wong RJ, Shaha AR, Shah JP, Ghossein R, Patel SG, Ganly I. Should multifocality be an indication for completion thyroidectomy in papillary thyroid carcinoma? Surgery 2019; 167:10-17. [PMID: 31515125 DOI: 10.1016/j.surg.2019.03.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Multifocality in papillary thyroid carcinoma is common. The aim of this study is to determine whether patients with multifocal disease, treated with lobectomy alone, have an increased risk of contralateral lobe papillary thyroid carcinoma, regional recurrence, and poorer survival. METHODS After institutional review board approval, papillary thyroid carcinoma patients managed from 1986 to 2015 with lobectomy alone were identified from an institutional database. Papillary thyroid carcinoma patients with pT3 to T4 classification, nodal disease, or distant metastases were excluded. After excluding 40 patients who underwent an immediate completion thyroidectomy, 849 were included in the analysis; 619 (72.9%) had unifocal disease and 230 (27.1%) had multifocal disease. Contralateral lobe papillary thyroid carcinoma-free probability, regional recurrence-free probability, disease-specific survival, and overall survival were calculated using the Kaplan-Meier method. RESULTS With a median follow-up of 58 months, unifocal disease and multifocal disease patients had similar rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival (10-year contralateral lobe papillary thyroid carcinoma-free probability 98.6% vs 97.8%; regional recurrence-free probability 99.5% vs 99.4%; overall survival 91.6% vs 93.1%, respectively). There were no disease-related deaths. CONCLUSION Select multifocal disease patients, managed with lobectomy alone, have rates of contralateral lobe papillary thyroid carcinoma, regional recurrence, and overall survival comparable to unifocal disease patients. Multifocal disease should not be an indication for completion thyroidectomy.
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Shaha AR, Tuttle RM. Pediatric Thyroid Cancer: A Surgical Challenge. Eur J Surg Oncol 2019; 45:2001-2002. [PMID: 31474417 DOI: 10.1016/j.ejso.2019.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022] Open
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Marti JL, Shaha AR. Molecular Testing for Indeterminate Thyroid Nodules—When the Rubber Meets the Road. JAMA Otolaryngol Head Neck Surg 2019; 145:792-793. [DOI: 10.1001/jamaoto.2019.1465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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91
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Abstract
Surgery for substernal goiters can be technically demanding. Extensive mediastinal extension brings the thyroid gland into close quarters with vital intrathoracic structures. Proper preoperative planning is required to determine the potential need for an extracervical approach. Assessing the risk of requiring an extracervical approach is typically based on findings from cross-sectional imaging of the neck and chest. This article addresses the important anatomical considerations when resecting a large substernal goiter and also reviews various extracervical approaches.
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Shaha AR, Michael Tuttle R. Completion thyroidectomy-indications and complications. Eur J Surg Oncol 2019; 45:1129-1131. [DOI: 10.1016/j.ejso.2019.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022] Open
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93
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Shaha AR. Transoral parathyroidectomy-Why make a simple operation complicated? A surgical fantasy. Head Neck 2019; 41:3466-3467. [PMID: 31157936 DOI: 10.1002/hed.25829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
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94
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Wu JX, Hanson M, Shaha AR. Sentinel node biopsy for cancer of the oral cavity. J Surg Oncol 2019; 120:99-100. [PMID: 31095727 DOI: 10.1002/jso.25493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 02/05/2023]
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95
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Shaha AR, Tuttle RM. Commentary "Incidence of total thyroidectomy and lobectomy". Surgery 2019; 166:48-49. [PMID: 30904174 DOI: 10.1016/j.surg.2019.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
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96
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Andrade F, Rondeau G, Boucai L, Zeuren R, Shaha AR, Ganly I, Vaisman F, Corbo R, Tuttle M. Serum calcitonin nadirs to undetectable levels within 1 month of curative surgery in medullary thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:137-141. [PMID: 30916162 DOI: 10.20945/2359-3997000000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/12/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Because serum calcitonin (CT) is a reliable marker of the presence, volume, and extent of disease in medullary thyroid cancer (MTC), both the ATA and NCCN guidelines use the 2-3 month post-operative CT value as the primary response to therapy variable that determines the type and intensity of follow up evaluations. We hypothesized that the calcitonin would nadir to undetectable levels within 1 month of a curative surgical procedure. SUBJECTS AND METHODS This retrospective review identified 105 patients with hereditary and sporadic MTC who had at least two serial basal CT measurements done in the first three months after primary surgery. RESULTS When evaluated one year after initial surgery, 42 patients (42/105, 40%) achieved an undetectable basal calcitonin level without additional therapies and 56 patients (56/84, 67%) demonstrated a CEA within the normal reference range. In patients destined to have an undetectable CT as the best response to initial therapy, the calcitonin was undetectable by 1 month after surgery in 97% (41/42 patients). Similarly, in patients destined to have a normalize their CEA, the CEA was within the reference range by 1 month post-operatively in 63% and by 6 months in 98%. By 6 months after curative initial surgery, 100% of patients had achieved a nadir undetectable calcitonin, 98% had reached the CEA nadir, and 97% had achieved normalization of both the calcitonin and CEA. CONCLUSION The 1 month CT value is a reliable marker of response to therapy that allows earlier risk stratification than the currently recommended 2-3 month CT measurement.
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Shaha AR, Tuttle RM. Thyroid cancer staging and genomics. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S49. [PMID: 31032328 DOI: 10.21037/atm.2019.03.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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98
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Shaha AR. Recent historic perspective on modified neck dissection. Head Neck 2019; 41:1541. [PMID: 30779250 DOI: 10.1002/hed.25700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 11/11/2022] Open
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Dy BM, Strajina V, Tuttle M, Shaha AR. Correction to: Completion Thyroidectomy: Revisited a Quarter of a Century Later. Ann Surg Oncol 2019; 26:882. [PMID: 30756326 DOI: 10.1245/s10434-019-07234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the original article's XML file, Benzon M. Dy's middle initial was tagged incorrectly. The error has been addressed with this correction.
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de Bree R, Takes RP, Shah JP, Hamoir M, Kowalski LP, Robbins KT, Rodrigo JP, Sanabria A, Medina JE, Rinaldo A, Shaha AR, Silver C, Suárez C, Bernal-Sprekelsen M, Ferlito A. Elective neck dissection in oral squamous cell carcinoma: Past, present and future. Oral Oncol 2019; 90:87-93. [PMID: 30846183 DOI: 10.1016/j.oraloncology.2019.01.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/01/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
In 1994 a decision analysis, based on the literature and utility ratings for outcome by a panel of experienced head and neck physicians, was presented which showed a threshold probability of occult metastases of 20% to recommend elective treatment of the neck. It was stated that recommendations for the management of the cN0 neck are not immutable and should be reconfigured to determine the optimal management based on different sets of underlying assumptions. Although much has changed and is published in the almost 25 years after its publication, up to date this figure is still mentioned in the context of decisions on treatment of the clinically negative (cN0) neck. Therefore, we critically reviewed the developments in diagnostics and therapy and modeling approaches in the context of decisions on treatment of the cN0 neck. However, the results of studies on treatment of the cN0 neck cannot be translated to other settings due to significant differences in relevant variables such as population, culture, diagnostic work-up, follow-up, costs, institutional preferences and other factors. Moreover, patients may have personal preferences and may weigh oncologic outcomes versus morbidity and quality of life differently. Therefore, instead of trying to establish "the" best strategy for the cN0 neck or "the" optimal cut-off point for elective neck treatment, the approach to optimize the management of the cN0 neck would be to develop and implement models and decision support systems that can serve to optimize choices depending on individual, institutional, population and other relevant variables.
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