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Perona M, Majdalani ME, Rodríguez C, Nievas S, Carpano M, Rossini A, Longhino JM, Cabrini R, Pisarev MA, Juvenal GJ, Dagrosa MA. Experimental studies of boron neutron capture therapy (BNCT) using histone deacetylase inhibitor (HDACI) sodium butyrate, as a complementary drug for the treatment of poorly differentiated thyroid cancer (PDTC). Appl Radiat Isot 2020; 164:109297. [PMID: 32768887 DOI: 10.1016/j.apradiso.2020.109297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/19/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study analyzed different protocols of administration of boronophenylalanine (BPA) and sodium butyrate (NaB) to increase the BNCT efficacy for poorly differentiated thyroid cancer (PDTC). MATERIALS AND METHODS Nude mice implanted with human PDTC cells (WRO) were distributed into four protocols: 1) BPA; 2) BPA + ip NaB; 3) BPA + oral NaB; 4) Control. Biodistribution and histologic studies were performed. LAT (BPA transporter) isoforms gene expression was assessed by RT-PCR. RESULTS Tumor growth delay was observed in animals of the Protocol #3 (p < 0.05). NaB (Protocol #2) increased tumor boron uptake 2-h post BPA injection (p < 0.05). On the other hand, NaB upregulated the expression of all the isoforms of the LAT transporter in vitro. Histologic studies showed a significant decrease of mitotic activity and an increase of vacuoles in tumors of Protocol #3. Neutrons alone or combined with NaB caused some tumor growth delay (p < 0.05), while in the BNCT and BNCT + NaB groups, there was a halt in tumor growth in 70 and 80% of the animals, respectively. CONCLUSIONS Intraperitoneally administration of NaB increased boron uptake while oral administration for a longer period of time induced tumor growth delay previous to BPA administration. The use of NaB via ip would optimize the irradiation results.
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Affiliation(s)
- M Perona
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (1425) CABA, Argentina
| | - M E Majdalani
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - C Rodríguez
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - S Nievas
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - M Carpano
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - A Rossini
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - J M Longhino
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - R Cabrini
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - M A Pisarev
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina
| | - G J Juvenal
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (1425) CABA, Argentina
| | - M A Dagrosa
- Comisión Nacional de Energía Atómica (CNEA), Av. Gral Paz 1499 (1650), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290 (1425) CABA, Argentina. http://
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Özden S, Saylam B, Daglar G, Yuksek YN, Tez M. ARE THYROID NODULES AN OBSTACLE TO MINIMAL INVASIVE PARATHYROID SURGERY? A SINGLE-CENTER STUDY FROM AN ENDEMIC GOITER REGION. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 15:531-536. [PMID: 32377254 DOI: 10.4183/aeb.2019.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Context Minimally invasive parathyroidectomy (MIP) procedure has become a widely accepted alternative to the standard four-gland exploration nowadays. Objective The aim of this study was to evaluate patients with primary hyperparathyroidism (PHPT), who had been treated with thyroidectomy and bilateral neck exploration (BNE), rather than MIP alone, due to coexisting thyroid nodules and to determine the benefits of simultaneous thyroidectomy and the possible negative outcomes of not performing this additional procedure. Design There were 185 patients who were operated for PHPT at our clinic from January 2014 to November 2016. Subjects and Methods 50 patients meet inclusion criteria: have thyroidectomy at the same time of parathyroid surgery, have concordant findings of parathyroid adenoma localization at preoperative MIBI-SPECT and the cervical US and have not had malignancy on fine needle aspiration biopsy (FNAB). Results The mean age of the patients was 55.3±10.4, and female to male ratio was 7:1. All patients had parathyroidectomy with BNE and thyroidectomy: 11 (22%) patients had micropapillary thyroid cancer (mPTC), 2 (4%) had papillary thyroid cancer (PTC). Conclusion The results were inconclusive in clearly demonstrating which patients presenting with coexisted thyroid nodules should undergo thyroidectomy, rather than MIP, and which should be monitored for thyroid nodules after MIP. However, we consider that in cases who are not clearly indicated for thyroidectomy, MIP followed by monitoring of thyroid nodules can be the treatment approach.
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Affiliation(s)
- S Özden
- TC Saglik Bakanligi, Ankara Numune Training and Research Hospital - Surgery, Altindag, Ankara, Turkey
| | - B Saylam
- TC Saglik Bakanligi, Ankara Numune Training and Research Hospital - Surgery, Altindag, Ankara, Turkey
| | - G Daglar
- TC Saglik Bakanligi, Ankara Numune Training and Research Hospital - Surgery, Altindag, Ankara, Turkey
| | - Y N Yuksek
- TC Saglik Bakanligi, Ankara Numune Training and Research Hospital - Surgery, Altindag, Ankara, Turkey
| | - M Tez
- TC Saglik Bakanligi, Ankara Numune Training and Research Hospital - Surgery, Altindag, Ankara, Turkey
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Radioguided occult lesion localization in patients with recurrent thyroid cancer. Eur Arch Otorhinolaryngol 2019; 276:1757-1766. [PMID: 30887167 DOI: 10.1007/s00405-019-05377-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Well planned re-surgery is critical for recurrent/persistent thyroid cancer (TC). We aimed to investigate the clinical outcome of radioguided-occult lesion localization (ROLL) guided surgery in patients with recurrent/persistent TC. METHODS This study includes 29 patients [F/M: 22/7, median age 43 ± 12 years (18-58)] with a diagnosis of TC (22 papillary, 2 follicular and 5 medullary). Before surgery, all patients underwent ultrasonography (USG) guided mapping and intra-lesional radioactivity injection. Surgery was performed based on the excision of radioactivity injected lesions by a gamma probe and non-injected tumor foci via USG-neck map. Researchers determined surgical success by post-operative tumor markers and neck-USG. RESULTS Among 29 patients, 60 metastatic lesions were identified by USG [median size 10 ± 6.3 mm (range 5-30)]. Neck-USG performed after surgery provided no evidence of disease (NED) in %97 (28/29) of TC patients. In the follow-up, stimulated thyroglobulin (Tg) levels were less than 1 ng/ml in 79%(19/24) of DTC patients and suppressed Tg < 0.2 ng/ml was noted in 92% (22/24).In patients with DTC with an incomplete structural response, we dramatically changed the American Thyroid Association (ATA) response category and achieved an excellent response in 92% (22/24) of patients. Among patients with MTC, 5/5 patients had normal USG and calcitonin levels were reduced by 60-80% in 4/5 and > 80% in1/5 patients. CONCLUSIONS In this study we have shown that, ROLL-guided surgery yielded NED rate of %97 (28/29) and increased excellent response rates according to ATA guidelines. Further studies with larger patient groups and longer follow-up should be performed to confirm the efficacy of this surgery.
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Han JM, Bae JC, Kim HI, Kwon S, Jeon MJ, Kim WG, Kim TY, Shong YK, Kim WB. Clinical Outcomes of Differentiated Thyroid Cancer Patients with Local Recurrence or Distant Metastasis Detected in Old Age. Endocrinol Metab (Seoul) 2018; 33:459-465. [PMID: 30513560 PMCID: PMC6279901 DOI: 10.3803/enm.2018.33.4.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. METHODS This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. RESULTS The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. CONCLUSION The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.
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Affiliation(s)
- Ji Min Han
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sam Kwon
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sun W, Liu J, Zhang H, Zhang P, Wang Z, Dong W, He L, Zhang T. A meta-analysis of intraoperative neuromonitoring of recurrent laryngeal nerve palsy during thyroid reoperations. Clin Endocrinol (Oxf) 2017; 87:572-580. [PMID: 28585717 DOI: 10.1111/cen.13379] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/19/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The rate of recurrent laryngeal nerve (RLN) palsy, a common complication of thyroid surgery, is especially high in thyroid reoperations. The present meta-analysis assesses whether intraoperative neuromonitoring (IONM) reduces the prevalence of RLN palsy in thyroid reoperations. DESIGN AND METHODS A systematic literature search was conducted in the PubMed, SCIE and Wan Fang databases for studies published up to 31 August 2016. All data were analysed using STATA (version 11) software. Publication bias was assessed using Begg's funnel plot and Egger's test, and sensitivity analysis was performed. RESULTS Nine studies including 2436 at-risk nerves met the inclusion criteria. The results were presented as pooled relative risks (RRs) with 95% confidence intervals (CI). The overall RLN palsy rate was significantly lower in reoperations conducted with IONM than in those conducted without IONM (RR=0.434, 95% CI=0.206-0.916, P=.029). High heterogeneity was found (I2 =70.2%, P=.001). The rates of transient RLN palsy with and without IONM did not differ significantly (RR=0.607, 95% CI=0.270-1.366, P=.227). The heterogeneity was high (I2 =67.4%, P=.005). However, IONM was significantly associated with a reduction in permanent RLN palsy (RR=0.426, 95% CI=0.196-0.925, P=.031). No significant heterogeneity was found (I2 =13.7%, P=.325). Funnel plots for overall and transient RLN palsy showed a possible publication bias. CONCLUSIONS Intraoperative neuromonitoring (IONM) is associated with a reduction in overall and permanent RLN palsy in thyroid reoperations. However, given the limited sample size and heterogeneity in this meta-analysis, further studies are required to confirm our preliminary findings.
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Affiliation(s)
- Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jinhao Liu
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ping Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Liang He
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ting Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
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Lombardi D, Accorona R, Paderno A, Cappelli C, Nicolai P. Morbidity of central neck dissection for papillary thyroid cancer. Gland Surg 2017; 6:492-500. [PMID: 29142840 DOI: 10.21037/gs.2017.05.07] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thyroid cancer has a very well-known propensity for nodal involvement, either in the central and lateral neck compartments. Neck dissection addressing the central compartment may be performed with an elective or therapeutic intent, the former concomitantly to a thyroidectomy whereas the latter may be accomplished also as a revision procedure for recurrent disease. In this paper complications of central compartment neck dissection will be described, analyzing separately primary and revision procedures.
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Affiliation(s)
- Davide Lombardi
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Remo Accorona
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
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Galectin-3 induced by hypoxia promotes cell migration in thyroid cancer cells. Oncotarget 2017; 8:101475-101488. [PMID: 29254179 PMCID: PMC5731889 DOI: 10.18632/oncotarget.21135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/26/2017] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study is to investigate the role of Galectin-3 in human thyroid cancer migration. Methods The expression of Galectin-3 in surgical specimens was investigated using immunohistochemistry and western blot. A papillary thyroid cancer cell line (B-cpap) and an anaplastic thyroid cancer cell line (8305c) were transfected with short-hairpin RNA against Galectin-3 (Gal-3-shRNA). Low-molecular citrus pectin (LCP) was also used to antagonize Galectin-3. The migration and invasion of the cell lines were examined. The related signaling pathways were investigated to explore the Galectin-3 mechanism of action. Results Galectin-3 was highly expressed in metastasized thyroid cancers. Knocking down and antagonizing Galectin-3 significantly suppressed the migration of thyroid cancer cells. Knocking down Galectin-3 inhibited the activity of Wnt, MAPK, Src and Rho signaling pathways. Galectin-3 was up-regulated via HIF-1α in a hypoxic environment. Galectin-3 knockdown could reduce cell motility in hypoxic environments. Conclusion This study suggests that Galectin-3 could act as a modulator of thyroid cancer migration, especially in hypoxic microenvironments. This regulation function of Galectin-3 may work through multiple signaling pathways.
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Nilubol N, Merkel R, Yang L, Patel D, Reynolds JC, Sadowski SM, Neychev V, Kebebew E. A phase II trial of valproic acid in patients with advanced, radioiodine-resistant thyroid cancers of follicular cell origin. Clin Endocrinol (Oxf) 2017; 86:128-133. [PMID: 27392538 PMCID: PMC5581405 DOI: 10.1111/cen.13154] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/19/2016] [Accepted: 07/02/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Valproic acid (VA) is a histone deacetylase (HDAC) inhibitor that has antiproliferative effects on several types of cancer, including thyroid cancer. In addition, VA has been reported to upregulate the sodium-iodine symporter in thyroid cancer cells and increases radioiodine uptake in preclinical studies. The aim of this study was to assess the antiproliferative effects of VA and to evaluate if VA can increase the radioiodine uptake in patients with advanced, radioiodine-negative thyroid cancer. DESIGN An open-label Simon two-stage phase II trial. PATIENTS AND MEASUREMENTS Valproic acid was administered orally, and doses were adjusted to maintain serum trough levels between 50 and 100 mg/l for 10 weeks, followed by injections of recombinant human thyroid-stimulating hormone and a radioiodine uptake scan. Anatomical imaging studies were performed at week 16 to assess tumour response and radioiodine therapy in patients with increased radioiodine uptake. RESULTS Thirteen patients with a median age of 66 years (50-78 years) were enrolled and evaluated. Seven patients had papillary thyroid cancer (PTC), two had follicular variant PTC, two had follicular thyroid cancer, and two had Hürthle cell carcinoma. None of the 10 patients who completed the 10-week treatment had increased radioiodine uptake at their tumour sites. Three patients were taken off the study prior to the 10-week radioiodine uptake scan: one with grade-3 hepatic toxicity, one with disease progression and one for noncompliance. Four of 13 patients had decreased stimulated serum thyroglobulin with VA treatment. None of the patients had complete or partial responses based on Response Evaluation Criteria in Solid Tumors (RECIST), and six patients had disease progression. CONCLUSIONS Valproic acid does not increase radioiodine uptake and does not have anticancer activity in patients with advanced, radioiodine-negative thyroid cancer of follicular cell origin.
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Affiliation(s)
- Naris Nilubol
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Roxanne Merkel
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lily Yang
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dhaval Patel
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Samira M. Sadowski
- Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Vladimir Neychev
- Department of Surgery, University Multiprofile Hospital for Active Treatment “Alexandrovska”, Medical University, Sofia, Bulgaria
| | - Electron Kebebew
- Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Kiernan CM, Schlegel C, Kavalukas S, Isom C, Peters MF, Solórzano CC. Does concomitant thyroidectomy increase risks of parathyroidectomy? J Surg Res 2016; 203:34-9. [DOI: 10.1016/j.jss.2016.03.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 10/22/2022]
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Chami L, Hartl D, Leboulleux S, Baudin E, Lumbroso J, Schlumberger M, Travagli JP. Preoperative localization of neck recurrences from thyroid cancer: charcoal tattooing under ultrasound guidance. Thyroid 2015; 25:341-6. [PMID: 25629658 DOI: 10.1089/thy.2014.0329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reoperation for thyroid cancer recurrence is a surgical challenge in previously dissected necks, and there is a need for a reliable procedure for surgeon guidance. In this study, the usefulness of preoperative charcoal tattooing for surgical guidance was evaluated. METHODS From July 2007 to May 2010, 53 patients (40 females; Mage=44 years, range 19-76 years) were prospectively included for preoperative localization of neck recurrences from differentiated (n=46) or medullary thyroid cancer (n=7). Preoperative cytological assessment was performed for at least one lesion in each patient. Ultrasound (US) imaging was performed with high-frequency probes (8-14 Mhz). Micronized peat charcoal (0.5-3 mL) was injected under US guidance using a 25 gauge needle, 0-15 days preoperatively. RESULTS A total of 106 lesions were selected for charcoal tattooing. Of these, 101 had been tattooed, and 102 were removed (85 metastases, 17 benign on pathology). The tolerance of charcoal injection was good in all but three patients. A mean volume of 1 mL of charcoal was injected with a mean of two targets per patient. Charcoal labeling facilitated intraoperative detection in 56 "difficult" lesions (i.e., small size, dense fibrosis, anatomical pitfalls), and charcoal trace facilitated intraoperative guidance in 17 lesions. Feasibility and usefulness rates were 83% and 70.7% respectively. CONCLUSION These findings suggest that charcoal tattooing under US guidance is an easy to implement, safe, and useful procedure for surgeon guidance in neck reoperation for thyroid cancer.
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Affiliation(s)
- Linda Chami
- 1 Radiology Department, Hôpital Pitié Salpétrière, APHP, UPMC , Paris, France
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Qiu ZL, Shen CT, Song HJ, Wei WJ, Luo QY. Differential expression profiling of circulation microRNAs in PTC patients with non-131I and 131I-avid lungs metastases: a pilot study. Nucl Med Biol 2015; 42:499-504. [PMID: 25682061 DOI: 10.1016/j.nucmedbio.2015.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/24/2014] [Accepted: 01/03/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Loss of the ability to concentrate (131)I is one of the important causes of radioiodine-refractory disease in papillary thyroid carcinoma (PTC). Recent advantages of serum microRNAs (miRNAs) open a new realm of possibilities for noninvasive diagnosis and prognosis of many cancers. The aim of the current study was to identify differential expression profiling of circulation miRNAs in PTC patients with non-(131)I and (131)I-avid lungs metastases. METHODS The expressions of miRNAs were examined using miRNA microarray chip. The most significantly changed miRNAs from microarray were verified by using qRT-PCR. The potential miRNAs regulating target genes and their preliminary biological functions were forecasted by Bioinformatic analysis. RESULTS Compared to (131)I-avid lung metastases, 13 kinds of significantly differential serum miRNAs including 5 upregulated miRNAs (miR-1249, miR-106a, miR-503, miR-34c-5p, miR-1281) and 8 downregulated miRNAs (miR-1915, miR-2861, miR-3196, miR-500, miR-572, miR-33b, miR-554, miR-18a) in PTC patients with non-(131) I-avid lung metastases were identified. Bioinformatic analysis demonstrated that miR-106a was the core miRNA regulating 193 genes in the network. The results of validation confirmed the up-regulation of miR-106a in non-(131)I-avid lungs metastatic PTC patients. CONCLUSION Differentially expressed serum miRNA profiles between PTC patients with non-(131)I and (131)I-avid lungs metastases were analyzed. These findings in our present study could represent new clues for the diagnostic and therapeutic strategy in PTC patients with non-(131)I-avid metastatic disease.
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Affiliation(s)
- Zhong-Ling Qiu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Chen-Tian Shen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Wei-Jun Wei
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, People's Republic of China.
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Song HJ, Xue YL, Qiu ZL, Luo QY. Comparative serum proteomic analysis identified afamin as a downregulated protein in papillary thyroid carcinoma patients with non-131I-avid lung metastases. Nucl Med Commun 2014; 34:1196-203. [PMID: 24089082 PMCID: PMC3815116 DOI: 10.1097/mnm.0000000000000001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The loss of 131I uptake ability in metastases from differentiated thyroid carcinoma (DTC) is becoming a major obstacle in radioiodine treatment. However, there is no effective way to screen for 131I uptake ability in metastases. The identification of differentially expressed proteins by serum proteomics may contribute to our understanding of the mechanisms underlying the dedifferentiation of DTC. MATERIALS AND METHODS Serum samples were obtained from papillary thyroid carcinoma patients with non-131I-avid lung metastases and 131I-avid lung metastases. Differential protein analysis was performed using two-dimensional gel electrophoresis. Candidate protein spots showing differences in expression between the two groups were identified by means of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and were validated by western blotting. RESULTS We found that afamin is downregulated in the serum of papillary thyroid carcinoma patients with non-131I-avid lung metastases. CONCLUSION Afamin may be a potential serum biomarker for early screening of 131I uptake ability in DTC metastases and could therefore be of value in guiding radioiodine treatment decisions.
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Affiliation(s)
- Hong-Jun Song
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Lee J, Song Y, Soh EY. Central lymph node metastasis is an important prognostic factor in patients with papillary thyroid microcarcinoma. J Korean Med Sci 2014; 29:48-52. [PMID: 24431905 PMCID: PMC3890476 DOI: 10.3346/jkms.2014.29.1.48] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/22/2013] [Indexed: 12/02/2022] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) has been increasing, without a consensus for the management of this condition. In the present study, we analyzed the clinicopathological features of patients with PTMC to examine the impact of initial therapy and establish appropriate treatment. A total of 2,018 patients with PTMC were enrolled at a single university hospital. Of them, 1,245 patients (61.8%) underwent total thyroidectomy, and 1,838 patients (91.3%) underwent central lymph node (LN) dissection. Five-and 10-yr recurrence rates were 3.2% and 4.6%, respectively. In univariate analysis, the prognostic factors for recurrence were N stage, the number of LN metastases, and extrathyroidal extension. However, multivariate analysis revealed LN metastases and N stage as the only significant prognostic factors after adjusting for confounding factors (P < 0.001). Additionally, multivariate analysis of a subgroup consisting of PTMC patients without N1b revealed the number of central LN metastases as the only significant factor. Therefore, intraoperative examination for central LN metastasis may discriminate high or low risk group.
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Affiliation(s)
- Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Yeongpeck Song
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Euy Young Soh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Lee J, Song Y, Soh EY. Prognostic Significance of the Number of Metastatic Lymph Nodes to Stratify the Risk of Recurrence. World J Surg 2013; 38:858-62. [DOI: 10.1007/s00268-013-2345-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim KJ, Kim BW, Lee YS, Chang HS, Park CS. On-site ultrasound-guided localization for impalpable nodal recurrences in papillary thyroid carcinoma patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:104-8. [PMID: 24020018 PMCID: PMC3764360 DOI: 10.4174/jkss.2013.85.3.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 05/20/2013] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
Purpose The cervical lymph nodes are the most common sites of locoregional recurrence in patients with papillary thyroid carcinoma (PTC). Accurate tumor localization is important for the successful removal of impalpable recurrences in the cervical lymph nodes. We evaluated the benefits of ultrasound-guided localization (UGL) performed by a single surgeon on site. Methods Of 53 PTC patients who underwent reoperation for impalpable nodal recurrences, 32 (group 1) were assessed only using preoperative imaging, while 21 (group 2) were additionally evaluated by on-site UGL performed by the operating surgeon. Postoperative outcomes were compared between the two groups. Results Operation times were significantly shorter (P < 0.001) and the mean size of the resected lymph nodes were smaller (P = 0.013) for group 2 patients. More lymph nodes were identified and resected in group 1 (3.56 vs. 3.19), but the rate of positive lymph nodes was significantly higher in group 2 (P < 0.001). There were no differences between the two groups in terms of resection success rate, complication rate, and postoperative hospital stay. During a mean follow-up period of 27.6 months, 52 patients (98.1%) showed no evidence of recurrence on routine ultrasound, and serum thyroglobulin concentrations remained < 1 ng/mL in 49 patients (92.5%). Conclusion On-site UGL performed by the operating surgeon is useful for accurate resection of impalpable nodal recurrences in PTC patients.
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Affiliation(s)
- Kuk-Jin Kim
- Department of Surgery, The Armed Forces Capital Hospital, Seongnam, Korea
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Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol 2013; 11:94. [PMID: 23618223 PMCID: PMC3660170 DOI: 10.1186/1477-7819-11-94] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous thyroid or parathyroid surgery induces scarring or distorts anatomy, and increases the risk of recurrent laryngeal nerve (RLN) injury for a reoperation. The benefit of intraoperative nerve monitoring (IONM) for re-exploration (a second nerve exploration) and reoperation has not been established. METHODS Two hundred and ten patients were given a thyroid or parathyroid reoperation at our hospital between 2001 and 2010. Using IONM, we re-explored 56 patients who had been operated on before June 2007. The injury rate in these patients was compared with that of the 15 patients re-explored without IONM between 2001 and 2006. RESULTS Of the 70 nerves that were re-explored using IONM, only one was incidentally injured, significantly fewer than the three injured in the 15 nerves re-explored without using IONM (1.43% vs. 20%, P = 0.0164). CONCLUSIONS IONM helped prevent RLN damage when re-exploring nerves during thyroid and parathyroid surgery. We recommend the routine use of IONM in thyroid and parathyroid reoperations.
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Affiliation(s)
- Yu-Chuan Chuang
- Department of Surgery, National Cheng Kung University Hospital, Tainan 704, Taiwan
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Damle N, Patnecha M, Kumar P, Maharjan S, Bal C. Retinoic acid therapy in patients with radioiodine negative differentiated thyroid cancer and clinical or biochemical evidence of disease: An initial experience. Indian J Nucl Med 2013; 26:144-8. [PMID: 23326066 PMCID: PMC3543580 DOI: 10.4103/0972-3919.103997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dedifferentiation of thyroid follicular cells renders radioiodine therapy ineffective in patients of differentiated thyroid cancer (DTC). An alternative therapy to treat the disease or reinduce radioiodine uptake is necessary. MATERIALS AND METHODS We evaluated the role of retinoic acid therapy in 13 cases of DTC with raised thyroglobulin and/or clinically evident disease. Retinoic acid was given in a dose of 1.5 mg/kg for a period ranging between 1.5 and 18 months. RESULTS Age of the patients was between 18 and 65 years with a median of 49 years. Ten patients had papillary while two had follicular and one patient had mixed papillary and follicular thyroid cancer. Mean radioiodine given before starting retinoic acid was 164 mCi. Mean duration of therapy was 6.4 months. Thyroglobulin decreased in 2 patients and increased in 11 patients at the end of therapy. Radioiodine uptake was demonstrable in six patients, though faintly, while 7 cases showed no uptake. Based on the clinical and biochemical parameters, four patients had progressive disease, eight had stable disease and one patient showed partial response. Of the six patients with reinduction of radioiodine uptake, three had biochemical progression and the other three had stable disease. CONCLUSION Our findings suggest that retinoic acid therapy may induce radioiodine uptake and reduce serum thyroglobulin levels in some patients with DTC, but whether this results in clinically significant response can only be ascertained on long-term follow-up.
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Affiliation(s)
- Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Choi HJ, Kim TY, Ruiz-Llorente S, Jeon MJ, Han JM, Kim WG, Shong YK, Kim WB. Alpha-lipoic acid induces sodium iodide symporter expression in TPC-1 thyroid cancer cell line. Nucl Med Biol 2012; 39:1275-80. [DOI: 10.1016/j.nucmedbio.2012.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/31/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
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Tufano RP, Bishop J, Wu G. Reoperative central compartment dissection for patients with recurrent/persistent papillary thyroid cancer: efficacy, safety, and the association of the BRAF mutation. Laryngoscope 2012; 122:1634-40. [PMID: 22549559 DOI: 10.1002/lary.23371] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/04/2012] [Accepted: 03/29/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aims of this study were to present our experience with reoperative central compartment dissection (RCCD) for recurrent/persistent papillary thyroid cancer (PTC), and to explore the association between the BRAF mutation status and the clinicopathologic characteristics and outcomes of a large cohort of PTC patients who have undergone RCCD. STUDY DESIGN Case series with chart review. METHODS This is a retrospective study. One hundred twenty consecutive patients between July 2001 and June 2010 who underwent RCCD for recurrent/persistent PTC performed by a single surgeon (r.p.t.) were reviewed. Data reviewed included demographic information; records from previous operations, RCCD, and any other concurrent procedures; pre- and postoperative serum and ionized calcium levels; pre- and postoperative fiberoptic laryngoscopic examination reports; postoperative notes; and pathology reports. V600E mutations in the BRAF gene were detected by performing pyrosequencing for the 107 patients deemed evaluable for the BRAF mutation. RESULTS The median time to tumor recurrence (TTR) was 36 months (range, 6-791 months). All recurrent laryngeal nerves (RLNs; 161/161) that were at risk were successfully identified. There were seven new findings of abnormal post-RCCD vocal fold (VF) motion that were the result of intentional RLN resection. Among them, six were because of the need for resection of a local recurrence, and one was because of bulky lymph nodes circumferentially involving the RLN. There were no findings of unexpected RLN injury or VF paralysis. Fifteen patients developed hypocalcemia as a result of RCCD that improved with oral calcium and vitamin D supplementation. Among them, 12 cases developed only post-RCCD transient hypocalcemia (≤6 months), and three patients developed permanent hypocalcemia. No patient exhibited central compartment recurrent/persistent PTC in the post-RCCD period based on semiannual high-resolution neck ultrasound examination with a median follow-up of 41.5 months (range, 6-123 months). Eighty (74.8%) of 107 cases demonstrated the BRAF V600E mutation. The presence of the BRAF mutation was significantly associated with a shorter TTR (P = .015) compared with the BRAF mutation-negative group. The BRAF mutation-positive group had a higher incidence of concurrent lateral lymph node metastases (P = .0064) than the BRAF mutation-negative group. CONCLUSIONS Recurrent/persistent PTC in the central compartment typically harbors the BRAF mutation. The time to central neck recurrence from initial treatment is significantly shorter in the BRAF-positive population of patients compared to the BRAF-negative group, making it more likely that a recurrence will be identified early in the surveillance period. Although we have demonstrated that RCCD can be performed safely and effectively for nodal metastases, there is still risk involved, and this must be carefully weighed by the multidisciplinary team and the patient in optimizing a tailored plan for management.
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Affiliation(s)
- Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Abstract
BACKGROUND Most research reporting the management of advanced thyroid cancer focuses on major aerodigestive system or vessel involvement. In the present study, we investigated patients with locally advanced thyroid cancers who presented with malignant skin infiltration. The term fungating thyroid cancer (fTC) has been used to describe such a condition. METHODS The study was based on prospective collection of clinical, laboratory, imaging, and pathological data of all patients admitted to the head and neck and endocrine surgery unit, Main University Hospital, Alexandria School of Medicine, during the period April 2005-March 2011. RESULTS Eleven patients were referred with fTC, eight of whom had undergone subtotal thyroidectomy for an undiagnosed well-differentiated thyroid cancer (DTC) in another institution. The final pathological diagnosis showed (DTC, n = 3), poorly differentiated thyroid cancer (n = 5), anaplastic cancer (n = 2), and medullary thyroid cancer (n = 1). Extensive resections and reconstruction using flaps (pectoralis major, n = 6; deltopectoral, n = 1; sternocleidomastoid, n = 1) were undertaken. Complete tumor clearance (R0) was achieved in one patient and the others had microscopic (R1, n = 6) or macroscopic (R2, n = 1) residual disease. The three patients who did not undergo operation died within one month of presentation. The latest review of the eight patients who did undergo operation ranged from 3 to 6 months, but their survival remains unknown as access for follow-up was limited.
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Arciero CA, Shiue ZS, Gates JD, Peoples GE, Dackiw APB, Tufano RP, Libutti SK, Zeiger MA, Stojadinovic A. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism. J Cancer 2011; 3:1-6. [PMID: 22211139 PMCID: PMC3245602 DOI: 10.7150/jca.3.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/18/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Primary hyperaparathyroidism (pHPT) is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and complicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US) in patients prior to undergoing parathyroidectomy for pHPT. METHODS An Institutional Review Board approved prospective study was undertaken from January 2005 through July 2008. All patients with pHPT meeting inclusion criteria (n=94) underwent preoperative thyroid ultrasound in addition to standard (99m)Tc-sestamibi scintigraphy for parathyroid localization. Demographics, operative management and final pathology were examined in all cases. RESULTS Fifty-four of the 94 patients (57%) were noted to have a thyroid nodule on preoperative US, of which 30 (56%) underwent further examination with fine needle aspiration biopsy. Alteration of the operative plan attributable to underlying thyroid pathology occurred in 16 patients (17%), with patients undergoing either total thyroidectomy (n=9) or thyroid lobectomy (n=7). Thyroid cancer was noted in 33% of patients undergoing thyroid resection, and 6% of all patients with HPT. CONCLUSIONS The routine utilization of preoperative thyroid ultrasound in patients prior to undergoing parathyroid surgery for pHPT is indicated. The added information from this non-invasive modality facilitates timely management of co-incidental, and sometimes malignant, thyroid pathology.
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Affiliation(s)
| | | | | | - George E. Peoples
- 4. Brooke Army Medical Center, Fort Sam Houston, TX, USA
- 5. United States Military Cancer Institute, Washington, D.C. , USA
- 6. Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Ralph P. Tufano
- 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven K. Libutti
- 8. Albert Einstein College of Medicine / Montefiore Medical Center, New York City, NY, USA
- 9. Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Martha A. Zeiger
- 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Stojadinovic
- 5. United States Military Cancer Institute, Washington, D.C. , USA
- 6. Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- 9. Walter Reed National Military Medical Center, Bethesda, MD, USA
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Weinrib SL, Lane WS, Rappaport JM. Successful management of differentiated thyroid cancer in a community-based endocrine practice. Endocr Pract 2011; 18:170-8. [PMID: 21940280 DOI: 10.4158/ep11144.or] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the range of differentiated thyroid cancer (DTC) cases, disease complexity, and treatment outcomes seen in our 3-physician community-based general endocrine practice during an 8-year period in order to make comparisons with published cohorts from university settings. METHODS Medical records of patients with DTC treated between 2002 and 2009 at Mountain Diabetes and Endocrine Center (Asheville, North Carolina) were reviewed. Pathologic features, staging, and disease status at last contact were determined. Multivariate analyses of adverse prognostic risk factors at diagnosis, recombinant human thyroid-stimulating hormone use, and radioiodine use were compared with the ultimate outcome of patients. RESULTS We treated a total of 167 patients with DTC during the study period (mean age at diagnosis, 44.4 years; mean duration of follow-up, 6.2 years). In our study cohort, 88.6% had papillary thyroid cancer, 74% had stage I disease, and 32.4% of those with papillary thyroid cancer had microscopic tumors (≤1 cm). Remission occurred in 67.1%, 17.1% had persistent disease, and 11.8% were indeterminate for remission; non-thyroid cancer death occurred in 2.6% and disease-specific death in 1.3%. The mean number of adverse prognostic risk factors per patient was 2.0 in those with remission and 4.7 in those with persistent disease. CONCLUSION Community-based endocrinologists evaluate the full spectrum of thyroid cancer disease complexity and can achieve excellent outcomes. In our current study group, disease persistence and disease-specific death occurred in 17.1% and 1.3%, respectively. Individualization of care based on prognostic variables guided our diagnostic and therapeutic decisions.
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Affiliation(s)
- Stephen L Weinrib
- Mountain Diabetes and Endocrine Center, Asheville, North Carolina 28803, USA.
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Oh SW, Moon SH, Park DJ, Cho BY, Jung KC, Lee DS, Chung JK. Combined therapy with 131I and retinoic acid in Korean patients with radioiodine-refractory papillary thyroid cancer. Eur J Nucl Med Mol Imaging 2011; 38:1798-805. [PMID: 21698415 DOI: 10.1007/s00259-011-1849-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/12/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to assess the clinical outcome of redifferentiation therapy using retinoic acid (RA) in combination with 131I therapy, and to identify biological parameters that predict therapeutic response in Korean patients with radioiodine-refractory papillary thyroid carcinoma (PTC). MATERIALS AND METHODS A total of 47 patients (13 men, 34 women; age 54.2±13.6 years) with radioiodine-refractory PTC underwent therapy consisting of consecutive treatment with 131I and RA. Each 131I/RA treatment cycle involved the administration of oral isotretinoin for 6 weeks at 1-1.5 mg/kg daily followed by a single oral dose of 131I (range 5.5-16.7 GBq). Therapeutic responses were determined using serum thyroglobulin (Tg) levels and the change in tumour size 6 months after completing the 131I/RA therapy. Biological parameters and pathological parameters before and after combined therapy were compared. RESULTS After completing 131I/RA therapy, 1 patient showed a complete response, 9 partial response, 9 stable disease, and 28 progressive disease, representing an overall response rate of 21.3%. Univariate analysis revealed that an age of <45 years and a persistently high serum Tg level were related to a good response. No clinical response was achieved when metastases showing no iodine uptake were present. Multivariate regression analysis showed that an age of <45 years was significantly associated with a good response. Of the 24 patients with well-differentiated carcinoma, 5 (20.8%) responded to 131I/RA therapy, whereas all 6 patients with poorly differentiated carcinoma failed to respond. CONCLUSION 131I/RA therapy was found to elicit a response rate of 21.3% among patients with radioiodine-refractory PTC, and an age of <45 years was found to be significantly associated with a good response.
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Affiliation(s)
- So Won Oh
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
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Coelho SM, Vaisman F, Buescu A, Mello RCR, Carvalho DP, Vaisman M. Follow-up of patients treated with retinoic acid for the control of radioiodine non-responsive advanced thyroid carcinoma. Braz J Med Biol Res 2010; 44:73-7. [PMID: 21085896 DOI: 10.1590/s0100-879x2010007500120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2010] [Indexed: 04/17/2023] Open
Abstract
During thyroid tumor progression, cellular de-differentiation may occur and it is commonly accompanied by metastatic spread and loss of iodine uptake. Retinoic acid (RA) administration might increase iodine uptake in about 40% of patients, suggesting that RA could be a promising therapeutic option for radioiodine non-responsive thyroid carcinoma, although a prospective study with a long-term follow-up has not been reported. This was a clinical prospective study assessing the value of 13-cis-RA in patients with advanced thyroid carcinoma and its impact on major outcomes such as tumor regression and cancer-related death with a long-term follow-up of patients submitted to radioiodine (¹³¹I) therapy after RA administration. Sixteen patients with inoperable disease and no significant radioiodine uptake on post-therapy scan were selected. Patients were treated orally with 13-cis-RA at a dose of 1.0 to 1.5 mg·kg⁻¹·day⁻¹ for 5 weeks and then submitted to radioiodine therapy (150 mCi) after thyroxine withdrawal. A whole body scan was obtained 5 to 7 days after the radioactive iodine therapy. RECIST criteria were used to evaluate the response. An objective partial response rate was observed in 18.8%, a stable disease rate in 25% and a progression disease rate in 56.2%. Five patients died (62.5%) in the group classified as progression of disease. Progression-free survival rate (PFS) ranged from 72 to 12 months, with a median PFS of 26.5 months. RA may be an option for advanced de-differentiated thyroid cancer, due to the low rate of side effects.
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Affiliation(s)
- S M Coelho
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ, Brasil
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Pai SI, Tufano RP. Reoperation for Recurrent/Persistent Well-Differentiated Thyroid Cancer. Otolaryngol Clin North Am 2010; 43:353-63, ix. [DOI: 10.1016/j.otc.2010.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Suliburk J, Delbridge L. Surgical management of well-differentiated thyroid cancer: state of the art. Surg Clin North Am 2009; 89:1171-91. [PMID: 19836491 DOI: 10.1016/j.suc.2009.06.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nonmedullary well-differentiated thyroid cancer (WDTC) comprises a group of tumors including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), with Hürthle cell carcinoma being a subtype of follicular carcinoma. This article reviews the epidemiology, pathogenesis, preoperative and diagnostic evaluation, imaging, and staging of WDTC. Different approaches to therapy and follow-up care are discussed. The prognosis for WDTC remains good and most patients can expect to be cured of their disease.
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Affiliation(s)
- James Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Abstract
The recommended initial treatment for locoregional recurrence of thyroid cancer is surgery. Of most value to the surgeon considering reoperation for thyroid cancer is the impact that such procedures have on patient survival; the data in this regard are limited. Also of great interest to the surgeon is morbidity associated with reoperation. Because these patients have already had a total or near total thyroidectomy, reoperation requires a surgical revisiting of an already operated bed; intuitively, one might predict a higher rate of complications owing to scar tissue. This article reviews the evidence regarding rates of various complications.
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Affiliation(s)
- Francis P Ruggiero
- Division of Otolaryngology-Head & Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
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Kim WG, Kim EY, Kim TY, Ryu JS, Hong SJ, Kim WB, Shong YK. Redifferentiation therapy with 13-cis retinoic acids in radioiodine-resistant thyroid cancer. Endocr J 2009; 56:105-12. [PMID: 18854619 DOI: 10.1507/endocrj.k08e-254] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radioiodine (I-131) therapy is of proven efficacy for treatment of differentiated thyroid carcinoma (DTC). However, loss of differentiation in recurrent or metastatic DTC which decrease I-131 uptake may decrease the efficacy of I-131 therapy. Therefore, strategies to improve I-131 uptake are mandatory. This study is an open label clinical study to evaluate the effectiveness of 13-cis retinoic acid (13-cis RA) for improving I-131 uptake in recurrent or metastatic of DTC with defective I-131 uptake. Eleven patients (Age 27-66 years, M : F=4 : 7) were given 13-cis RA (1.5 mg/kg daily for 5 weeks), followed by 200 mCi (7.4 GBq) I-131 treatment. The differences of serum thyroglobulin (Tg) level and I-131 uptake on the post-treatment whole body scan (RxWBS) were compared before and after 13-cis RA therapy. Six out of 11 patients showed significantly increased (above 50%) Tg levels just after RA therapy. However, Tg levels a year after I-131 therapy were increased, stable and decreased in 7, 2 and 1 patients, respectively. Iodine uptake on RxWBS showed marginal improvement in only 2 patients and their Tg levels after one year follow-up increased. Most frequent adverse events were dry skin and lips. 13-cis RA partially restores I-131 uptake in few patients with recurrent or metastatic DTC. The use of 13-cis RA in current protocol has only limited usefulness and is not routinely recommended as currently used protocol.
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Affiliation(s)
- Won Gu Kim
- Department of Endocrinology & Metabolism, University of Ulsan College of Medicine, Seoul, Korea
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Thyroid Follicular Epithelial Cell-Derived Carcinomas: An Overview of the Pathology of Primary and Recurrent Disease. Otolaryngol Clin North Am 2008; 41:1079-94, vii-viii. [DOI: 10.1016/j.otc.2008.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roh JL, Park JY, Rha KS, Park CI. Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma? Head Neck 2008; 29:901-6. [PMID: 17405173 DOI: 10.1002/hed.20606] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although the pattern of cervical lymph node metastases from papillary thyroid carcinoma (PTC) has been described, little is known about the pattern of lateral cervical nodal recurrence. The aim of this study was to establish the optimal strategy for neck dissection in patients who underwent reoperation for lateral cervical recurrence of PTC. METHODS We reviewed the records of 22 patients who underwent neck dissection for lateral nodal recurrence of thyroid cancer between 2002 and 2004. Eight patients had thyroid remnants or recurrent tumors in the bed and 6 had undergone lateral neck dissection prior to referral. Patients underwent comprehensive dissection of the posterolateral and ipsilateral (n = 10) or bilateral (n = 12) central neck. The pattern of nodal recurrence and postoperative morbidity were analyzed. RESULTS All patients had lateral compartment involvement, 91% at mid-lower, 45% at upper, and 18% at posterior sites. Central nodes were involved in 86% of patients: 82% at ipsilateral paratracheal, 32% at pretracheal, 27% at superior mediastinal, and 2 patients at contralateral sites. Skip lateral recurrence with no positive central nodes was rarely observed (14%). Postoperative vocal cord palsy (n = 1) and hypoparathyroidism (n = 5) developed only in patients undergoing bilateral central compartment dissection. CONCLUSIONS The inclusion of comprehensive ipsilateral central and lateral neck dissection in the reoperation for patients with lateral neck recurrence of PTC is an optimal surgical strategy.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Reoperative Surgery for Benign Thyroid Diseases. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Catalano MG, Costantino L, Fortunati N, Bosco O, Pugliese M, Boccuzzi G, Berta L, Frairia R. High energy shock waves activate 5'-aminolevulinic Acid and increase permeability to Paclitaxel: antitumor effects of a new combined treatment on anaplastic thyroid cancer cells. Thyroid 2007; 17:91-9. [PMID: 17316109 DOI: 10.1089/thy.2006.0142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Multimodal treatments do not meaningfully improve survival of anaplastic thyroid cancer. Consequently, new effective therapeutic modalities are needed. The use of paclitaxel is under clinical investigation; it shows about a 50% response rate, but it is not able to alter the fatal outcome for patients with anaplastic carcinoma. High energy shock waves (HESW) have been shown to cause a transient increase in the permeability of cell membranes thus allowing higher intracellular drug concentrations. 5-Aminolevulinic acid (ALA) is used in the photodynamic therapy (PDT) of cancer, and HESW are under evaluation for their use as an activator in ALA-PDT. DESIGN We investigated the effect of HESW produced by a piezoelectric generator on the sensitivity to paclitaxel and ALA treatments of two different anaplastic thyroid cancer cell lines (ARO and CAL-62). Cells, treated sequentially with ALA and paclitaxel were exposed to HESW; thereafter, cell viability and apoptosis induction were evaluated. MAIN OUTCOME Combined exposure to ALA, paclitaxel, and shock waves resulted in a significant enhancement of cytotoxicity and induction of apoptosis in thyroid cancer cells with respect to cells treated with paclitaxel alone. CONCLUSIONS These preliminary data suggest the possibility of using HESW and ALA in combination with paclitaxel as a promising new therapy in the treatment of anaplastic thyroid cancer.
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Affiliation(s)
- M G Catalano
- Department of Clinical Pathophysiology, University of Turin, Italy
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Kebebew E, Peng M, Reiff E, Treseler P, Woeber KA, Clark OH, Greenspan FS, Lindsay S, Duh QY, Morita E. A phase II trial of rosiglitazone in patients with thyroglobulin-positive and radioiodine-negative differentiated thyroid cancer. Surgery 2007; 140:960-6; discussion 966-7. [PMID: 17188145 DOI: 10.1016/j.surg.2006.07.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 07/04/2006] [Accepted: 07/04/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND Rosiglitazone is a peroxisome proliferator-activated receptor gamma (PPARgamma) agonist that has been shown to induce differentiation, cell cycle arrest, and apoptosis in a variety of human cancers including thyroid cancer. METHODS Ten patients with differentiated thyroid cancer were enrolled in an open-label, phase II trial of oral rosiglitazone treatment (4 mg daily for 1 week, then 8 mg daily for 7 weeks). The levels of PPARgamma receptor mRNA and protein expression were determined in the patient's neoplasm. RESULTS Of 10 patients, 4 had positive radioiodine scans after rosiglitazone therapy with uptake in the neck in 3 patients and in the pelvis in 1 patient. After treatment, the serum thyroglobulin level decreased in 2 patients, increased in 5 patients, and was stable in 3 patients. No patient developed clinically important toxicity associated with rosiglitazone treatment. We found no relationship in the level of PPARgamma mRNA and protein expression in patients who had radioiodine uptake compared with those who did not. CONCLUSIONS Our findings suggest that rosiglitazone treatment may induce radioiodine uptake in some patients with thyroglobulin-positive and radioiodine-negative differentiated thyroid cancer. We found no relationship between the expression level of the PPARgamma mRNA and protein in the neoplasm and radioiodine uptake status after rosiglitazone therapy, questioning the potential pathway of effect.
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Affiliation(s)
- Electron Kebebew
- Department of Surgery, University of California, San Francisco, CA 94143, USA.
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Triponez F, Poder L, Zarnegar R, Goldstein R, Roayaie K, Feldstein V, Lee J, Kebebew E, Duh QY, Clark OH. Hook needle-guided excision of recurrent differentiated thyroid cancer in previously operated neck compartments: a safe technique for small, nonpalpable recurrent disease. J Clin Endocrinol Metab 2006; 91:4943-7. [PMID: 16968803 DOI: 10.1210/jc.2006-0386] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT As a result of more sensitive techniques to detect recurrent thyroid cancer, the number of patients presenting with small, nonpalpable recurrent thyroid cancer in cervical lymph nodes is increasing. Surgical excision of nonpalpable recurrent thyroid cancer can be difficult, particularly in a previously operated area. OBJECTIVE The objective of this study was to investigate whether preoperative insertion of a hook needle under ultrasound guidance is useful in neck reoperations for recurrent thyroid cancer. PATIENTS Ten consecutive patients presenting over a 4-month period with nonpalpable, ultrasound-visible, fine needle biopsy-proven recurrent thyroid cancer in previously operated neck compartment(s) were studied. MAIN OUTCOME MEASURES We measured whether it was technically possible to insert a hook needle preoperatively, rate of negative neck exploration, and complication rate. RESULTS The hook needle was inserted in seven patients. In three patients, the hook needle was not inserted; one patient had palpable disease 4 months after the preoperative clinic visit, one patient had a tumor too close to the carotid artery, and one patient had multiple bilateral foci of recurrent disease in the central neck. One patient had bleeding after insertion of the needle due to a penetration of an anterior jugular vein that was easily managed at neck reexploration. No other complication occurred during the hook needle insertion, and the only surgical complication was a transient recurrent nerve palsy. All pathology reports showed malignant disease. CONCLUSION Hook needle-guided excision of recurrent thyroid cancer is feasible and appears to be a promising tool for safe and successful reoperation of patients with small recurrent thyroid cancer in cervical lymph nodes.
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Affiliation(s)
- Frederic Triponez
- Endocrine Surgical Oncology, University of California/Mount Zion Medical Center, CA 94143-1674,USA.
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Huang SH, Wang PW, Huang YE, Chou FF, Liu RT, Tung SC, Chen JF, Kuo MC, Hsieh JR, Hsieh HH. Sequential follow-up of serum thyroglobulin and whole body scan in thyroid cancer patients without initial metastasis. Thyroid 2006; 16:1273-8. [PMID: 17199438 DOI: 10.1089/thy.2006.16.1273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the usefulness of whole body scan (WBS) and serum thyroglobulin (Tg) measurement after thyroxine withdrawal during sequential follow-ups in patients with differentiated thyroid cancer (DTC). DESIGN Two hundred and sixty-five consecutive DTC patients were enrolled. They were previously treated with near-total thyroidectomy and I-131 remnant ablation, without initial metastases or Tg antibodies. All had the first follow-up WBS and serum Tg measurement 6-12 months after initial treatment, and 165 patients received the second follow-up without further therapy. Positive/negative predictive values (PPV/NPV) were calculated by the outcome of patients being followed up for more than 8 years (mean+/-SD: 133+/-26 months). RESULTS Serum Tg levels while the patients were off thyroxine therapy decreased spontaneously in 39.3% of the cases without further therapy. The NPV of the first follow-up serum Tg level was excellent: <2 microg/L and <0.5 microg/L were 95.1% and 98.2%, respectively. However, the PPV of the first follow-up serum Tg level was low: >10 microg/L and 2-10 microg/L were 40% and 9.6%, respectively. The trend of Tg levels was more informative; the PPV was 62.5% in cases with an increase of serum Tg of >10 microg/L and 16.6% with an increase of <5 microg/L. However, decreasing Tg levels may associate with rapid deterioration of disease, in which cases decrease of Tg indicated dedifferentiation of the tumor. The diagnostic WBS showed the same picture in 91.5% of the patients. Only one patient (0.6%) turned from negative study to positive during the follow-up. In the meanwhile his serum Tg levels increased from 0.56 to 13.6 microg/L. CONCLUSION It is most informative when both the trend and the levels of Tg during sequential follow-up are considered. The diagnostic WBS may be performed for selected patients with indication based on Tg levels to localize the disease.
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Affiliation(s)
- Shu-Hua Huang
- Department of Nuclear Medicine, Chang Gung Memorial Hospital-Ksohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Courbon F, Zerdoud S, Bastie D, Archambaud F, Hoff M, Eche N, Berry I, Caron P. Defective efficacy of retinoic acid treatment in patients with metastatic thyroid carcinoma. Thyroid 2006; 16:1025-31. [PMID: 17042689 DOI: 10.1089/thy.2006.16.1025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Radioiodine (I-131) therapy is of proven efficacy for differentiated thyroid carcinoma. However, its efficacy relies on specific uptake mechanisms, which may be lost during the evolution of the disease. Attempts to increase the iodine uptake of such tumors have been made using retinoic acid because it exerts redifferentiating effects on thyrocytes. This study aims to assess the capability of the retinoic acid (RA) treatment to reinforce iodine 131-irradiation efficacy for metastatic and progressive multi-irradiated thyroid cancer. In this clinical prospective study, 11 patients (mean age +/- 1 SD = 61 +/- 12 years, sex ratio M/F = 5/6) with a progressive disease despite iterative surgery and iodine irradiations were treated with 13-cis-retinoic acid (1.5 mg/kg day) over 8 weeks prior to I-131 irradiation. The redifferentiating effect of RA was evaluated by serum thyroglobulin (Tg) monitoring during RA treatment and qualitative analysis of iodine uptake on the post-therapeutic whole body scan. The clinical usefulness of RA treatment was assessed by clinical follow-up, Tg monitoring, and tumor size. No serious event that could possibly be related to the treatment was reported. The mean follow up time was 24.2 +/- 12 months (range 3-46 months). Iodine uptake was only slightly improved in two patients. Nevertheless, the clinical benefits of RA seem to be very poor. Five patients died of a metastatic disease. Five others presented new clinical evidences of a progressive disease. In conclusion, this prospective study demonstrates the absence of efficacy of I-131 irradiation combined with RA for the treatment of patients with aggressive, rapidly growing metastatic thyroid cancer. Thus, patients with highly aggressive disease, rapidly growing in a short period from 2 to 6 months, should not be considered for RA therapy.
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Affiliation(s)
- F Courbon
- Department of Nuclear Medicine, University Hospital Toulouse Rangueil 1, Toulouse, France.
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Gilliam LK, Kohn AD, Lalani T, Swanson PE, Vasko V, Patel A, Livingston RB, Pickett CA. Capecitabine therapy for refractory metastatic thyroid carcinoma: a case series. Thyroid 2006; 16:801-10. [PMID: 16910885 DOI: 10.1089/thy.2006.16.801] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are few effective therapies for metastatic medullary (MTC) or radioiodine-resistant follicular thyroid carcinomas (FTC). We report a single institution's experience with capecitabine, a thymidylate synthase (TS) inhibitor, in the treatment of MTC and FTC. DESIGN We retrospectively analyzed five cases of metastatic thyroid carcinoma, three MTCs and two radioiodine-resistant FTCs, treated with capecitabine alone or in combination with other chemotherapeutics. Patients were selected for treatment based on low tumor TS immunohistochemical staining (< or =5%). Staining for thymidylate phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) was also performed. Therapeutic response was assessed by imaging studies and serum tumor markers: calcitonin and carcinoembryonic antigen (MTC), and thyroglobulin (FTC). MAIN OUTCOME Two of three patients with MTC had stable disease or disease regression on capecitabine. One of these patients had a 90% reduction in calcitonin and stabilization by imaging that lasted 4 years. Both patients with FTC initially had stable disease on capecitabine. One patient, who was treated with capecitabine in combination first with doxorubicin and then etoposide, had an initial decrease in tumor burden, followed by stable disease for 2.8 years. The second patient had stable disease, but capecitabine was discontinued after 11 months because of hand/foot syndrome. CONCLUSIONS This series demonstrates promising results for the use of capecitabine in treatment of MTC and radioiodine-resistant FTC, for which there is a limited repertoire of therapeutic agents. Larger studies are needed to confirm these findings and to establish the role of fluoropyramidine metabolism markers in predicting response.
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Affiliation(s)
- Lisa K Gilliam
- Divisions of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington 98195, USA.
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Podtcheko A, Ohtsuru A, Namba H, Saenko V, Starenki D, Palona I, Sedliarou I, Rogounovitch T, Yamashita S. Inhibition of ABL tyrosine kinase potentiates radiation-induced terminal growth arrest in anaplastic thyroid cancer cells. Radiat Res 2006; 165:35-42. [PMID: 16392960 DOI: 10.1667/rr3466.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gleevec, a selective tyrosine kinase inhibitor, retarded the growth of anaplastic thyroid cancer cell lines in vitro and in vivo through selective inhibition of ABL tyrosine kinase activity. In the present study, we investigated the ability of Gleevec to modulate the in vitro and in vivo radiation response of anaplastic thyroid cancer cells. Cell growth assays, colony formation assays and xenograft models were used to quantify the radiosensitizing effect of Gleevec in cells of the anaplastic thyroid cancer cell lines ARO and FRO. FACS, Western blotting and histochemical techniques were employed to study the mechanisms of radiation response after exposure to Gleevec. Gleevec (7.0 microM) increased the anti-proliferative effect of radiation on the growth ARO and FRO cells in vitro. Clonogenic analysis demonstrated that Gleevec reduced cell survival after irradiation. Gleevec combined with radiation produced an increase in tumor growth inhibition compared to treatment with either modality alone in mice bearing anaplastic thyroid cancer xenografts. The drug suppressed radiation-induced ABL activation and promoted CDKN1A (p21(cip1)) accumulation in irradiated anaplastic thyroid cancer cells. Gleevec had an additional effect on radiation-induced apoptosis in cells of both cell lines and potentiated the induction of terminal growth arrest accompanied by the expression of senescence-associated beta-galactosidase. The antitumor effect of Gleevec is potentiated in adjunctive therapy with radiation not only due to inhibition of proliferative cell growth with transient cell cycle arrest and apoptosis, but also due to the terminal growth arrest associated with senescence, suggesting that tumor cell senescence is a mechanism for tumor targeting therapy in combination with ionizing radiation.
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Affiliation(s)
- A Podtcheko
- Department of Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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Negele T, Meisetschläger G, Brückner T, Scheidhauer K, Schwaiger M, Vogelsang H. Radio-guided surgery for persistent differentiated papillary thyroid cancer: case presentations and review of the literature. Langenbecks Arch Surg 2006; 391:178-86. [PMID: 16491404 DOI: 10.1007/s00423-005-0013-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 11/16/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Persistent differentiated papillary thyroid cancer following radical locoregional surgery with metastases is an indication for limited reoperation or radioiodine therapy. Following injection of radioiodine, radio-guided surgery with application of an intraoperative gamma probe offers detection of metastases not seen by conventional imaging and control of completeness of resection. PATIENTS/METHODS We demonstrate four patients with locoregional metastases, two of them with additional distant metastases of papillary thyroid cancer following radical neck surgery. Postoperative radioiodine scans demonstrated persistent ipsilateral or contralateral cervical and mediastinal lymph node and isolated rib metastases. RESULTS Radio-guided surgery (RGS) leads to complete clearance of persistent lymph node metastases by limited recurrent neck surgery, resection of metastases not seen by conventional imaging and control of complete mediastinal lymph node dissection. Post-RGS scans allowed early diagnosis of occult diffuse or nodal pulmonary metastases in two patients. At last follow-up, 23 to 48 months following RGS and radioiodine therapy, there was no evidence of disease. CONCLUSIONS Radio-guided surgery is an additive surgical technique with low morbidity in selected patients with persistent thyroid cancer individualizing tumor therapy options in multimode oncological therapy.
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Affiliation(s)
- T Negele
- Department of Surgery, Interdisciplinary Center for Thyroid Diseases, Klinikum rechts der Isar, University of Polytechnique, Ismaninger Strasse 22, 81675, Munich, Germany
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Gol Choe J, Kim YR, Kim KN, Choo HJ, Shin JH, Lee YJ, Chung JK, Kim MK. Altered gene expression profiles by sodium/iodide symporter gene transfection in a human anaplastic thyroid carcinoma cell line using a radioactive complementary DNA microarray. Nucl Med Commun 2005; 26:1155-62. [PMID: 16264365 DOI: 10.1097/00006231-200512000-00017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The sodium/iodide symporter (NIS) is a membrane glycoprotein that mediates active 131I uptake during the treatment of cancer of the thyroid gland and extrathyroidal tissues. NIS gene transfection, a gene-therapy modality, has been introduced in many types of cancer, such as prostate cancer and breast cancer, and has demonstrated a high potential for the treatment of non-thyroidal cancers. AIM To investigate the pattern of NIS gene expression and provide evidence of its beneficial effects in human anaplastic cancer ARO cells by using a radioactive complementary DNA (cDNA) microarray. METHODS For cDNA microarray data analysis, superimposed images and clustergrams were prepared from basic radioactivity data obtained using a phosphoimager system. Gene expression profiles were constructed using the Z-transformed values of genes related to cancer biology. RESULTS Radioactive cDNA microarray studies showed that 11 genes were upregulated (Z ratio > 1.5) and 31 genes were downregulated (Z ratio < -1.5) in response to NIS gene transfection. Of these differentially expressed genes, 33% were related to cell proliferation and apoptosis. Moreover, NIS gene transfection into an anaplastic thyroid cancer cell line affected the expression of the protein tyrosine phosphatase (PTP) family and Ras oncogene family, including Ras, Rac and Rab. CONCLUSION The identification of changes in the patterns of gene expression may provide a better understanding of the response of molecular mechanisms to NIS gene transfection.
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Affiliation(s)
- Jae Gol Choe
- Department of Nuclear Medicine, Korea University Medical School, Seoul, South Korea
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Philips JC, Petite C, Willi JP, Buchegger F, Meier CA. Effect of peroxisome proliferator-activated receptor gamma agonist, rosiglitazone, on dedifferentiated thyroid cancers. Nucl Med Commun 2005; 25:1183-6. [PMID: 15640776 DOI: 10.1097/00006231-200412000-00005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHOD As genetic alterations in the gene for the peroxisome proliferator-activated receptor gamma (PPARgamma) have been described and PPAR agonists have been shown to redifferentiate thyroid cancers in animal models, we performed a pilot study in five patients with thyroglobulin-positive and I scan-negative thyroid cancers using the PPARgamma agonist rosiglitazone. RESULTS Although thyroglobulin levels increased in four of the five patients after 3 months of treatment with rosiglitazone, the I scan remained negative in four patients and became only faintly positive in one patient for two lung metastases that could be correlated with metabolically active lung metastases shown by F-fluorodeoxyglucose positron emission tomography (F-FDG PET) and by computed tomography (CT). F-FDG PET, performed in four patients, revealed metastases of significant size in two patients, including the patient mentioned above and in a second patient confirmed by surgery. CONCLUSIONS Treatment with rosiglitazone increased the production of thyroglobulin in some patients with thyroid cancers, but only rarely restored scintigraphically significant iodine trapping. It remains to be shown whether longer treatment periods might result in a more efficient redifferentiating effect.
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Affiliation(s)
- Jean-Christophe Philips
- Division of Endocrinology, Diabetes and Nutrition, Department of Internal Medicine bDivision of Nuclear Medicine, University Hospital Geneva, Geneva, Switzerland
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Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 2005; 136:1107-15. [PMID: 15657563 DOI: 10.1016/j.surg.2004.06.040] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Injury to the recurrent laryngeal nerve (RLN) is a rare complication of initial thyroid and parathyroid surgery, but the prevalence is much higher in the reoperative setting. The use of continuous, intraoperative electromyographic monitoring of the RLN has been suggested to improve the safety of cervical explorations. METHODS Outcomes of a group of reoperative thyroid and parathyroid cases that used EMG monitoring with endoscopically applied hook-wire electrodes were compared with a group of cervical reoperations without monitoring. Office laryngoscopy (indirect or fiberoptic) was used to evaluate and follow suspected RLN complications. RESULTS Electromyography was used in 52 cervical reexploration procedures. Patients averaged 1.8 previous explorations (range, 1-7 explorations) and underwent procedures for parathyroid (31%) and/or thyroid (77%) disease (overall, 72% malignant). The non-monitored group had 59 patients with similar characteristics. Only 1 permanent nerve complication in each group was unintended (electromyography, 1.9%; non-electromyography, 1.7%). Seven false-negative and 2 false-positive electromyographic findings occurred. No complications resulted from placement of the electromyography electrodes. CONCLUSIONS Intraoperative electromyographic monitoring of the RLN in reoperative neck surgery can be performed safely but did not decrease RLN complications in this study. Experience and routine nerve exposure remain crucial to the minimization of RLN complications.
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Affiliation(s)
- Donald E Yarbrough
- Department of Surgery, College of Medicine, Mayo Clinic, Mayo Building W6, 200 First Street SW, Rochester, MN 55905, USA
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Binyousef HM, Alzahrani AS, Al-Sobhi SS, Al SHS, Chaudhari MA, Raef HM. Preoperative neck ultrasonographic mapping for persistent/recurrent papillary thyroid cancer. World J Surg 2005; 28:1110-4. [PMID: 15490054 DOI: 10.1007/s00268-004-7636-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical resection of persistent/recurrent (P/R) papillary thyroid cancer (PTC), when localized to the neck, is generally recommended; however, its impact on the course of the disease is not clear. We introduced a new technique in the form of preoperative neck ultrasonographic mapping (US-M) to improve the outcome of the surgical resection of P/R PTC. A total of 19 patients had undergone regional (central, lateral, or both) neck dissection before introducing the current technique (group 1, or G1), and 26 patients (group 2, or G2) had limited lymph node resection guided by US-M with findings accurately plotted on a standard diagram. All of the operations were performed by a single surgeon. The surgical outcomes of the two groups were compared. The resected lesions were positive for PTC in 17 patients (89.5%) in G1 and in 25 patients (96.2%) in G2. In G2, the intraoperative findings exactly matched the US-M in 23 patients (88.5%). Postoperatively, neck US became negative in 50% in G1 and in 83.3% in G2 (p = 0.02). Thyroglobulin (Tg) became undetectable in 37.5% in G1 and 52.3% in G2 (p = 0.37). Whole-body iodine scans (WBS) became negative in one of six patients (16.7%) in G1, and in three of four patients (75%) in G2, (p = 0.06). After a mean follow-up of 23.8+/-7.1 months in G1 and 9.8+/-4.7 months in G2, 6 patients (31.6%) in G1 and 15 patients (62.5%) in G2 were in remission (p = 0.04), whereas the disease persisted in 13 cases (68.4%) in G1 and 9 (37.5%) in G2 (p = 0.04). In conclusion, US-M improved the surgical outcome, as evidenced by the postoperative US, Tg, and WBS findings and the higher remission rate for the G2 patients than for the G1 patients.
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Affiliation(s)
- Hussam M Binyousef
- Department of Surgery, King Faisal Specialist Hospital & Research Centre, 11211 Riyadh, Saudi Arabia
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44
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Vogelsang H, Brückner T, Scheidhauer K, Schwaiger M, Siewert JR. Wiederholungseingriffe beim Schilddr�senkarzinom. Chirurg 2005; 76:238-49. [PMID: 15739058 DOI: 10.1007/s00104-005-1006-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reoperation for thyroid cancer needs to consider patient-, tumor- and therapy-related aspects as well as present diagnostic results. Reoperation because of thyroid remnants, persistence of the primary tumor and lymph node metastasis (completion surgery) has to be distinguished from reoperation due to locoregional recurrence (primary tumor, lymph nodes). The primary surgical strategy should avoid the need for reoperation. The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis. The timing and indication of reoperation for differentiated thyroid carcinoma in an interdisciplinary multimodal treatment setting depends on diagnostic radioiodine scans and radioiodine therapy. Long-term, recurrence-free survival is achieved by sufficiently radical surgery with acceptable morbidity, including all additive or adjuvant treatment options.
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Affiliation(s)
- H Vogelsang
- Chirurgische Klinik und Poliklinik, Technische Universität München.
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Verburg FA, de Keizer B, Lips CJM, Zelissen PMJ, de Klerk JMH. Prognostic significance of successful ablation with radioiodine of differentiated thyroid cancer patients. Eur J Endocrinol 2005; 152:33-7. [PMID: 15762184 DOI: 10.1530/eje.1.01819] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Currently, little is known about the prognostic significance of achieving successful ablation with the first dosage of I-131 in patients with differentiated thyroid cancer. This study aimed to assess the following: (i) whether successful or unsuccessful ablation at post-ablation follow-up has prognostic consequences; (ii) possible factors predicting success of ablation in a patient. METHODS In order to do this, we retrospectively studied 180 patients with a median follow-up of 55 months. Ablation was considered to be successful if 1 year after the initial dosage of I-131 patients fulfilled all of the following criteria: not dead from thyroid cancer, no additional therapy needed for any kind for thyroid cancer within the first year, undetectable thyroglobulin (Tg) levels under TSH stimulation, and negative I-131 scintigraphy. Tg levels at the time of ablation (P < 0.001), lymph node metastasis (P = 0.04) and distant metastasis (P < 0.001) have a significant influence on the success of ablation. P values were calculated by Mann-Whitney U test and Chi-square test, respectively. RESULTS Patients with successful ablation had a better prognosis than those with unsuccessful ablation: disease-free survival was 87% versus 49% after 10 years; additionally, thyroid-cancer related survival was 93% versus 78%. CONCLUSION We conclude that the extent of the remaining normal or neoplastic thyroid tissue influences the outcome of ablation, and that successful ablation leads to a better prognosis. It seems that it is very important to achieve complete ablation as soon as possible in order to ensure the best possible prognosis for a patient.
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Affiliation(s)
- Frederik A Verburg
- Department of Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Woodrum DT, Gauger PG. Role of131I in the treatment of well differentiated thyroid cancer. J Surg Oncol 2005; 89:114-21. [PMID: 15719384 DOI: 10.1002/jso.20185] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
(131)I is an integral component in postsurgical management of well-differentiated thyroid cancer (WDTC), which includes papillary and follicular types. (131)I is used postsurgically to either destroy remaining thyroid tissue (thyroid ablation) or to treat recurrence and metastases (radioiodine therapy). (131)I is no longer a routine diagnostic modality, but it is widely used for remnant ablation after thyroidectomy for WDTC > 1 cm, under conditions of thyroxine withdrawal. It is generally-though not unanimously-accepted that postsurgical radioiodine is the most powerful method by which to lengthen disease-free survival. (131)I cannot be used if the residual thyroid remnant is large; many surgeons therefore perform near-total or total thyroidectomy for all WDTC > 1 cm. Since 1997, radioiodine treatment has been performed in outpatient settings, where side effects are common, but mild and transient. Secondary screening is by physical exam, thyroglobulin measurements, and (131)I diagnostic whole-body scans. This is performed under conditions of thyrotropin stimulation, which is accomplished either by thyroxine withdrawal or administration of recombinant human thyrotropin. While most cancers are well treated with radioiodine, some advanced cancers may no longer take up radioiodine, rendering them resistant to treatment. For these cancers, redifferentiation therapy and molecular target-specific medicines hold future promise for improved treatment.
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Affiliation(s)
- Derek T Woodrum
- Division of Endocrine Surgery, University of Michigan Department of Surgery, Ann Arbor, Michigan, USA
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Abstract
Thyroid tumorigenesis and carcinogenesis accompany progressive loss of thyroid-specific differentiated functions. Some thyroid cancers are or become dedifferentiated, and they become refractory to efficacy-proven conventional therapies such as radioiodine ablation therapy and thyrotropin (TSH)-suppressive therapy. Redifferentiation therapy by either redifferentiating agents or gene transfer of differentiation-related genes may retard tumor growth and make tumors respond to conventional therapies.
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Affiliation(s)
- Jin-Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, San 62 Kaeshin-dong, Heungdok-gu, Cheongju, 361-763 South Korea
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Raffel A, Cupisti K, Krausch M, Wolf A, Schulte KM, Röher HD. Incidentally found medullary thyroid cancer: treatment rationale for small tumors. World J Surg 2004; 28:397-401. [PMID: 14994142 DOI: 10.1007/s00268-003-7121-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The object of this study was to assess the extent of surgery required for small sporadic medullary thyroid cancers (sMTCs). We retrospectively studied 261 patients with MTCs treated in our institution between 1986 and 2002 and identified 15 patients with small pT1 or pT2 sMTCs. The tumors were diagnosed incidentally, so surgical therapy was less than total thyroidectomy. Total thyroidectomy with or without neck dissection was applied to all other patients as standard surgical treatment of care. Patients were systematically followed up by postoperative ultrasonography, calcitonin, carcinoembryonic antigen levels, and pentagastrin stimulation tests. On long-term follow-up over a period of 4.6 years, the rate of biochemical cure in these patients who underwent less than total thyroidectomy for a sporadic incidentally diagnosed tumor was 100%. We concluded that completion thyroidectomy and neck dissection are not mandatory in patients in whom a solitary small sMTC is incidentally discovered by histologic diagnosis following operation so long as a genetic background is excluded. Nevertheless, such patients require systematic careful long-term follow-up.
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Affiliation(s)
- Andreas Raffel
- Department of General and Trauma Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Affiliation(s)
- Jin-Woo Park
- Department of Surgery, Chungbuk National University, College of Medicine & Hospital, Korea.
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Chang HS. Treatment of Locally Advanced Thyroid Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.12.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hang-Seok Chang
- Department of Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Korea.
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