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Mishra A, Singh V, Khandelwal Y, Smitha AM, Kavali DJP, Barai S. Incidentally Detected Metachronous Malignancy in Patients of Papillary Carcinoma of Thyroid Posthigh-Dose Radioiodine Therapy. Indian J Nucl Med 2023; 38:264-269. [PMID: 38046960 PMCID: PMC10693376 DOI: 10.4103/ijnm.ijnm_188_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 12/05/2023] Open
Abstract
Thyroid cancer is one of the most common endocrine cancers. The most common histological subtypes are papillary and follicular variants; these are "differentiated thyroid cancers" and are associated with an excellent prognosis. The exact mechanism of thyroid cancer is not known. Several genetic alterations and environmental factors are found to be associated with this cancer. Patients with differentiated thyroid cancer are treated with postoperative radioactive iodine (RAI) therapy to ablate residual thyroid tissue and metastatic micro-foci. It is thought that after RAI, there is an increased risk of secondary malignancies such as lung, renal, and stomach cancer and lymphomas. However, the risk of secondary malignancy is not clear. They may be associated with genetic syndromes, environmental factors, and radiation exposure. The secondary malignancy may be detected incidentally during follow-up or present with signs and symptoms of that malignancy. There is no direct association between second malignancy and radiation exposure in I-131 therapies. We present a case series of five patients treated with high doses of I-131 for the remnant. The patients developed metachronous malignancies later in life.
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Affiliation(s)
- Ayush Mishra
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vijay Singh
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Yogita Khandelwal
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | | | - Sukanta Barai
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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2
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Sharma AK, Jain K, Singhal P, Rawat DS, Jain SK, Sharma S. Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A review on Surgical Treatment. Indian J Otolaryngol Head Neck Surg 2022; 74:6384-6390. [PMID: 36742493 PMCID: PMC9895742 DOI: 10.1007/s12070-022-03107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
Differentiated thyroid carcinoma is one of the commonest malignancies in head and neck region. Among differentiated thyroid carcinoma, papillary carcinoma is the commonest. Encapsulated follicular variant of papillary thyroid carcinoma tumors are very indolent tumors which behave like benign tumors. Many tumors have been over diagnosed and over treated in spite of their indolent nature. We aimed to find out if total thyroidectomy is really required for very low grade tumors like encapsulated FVPTC. We operated 672 patients of thyroid disease during 2012 to 2020 in SMS Medical College, Jaipur. Out of 256 patients, 199 patients (78%) had papillary carcinoma of thyroid. Classical variant was present in 40% and follicular variant was present in 35% (N-69). Out of 69 patients with follicular variant of PTC, 59 patients had well encapsulated type of follicular variant of PTC while 10 patients had invasive type of follicular variant of PTC. Encapsulated FVPTC are less aggressive and indolent tumors. They should be treated more conservatively. Hemithyroidectomy is sufficient treatment for its complete cure. Out of 69 patients with Follicular variant of PTC, 59 patients had encapsulated disease. Out of 59 patients, 14 (24%) had bilateral nodular disease. 45 (77%) patients had unilateral disease; multicentric in one lobe in 9 (15%) patients and unicentric in 36 (61%) patients. However, encapsulated FVPTC was only found in predominant lobe and the non dominant lobe had benign disease.
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Affiliation(s)
- Anjani Kumar Sharma
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Khushboo Jain
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | | | - Shailesh Kumar Jain
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Shivam Sharma
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
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3
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Ansari M, Rezaei Tavirani M. Assessment of Different Radioiodine Doses for Post-ablation Therapy of Thyroid Remnants: A Systematic Review. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e123825. [PMID: 36060901 PMCID: PMC9420215 DOI: 10.5812/ijpr-123825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/03/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
The determination of radioiodine remnant ablation (RRA) dosage in post-operation thyroid residual tissues resection has been largely subject of discussion, yet no concise conclusion is released through systematic review studies. In this study, we conducted a systematic review of comparative experiments to evaluate and compare the efficacy of different prescribed dosages of radioiodine in post-op thyroid residual tissues resection among low, intermediate, and high-risk patients to approve the common method. Using automated searches, studies were collected from PubMed, Google Scholar, Elsevier, Scopus, and UpToDate, all until April 2021. Alongside the aforementioned sources, comparative experiments were added in for further investigation. Overall, 4000 patients with papillary thyroid cancer, differentiated thyroid carcinoma (DTC), metastasized and non-metastasized thyroid cancer took part in twenty-one trials are assessed. We discovered no significant difference in successful thyroid residual tissues excision between low-activity and high-activity radioiodine treatment in people with low and intermediate risk. In these individuals, there was no significant difference between the high therapeutic dose of 3700 MBq and the lesser dose of 1850 MBq for RRA. However, high-dose treatment usually yielded superior results. Low activity RRA causes fewer adverse effects in metastasis-free patients than high-activity 3.7 GBq. There was no significant therapeutic difference regarding treatment efficacy in patients with low and moderate risks. However, in patients with high-risk status, applying a high-dose regimen of RRA produced a significantly better response.
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Affiliation(s)
- Mojtaba Ansari
- Faculty of Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Faculty of Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mostafa Rezaei Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fontes LF, do Nascimento MMG, Ramalho-de-Oliveira D, Rezende CDP, Costa CHFD, Melo RCRD, Brunelli Pujatti P. Clinical pharmaceutical screening in critical situations in a radioiodine therapy management service. J Oncol Pharm Pract 2021; 28:135-140. [PMID: 34661492 DOI: 10.1177/10781552211045361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radioiodine therapy can be used in differentiated thyroid carcinoma and requires extensive evaluation to ensure effectiveness and safety. Therefore, it is necessary to evaluate all health problems and medications used in the pre-radioiodine therapy period and comprehensive medication managementservices can serve as a screening tool in this context. The present study aims to describe critical clinical situations identified during the initial assessments of a comprehensive medication management service offered to differentiated thyroid carcinoma patients pre-radioiodine therapy, and the pharmaceutical interventions performed to solve them. A descriptive study with regard to the initial ten months of a comprehensive medication management service was carried out in a large oncology hospital (Rio de Janeiro, Brazil). Descriptive analysis was used to describe the critical clinical situations identified, as well as the correspondent drug therapy problems and the type, acceptability, and outcomes of the pharmaceutical interventions performed to solve them. Thirty patients with an average of 45.8 years and 5.1 medications were evaluated. Five critical clinical situations were identified; corresponding to drug therapy problems two(needs additional drug therapy - n = 4) and drug therapy problems four (dosage too low - n = 1). All pharmaceutical interventions were accepted. The comprehensive medication management service provision pre-radioiodine therapy is feasible and represents an important screening strategy.
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Affiliation(s)
- Lídia Freitas Fontes
- Nuclear Medicine Service, Cancer Hospital I, 37908National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Mariana Martins Gonzaga do Nascimento
- College of Pharmacy, Center for Pharmaceutical Care Studies, 28114Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.,College of Pharmacy, Department of Pharmaceutical Products, 28114Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Djenane Ramalho-de-Oliveira
- College of Pharmacy, Center for Pharmaceutical Care Studies, 28114Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.,College of Pharmacy, Department of Social Pharmacy, 28114Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Cristiane de Paula Rezende
- College of Pharmacy, Center for Pharmaceutical Care Studies, 28114Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Rossana Corbo Ramalho de Melo
- Nuclear Medicine Service, Cancer Hospital I, 37908National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil.,Oncological Endocrinology, Cancer Hospital I, 37908National Cancer Institute (INCA), Rio de Janeiro, RJ, Brasil
| | - Priscilla Brunelli Pujatti
- Nuclear Medicine Service, Cancer Hospital I, 37908National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
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5
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James DL, Ryan ÉJ, Davey MG, Quinn AJ, Heath DP, Garry SJ, Boland MR, Young O, Lowery AJ, Kerin MJ. Radioiodine Remnant Ablation for Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:544-552. [PMID: 33792650 DOI: 10.1001/jamaoto.2021.0288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Postoperative radioactive iodine (RAI) remnant ablation for differentiated thyroid cancer (DTC) facilitates the early detection of recurrence and represents an adjuvant therapy that targets persistent microscopic disease. The optimal activity of RAI in low- and intermediate-risk DTC remains controversial. Objective To evaluate the long-term cure rate of different RAI activities in low- and intermediate-risk DTC. Secondary outcomes included successful remnant ablation, adverse effects, and hospital length of stay. Data Source A systematic search of the databases PubMed, Cochrane Collaboration, Embase, Scopus, and Web of Science was performed to identify randomized clinical trials (RCTs) and observational studies that compared long-term outcomes (>12 months) for American Thyroid Association-classified low- and intermediate-risk DTC based on receipt of either low-activity or high-activity RAI postoperatively. Study Selection All RCTs or observational studies evaluating patients with low- and intermediate-risk DTC who were treated initially with total/near-total thyroidectomy, followed by remnant RAI ablation with either low or high activities. Eligible studies had to present odds ratio, relative risk (RR), or hazard ratio estimates (with 95% CIs), standard errors, or the number of events necessary to calculate these for the outcome of interest rate. Data Extraction Two investigators reviewed the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Dichotomous variables were pooled as risk ratios and continuous data as weighted-mean differences. Quality assessment of the included studies was performed using the Newcastle-Ottawa and Jadad scales. Main Outcomes and Measures Disease recurrence was the primary outcome. Secondary outcomes included successful ablation, adverse effects, and length of stay. Results Ten studies that included 3821 patients met inclusion criteria, including 6 RCTs and 4 observational studies. There was no difference in long-term cure recurrence rates (RR, 0.88; 95% CI, 0.62-1.27, P = .50) or successful remnant ablation (RR, 0.95; 95% CI, 0.87-1.03; P = .20) between low-activity and high-activity RAI. Conclusions and Relevance In this systematic review and meta-analysis, low-activity RAI was comparable with high-activity RAI regarding successful ablation and recurrence rates. This suggests that low-activity RAI is preferable to high-activity in low- and intermediate-risk DTC because of its similar efficacy but reduced morbidity. Trial Registration PROSPERO Identifier: CRD42020166780.
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Affiliation(s)
- Danielle L James
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Éanna J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Matthew G Davey
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Alanna Jane Quinn
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - David P Heath
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - Stephen James Garry
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Michael R Boland
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - Orla Young
- Department of Otorhinolaryngology, Head & Neck Surgery, Galway University Hospitals, Galway, Ireland
| | - Aoife J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
| | - Michael J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, Ireland
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6
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Nine Genes Mediate the Therapeutic Effects of Iodine-131 Radiotherapy in Thyroid Carcinoma Patients. DISEASE MARKERS 2020; 2020:9369341. [PMID: 32626543 PMCID: PMC7317313 DOI: 10.1155/2020/9369341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Abstract
Background Thyroid carcinoma (THCA) is one of the most common malignancies of the endocrine system, which is usually treated by surgery combined with iodine-131 (I131) radiotherapy. Aims This study is aimed at exploring the potential targets of I131 radiotherapy in THCA. Methods The RNA-sequencing data of THCA in The Cancer Genome Atlas database (including 568 THCA samples) was downloaded. The differentially expressed genes (DEGs) between the tumour samples whether or not subjected to I131 radiotherapy were identified using edgeR package. Using the WGCNA package, the module that was relevant with I131 radiotherapy was selected. The intersection genes of the hub module nodes and the DEGs were obtained as hub genes, followed by the function and pathway enrichment analyses using the clusterProfiler package. Moreover, the protein-protein interaction (PPI) network for the hub genes was constructed using Cytoscape software. In addition, more important hub genes were analysed with function mining using the GenCLiP2 online tool. The qPCR analysis was used to verify the mRNA expression of more important hub genes in THCA tissues. Results There were 500 DEGs (167 upregulated and 333 downregulated) between the two groups. WGCNA analysis showed that the green module (428 nodes) exhibited the most significant correlation with I131 radiotherapy. A PPI network was built after the identification of 53 hub genes. In the PPI network, CDH5, KDR, CD34, FLT4, EMCN, FLT1, ROBO4, PTPRB, and CD93 exhibited higher degrees, which were mainly implicated in the vascular function. The relative expression of nine mRNAs in the THCA tissues treated with I131 was lower. Conclusion I131 radiotherapy might exert therapeutic effects by targeting CDH5, KDR, CD34, FLT4, EMCN, FLT1, ROBO4, PTPRB, and CD93 in THCA patients.
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7
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The overuse of radioactive iodine in low-risk papillary thyroid cancer patients. Surg Oncol 2019; 29:184-189. [DOI: 10.1016/j.suronc.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/23/2019] [Accepted: 05/18/2019] [Indexed: 11/20/2022]
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8
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Liu J, Tang X, Shi F, Li C, Zhang K, Liu J, Wang G, Yin J, Li Z. Genetic polymorphism contributes to 131I radiotherapy-induced toxicities in patients with differentiated thyroid cancer. Pharmacogenomics 2018; 19:1335-1344. [PMID: 30430914 DOI: 10.2217/pgs-2018-0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM To investigate the association between SNPs in DNA damage response pathways and toxicities following 131I radiotherapy of differentiated thyroid cancer (DTC). Materials & methods: We identified 22 functional SNPs of genes in DNA damage response pathways. MassArray was used to sequence SNP genotypes in 203 DTC patients. Hardy-Weinberg equilibrium and the associations between the two alleles of each SNP and toxicity reactions were evaluated using χ2 analysis. RESULTS Ataxia-telangiectasia mutated (ATM) rs620815 T-allele carriers were at increased risk of 131I radiation-induced gastrointestinal reaction compared with C allele carriers. TNFα rs1800629 GA genotype may increase the incidence of neck pain compared with GG genotype. Furthermore, TNFα rs1800629, ATM rs11212570, NF-κβ rs230493, and TGF-β rs1800469, rs2241716 were associated with throat pain following 131I radiotherapy. CONCLUSION The identified SNPs might serve as novel biomarkers for DTC treated with 131I radiotherapy.
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Affiliation(s)
- Jianqiu Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Xinyue Tang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China.,Department of Center for ADR Monitoring of Hubei, Wuhan 430071, PR China
| | - Feng Shi
- Department of Thyroid internal medicine, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, PR China
| | - Cuilin Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Ke Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Jie Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Guo Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Jiye Yin
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
| | - Zhi Li
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha 410008, PR China.,Institute of Clinical Pharmacology, Central South University & Hunan Key Laboratory of Pharmacogenetics, Changsha 410078, PR China
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Incidence of Second Malignancy in Patients with Papillary Thyroid Cancer from Surveillance, Epidemiology, and End Results 13 Dataset. J Thyroid Res 2018; 2018:8765369. [PMID: 30046434 PMCID: PMC6038658 DOI: 10.1155/2018/8765369] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/14/2018] [Indexed: 12/14/2022] Open
Abstract
Increased risk of second primary malignancy (SPM) in papillary thyroid cancer (PTC) has been reported. Here, we present the most updated incidence rates of second primary malignancy from original diagnosis of PTC by using the data from the Surveillance, Epidemiology, and End Results. In this cohort, 3,200 patients developed SPM, a substantially higher number than in the reference population of 2,749 with observed to expected ratio (O/E) of 1.16 (95% CI; 1.12–1.21). Bone and joint cancer had the highest O/E ratio of 4.26 (95% confidence interval [CI] 2.33–7.15) followed by salivary gland (O/E 4.15; 95% CI 2.76–6.0) and acute lymphocytic leukemia (O/E 3.98; 95% CI 2.12–6.8). Mean age at the diagnosis of SPM was 64.4 years old. Interestingly, incidence of colorectal cancer was lower in thyroid cancer survivors compared to general population (large intestine O/E 0.3; 95% CI 0.06–0.88, rectum O/E 0.6; 95% CI 0.41–0.85); however, this was not observed in patients who underwent radiation therapy. The incidence of SPM at all sites was higher during 2000–2012 compared to 1992–1999 (O/E 1.24 versus 1.10). Surprisingly, patients with micropapillary cancer had higher incidence of SPM than counterparts with a larger tumor in radiation group (O/E of 1.40 versus 1.15). O/E of all cancers were higher in males compared to females with O/E of 1.41 versus 1.17 during the period of 2000–2012. Diagnosis of PTC before age 50, especially at age 30–34, was associated with higher incidence of overall SPM (age 30–34; O/E 1.43; 95% CI; 1.19–1.71). Efficient monitoring strategies that include age at the time of thyroid cancer diagnosis, exposure to radiation, gender, and genetic susceptibility may successfully detect SPM earlier in the disease course. This is especially important given the excellent prognosis of the initial thyroid cancer itself.
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10
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Xue S, Wang P, Liu J, Chen G. Radioactive Iodine Ablation Decrease Recurrences in Papillary Thyroid Microcarcinoma with Lateral Lymph Node Metastasis in Chinese Patients. World J Surg 2018; 41:3139-3146. [PMID: 28741199 PMCID: PMC5680383 DOI: 10.1007/s00268-017-4134-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction We aimed to carry out a retrospective study from a single institution to determine whether radioactive iodine (RAI) ablation decreases the risk of recurrence of papillary thyroid microcarcinoma (PTMC) patients that presented with lateral lymph node metastasis (LLNM). Methods We retrospectively analyzed a total of 6361 consecutive PTMC patients who initially underwent surgery for the treatment of thyroid carcinoma at the First Hospital of Jilin University, between January 2005 and February 2015. Altogether, 137 patients with PTMC with LLNM have been enrolled in our study. Results The disease-free survival period was significantly shorter for the RAI (−) patients than for the RAI (+) patients (p = 0.0074 by the log-rank test). The disease-free survival rates at 5 and 10 years were 93.02 and 87.5%, respectively, in the RAI (−) group and 100 and 96.81%, respectively, in the RAI (+) group. CLNM ratio and LLNM ratio were factors identified for multivariate analysis by Cox’s proportional hazards method yielding risk ratios of 7.281 [CI 1.804–17.554; p = 0.010] and 1.157 [CI 1.0125–9.381; p = 0.048] in the RAI (−) group. Conclusion Taken together, RAI may be beneficial for PTMC with LLNM, especially when CLNM ratio or LLNM ratio was greater than 0.5.
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Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Peisong Wang
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Jia Liu
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Guang Chen
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, 130021, People's Republic of China.
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11
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Chae AW, Martinez SR. Too Much of a Good Thing: Radioactive Iodine Ablation Use for Micropapillary Thyroid Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radioactive iodine (RAI) is not routinely recommended for the adjuvant treatment of micro-papillary thyroid carcinoma (MPTC). We aimed to report on clinical and pathologic factors associated with the use of RAI in these patients. We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery for MPTC (tumor size ≤1 cm) from 1988 to 2009. We excluded patients without a biopsy-proven diagnosis, those diagnosed at autopsy, and patients with documented extra-thyroidal extension. Multivariate logistic regression models predicted the use of RAI based on patient, tumor, and treatment-related factors. We identified 24,076 patients with MPTC that were eligible for study inclusion. Of these, 6,172 (25.6%) received RAI. Lymph node metastases were present in 23.8 per cent of those for whom lymph node status was known. On multivariate analysis, an increasing number of positive nodes, increasing tumor size, Asian race, and male gender predicted the use of RAI. RAI use was less likely in those with advancing age, an increasing number of lymph nodes examined and patients that received less than a total thyroidectomy. Among node-negative patients, Asian race and increasing tumor size predicted the use of RAI. Factors predicting decreased use of RAI were an increasing number of lymph nodes examined, unknown race, less than a total thyroidectomy, and advancing age. A significant number of MPTC patients receive potentially unnecessary RAI.
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Affiliation(s)
- Andrew W. Chae
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, California and
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12
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Clinico-social factors to choose radioactive iodine dose in differentiated thyroid cancer patients. Nucl Med Commun 2018; 39:283-289. [DOI: 10.1097/mnm.0000000000000804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Anderson C, Engel SM, Weaver MA, Zevallos JP, Nichols HB. Birth rates after radioactive iodine treatment for differentiated thyroid cancer. Int J Cancer 2017; 141:2291-2295. [PMID: 28791691 DOI: 10.1002/ijc.30917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/21/2017] [Indexed: 02/05/2023]
Abstract
Treatment with radioactive iodine (RAI) for differentiated thyroid cancer has been associated with alterations in gonadal function in women, including changes in menstrual function and an earlier age at menopause. Our objective was to evaluate associations between RAI and postdiagnosis live birth rates among thyroid cancer survivors diagnosed at ages 15-39 years. We identified women diagnosed with differentiated thyroid cancer between January 2000 and December 2013 in the North Carolina Central Cancer Registry (CCR). CCR records were linked to state birth certificate files to identify livebirths to thyroid cancer survivors through December 2014. Person-years of follow-up were accrued from 6 months after diagnosis to first birth, 46th birthday, death, or December 31, 2014, whichever came first. Cox proportional hazards regression was used to estimate hazards ratios (HR) and 95% confidence intervals (CI) for first livebirth. Among 2,360 women with a differentiated thyroid cancer diagnosis, 53% received RAI. The cumulative incidence of birth at the end of follow-up (maximum 14.5 years) was 30.0 and 29.3% among those who were and were not treated with RAI, respectively. Overall, first birth rates did not significantly differ between groups (HR = 1.00; 95% CI: 0.82, 1.23). In our observational cohort, treatment with RAI was not associated with a reduced birth rate. Our findings add to the evidence available for counseling thyroid cancer patients with concerns about future fertility.
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Affiliation(s)
- Chelsea Anderson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Mark A Weaver
- Departments of Medicine and Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Jose P Zevallos
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC.,Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
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Yang Z, Flores J, Katz S, Nathan CA, Mehta V. Comparison of Survival Outcomes Following Postsurgical Radioactive Iodine Versus External Beam Radiation in Stage IV Differentiated Thyroid Carcinoma. Thyroid 2017; 27:944-952. [PMID: 28446057 DOI: 10.1089/thy.2016.0650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a lack of well-powered data regarding outcomes in stage IV differentiated thyroid carcinoma (DTC) treated with postsurgical radiation. The objective of this study was to examine survival in patients with stage IV papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) who received radioactive iodine (RAI), external beam radiation therapy (EBRT), or neither following surgery. METHODS In this retrospective cohort study, data collected from the National Cancer Data Base (NCDB) yielded 11,832 patients with stage IV DTC who underwent primary surgical treatment between 2002 and 2012. Patients were stratified by histology and sub-stage. Fully parametric, multilevel survival-time models were used to evaluate survival outcomes in three adjuvant treatment groups: RAI, EBRT, or no adjuvant radiation. Hazard ratios (HR) and time ratios (TR) were calculated against patients who did not receive radiation. All models were adjusted for demographic and clinical factors. RESULTS The mean age of all patients was 61.6 years (SD = 11.6), and 57.5% were female. Patients who received EBRT had significantly higher 5- and 10-year hazards of death in several PTC sub-stages (10-year HRPTC Stage IV-A = 2.12 [confidence interval (CI) 1.79-2.52]; HRPTC Stage IV-B = 2.03 [CI 1.33-3.10]). For stage IV-B PTC requiring EBRT, lifespan after diagnosis was shortened by a factor of 3 when compared to patients who did not receive radiation (TRPTC Stage IV-B = 0.32 [CI 0.16-0.62]). In contrast, RAI was significantly associated with improved 5- and 10-year survival in both PTC and FTC patients regardless of pathological sub-stage. Large reductions in mortality were observed in patients with FTC who were treated with RAI (HRFTC Stage IV-C = 0.19 [CI 0.06-0.65]). When patients with stage IV-C FTC were treated with RAI, life-span after diagnosis doubled (TRFTC Stage IV-C = 1.98 [CI 1.31-3.00]). CONCLUSIONS Through the NCDB, this study sought to describe prognosis and survival for adjuvant radiation in stage IV DTC. RAI was associated with improved survival for stage IV DTC. Despite treatment benefits conferred by adjuvant EBRT, indications to treat with EBRT were associated with poorer survival outcomes in patients with advanced-stage DTC, particularly PTC.
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Affiliation(s)
- Zao Yang
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
| | - Jose Flores
- 2 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sanford Katz
- 3 Department of Radiation Oncology, Willis-Knighton Cancer Center , Shreveport, Louisiana
| | - Cherie-Ann Nathan
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
| | - Vikas Mehta
- 1 Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport , Shreveport, Louisiana
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15
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Goldfarb M, Sener SF. Comparison of radioiodine utilization in adolescent and young adult and older thyroid cancer patients. Endocr Pract 2016; 20:405-11. [PMID: 24326000 DOI: 10.4158/ep13343.or] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Differentiated thyroid cancer (DTC) is 1 of the most common cancers in adolescents and young adults (AYA, ages 15-39). Although most AYAs with DTC are considered low risk compared to older patients, there are no specific postoperative radioiodine (RAI) treatment recommendations despite the potential adverse effects specific to this age group, namely secondary malignancies and fertility difficulties. This study compares factors influencing RAI utilization in AYA and older patients. METHODS A total of 5,687 primary DTC patients were identified from the SEER (Surveillance, Epidemiology, and End RESULTS) database between January 1, 2004 and January 31, 2009. The 2009 American Thyroid Association (ATA) guidelines were used to classify patients as low (LR) or intermediate/high risk (IHR) based on tumor characteristics. Multivariate logistic regression analysis was performed. RESULTS Overall, 56.9% of AYA (n = 1,963) patients received postoperative RAI compared to 52.2% of older (n = 3,724) patients (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.09-1.35, P = .001). For AYA patients, having a total thyroidectomy (TTx) (OR: 3.53, 95% CI: 2.7-4.61, P<.001) predicted RAI in a multivariate model whereas LR status (OR: 0.52, 95% CI: 0.43-0.63, P<.001) and northeast residence (OR: 0.39, 95% CI: 0.29-0.52, P<.001) decreased the probability. All 3 factors similarly affected older patients in addition to an increased likelihood after lymph node (LN) dissection. Additionally, after selecting for TTx (n = 1,077), no factor influenced the use of RAI for AYA patients, whereas LR (OR: 0.30, 95% CI: 0.21-0.43, P<.001) and northeast residence (OR: 0.39, 95% CI: 0.19-0.79, P = .008) were associated with decreased RAI use in older patients. CONCLUSION Despite their excellent prognosis, AYA thyroid cancer patients are more likely to receive postoperative RAI compared to older patients. Increased awareness of the unique survivorship implications for AYA patients will be an important aspect to address going forward.
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Affiliation(s)
- Melanie Goldfarb
- Division of Breast/Soft Tissue and Endocrine Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Stephen F Sener
- Division of Breast/Soft Tissue and Endocrine Surgery, University of Southern California Keck School of Medicine, Los Angeles, California
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16
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Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma: A name change to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features would help prevent overtreatment. Mod Pathol 2016; 29:698-707. [PMID: 27102347 DOI: 10.1038/modpathol.2016.65] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 11/09/2022]
Abstract
Encapsulated follicular variant of papillary thyroid carcinoma is a common thyroid gland cancer, with a highly indolent behavior. Recently, reclassification as a non-malignant neoplasm has been proposed. There is no comprehensive, community hospital based longitudinal evaluation of encapsulated follicular variant of papillary thyroid carcinoma. Ninety-four cases of encapsulated follicular variant of papillary thyroid carcinoma were identified in a review of all thyroid gland surgeries performed in 2002 within the Southern California Permanente Medical Group. All histology slides were reviewed and follow-up obtained. Seventy-five women and nineteen men, aged 20-80 years (mean 45.6 years), had a single (n=61), multiple (same lobe; n=20), or bilateral (n=13) tumor(s), ranging in size from 0.7 to 9.5 cm in diameter (mean 3.3 cm). Histologically, all cases demonstrated a well-formed tumor capsule, with capsular and/or lymphovascular invasion in 17 and no invasion in 77 cases. Lymph node metastases were not identified. The tumors had a follicular architecture, without necrosis or >3 mitoses/10 high-power fields (HPFs). Classical papillary thyroid carcinoma nuclear features were seen in at least three HPFs per 3 mm of tumor diameter, including enlarged, elongated, crowded, and overlapping nuclei, irregular nuclear contours, nuclear grooves, and nuclear chromatin clearing. Lobectomy alone (n=41), thyroidectomy alone (n=34), or completion thyroidectomy (n=19) was the initial treatment combined with post-op radioablative iodine in 25 patients. All patients were without evidence of disease after a median follow-up of 11.8 years. Encapsulated follicular variant of papillary thyroid carcinoma showed benign behavior, supporting conservative surgery alone and reclassification of these tumors to Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP).
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Abstract
Although thyroid surgery for treatment of papillary thyroid carcinoma (PTC) has been practiced for more than 100 years, there is still controversy regarding the minimal surgery needed for cure. The main reason for this controversy is lack of prospective randomized trials. The data accumulated in the last four decades indicate that hemithyroidectomy can be sufficient and safely practiced in low-risk patients with PTC. Patients <45 years of age with a single tumor less than 2 cm, with no lymphatic spread, and in the absence of other risk factors, can be equally managed by hemithyroidectomy or total thyroidectomy. A slight increase in the risk of vocal cord paralysis and hypocalcemia after total thyroidectomy suggests that hemithyroidectomy is appropriate for the management of patients with stage T1 disease. Any choice regarding the extent of surgery should be made with the patient and his family and in a multidisciplinary setup, which has been shown to improve decision-making procedures before the operation and during follow-up.
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Affiliation(s)
- Eran Fridman
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, the Clinical Research Institute, Rambam Health Care Campus, Rappaport Institute of Research and Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, The Head and Neck Center, the Clinical Research Institute, Rambam Health Care Campus, Rappaport Institute of Research and Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
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18
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Wu HX, Zhong H, Xu YD, Xu CP, Zhang Y, Zhang W. Psychological and behavioral intervention improves the quality of life and mental health of patients suffering from differentiated thyroid cancer treated with postoperative radioactive iodine-131. Neuropsychiatr Dis Treat 2016; 12:1055-60. [PMID: 27194911 PMCID: PMC4859420 DOI: 10.2147/ndt.s105460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We examined the effects of psychological and behavioral intervention on health-related quality of life and mental health among patients suffering from differentiated thyroid cancer (DTC) treated with postoperative radioactive iodine-131 (RAI). METHODS Sixty patients with DTC, undergoing RAI, were randomly assigned to receive either conventional nursing (n=30) or a 1-year psychological and behavioral intervention based on conventional nursing (n=30). Health-related quality of life and mental health issues, depression, and anxiety were measured using the Quality of Life Core Questionnaire, Self-rating Depression Scale, and Self-rating Anxiety Score, respectively. RESULTS After RAI treatment, patients in both groups showed improved functional capacities (ie, physical, role, cognitive, emotional, and social) and global quality of life, along with reduced depression and anxiety (P<0.05). At 1-year follow-up, compared with patients in the routine nursing group, those in the psychological and behavioral intervention group demonstrated greater improvements in functional capacities, global quality of life, and depression and anxiety symptoms (P<0.05). CONCLUSION Psychological and behavioral interventions for patients with DTC undergoing RAI facilitated positive outcomes, suggesting that nursing care models that include psychological and behavioral interventions may be a complementary strategy for this patient population.
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Affiliation(s)
- Hong-Xia Wu
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Hua Zhong
- Department of Oncology, Shandong University of Traditional Chinese Medicine, Shandong University, Jinan, Shandong, People's Republic of China; Department of Traditional Chinese Medicine, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yue-Dong Xu
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Cui-Ping Xu
- Department of Nursing, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
| | - Ying Zhang
- Department of Nursing, Tianjin Chest Hospital, Tianjing, People's Republic of China
| | - Wei Zhang
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, People's Republic of China
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Keegan THM, Grogan RH, Parsons HM, Tao L, White MG, Onel K, Horn-Ross PL. Sociodemographic disparities in differentiated thyroid cancer survival among adolescents and young adults in California. Thyroid 2015; 25:635-48. [PMID: 25778795 PMCID: PMC4490589 DOI: 10.1089/thy.2015.0021] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have focused on prognostic factors among adolescents and young adults (AYAs) 15 to 39 years of age when diagnosed with differentiated thyroid cancer (DTC). Our study expands upon prior work by including an evaluation of survival among AYA men and by neighborhood socioeconomic status, health insurance, and clinical factors to identify subgroups of young DTC patients at higher risk of mortality. METHODS Data for 16,827 AYA DTC patients diagnosed between 1988 and 2010 were obtained from the California Cancer Registry. Survival, through 2010, by sociodemographic and clinical factors was analyzed using Cox proportional hazards regression. RESULTS Of the 2.1% of AYAs who died, 16.7% died from thyroid cancer and 21.4% died from a subsequent cancer. In multivariate analyses, older AYAs 35 to 39 year of age (versus 15- to 29-year-olds), men (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.62-4.72), and AYAs of African American or Hispanic race/ethnicity (versus non-Hispanic whites) had worse thyroid cancer specific survival. In addition, residing in low socioeconomic status neighborhoods (HR 3.11 [CI 1.28-7.56]) and nonmetropolitan areas (HR 5.53 [CI 2.07-14.78]) was associated with worse thyroid cancer-specific survival among AYA men, but not AYA women. CONCLUSIONS Despite the generally good prognosis among AYAs with DTC, we identified subgroups of AYA patients at risk for poor outcomes. Further study of the factors underlying these associations, including possible barriers to receiving high-quality treatment and follow-up care, as well as lifestyle factors, are critical to reducing these disparities.
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Affiliation(s)
- Theresa H M Keegan
- 1Cancer Prevention Institute of California, Fremont, California
- 2Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Raymon H Grogan
- 3Endocrine Surgery Research Program, Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago Illinois
| | - Helen M Parsons
- 4Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Li Tao
- 1Cancer Prevention Institute of California, Fremont, California
| | - Michael G White
- 3Endocrine Surgery Research Program, Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago Illinois
| | - Kenan Onel
- 5Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Pamela L Horn-Ross
- 1Cancer Prevention Institute of California, Fremont, California
- 2Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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20
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Sacks W, Wong RM, Bresee C, Braunstein GD. Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid 2015; 25:377-85. [PMID: 25578116 DOI: 10.1089/thy.2014.0298] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The goal was to determine if there was a relation between the introduction of evidence-based radioactive iodine (RAI) treatment guidelines for differentiated thyroid cancer (DTC) at Cedars-Sinai Medical Center (CSMC) and subsequent RAI use. In addition, we compared RAI treatment rates for DTC at CSMC to data from the National Cancer Database (NCDB) to see if the trends in RAI use at CSMC differed from the national trends. METHODS RAI data from the CSMC Thyroid Cancer Center were reviewed to determine if RAI treatment was given appropriately. Kaplan-Meier curves were used to estimate disease-free survival for patients who received or did not receive treatment. RAI data from the NCDB were also used to compare how CSMC treatment rates compare nationally. RESULTS There were 444 CSMC patients identified with DTC between 2009 and 2012. Approximately 95% of the patients had papillary thyroid cancer (n=423) with 65% in the stage I risk group (n=290). Kaplan-Meier curves for stages I-III show that those who did not receive RAI treatment had 100% disease-free survival, which was better than those who had received RAI. However, given that the total population in both stages II and III is quite small, having received RAI ablation was not found to be statistically significant. Stage I patients who received RAI had a significantly increased incidence of recurrent disease. The NCDB RAI rates for all DTC stages in each year have consistently been over 50% with an overall treatment rate of 57%. There were significant differences in the treatment rates between CSMC and NCDB, with a decrease in the use of RAI in low-risk patients with stage I tumors at CSMC following institution of the guidelines. CONCLUSION Prudent use of RAI treatment should be considered for low-risk patients. Ablation rates have been decreasing steadily at CSMC, particularly among low-risk patients, with the adoption of more stringent RAI treatment guidelines. It is apparent from our data that physician practices can change with the implementation and dissemination of evidence-based guidelines for the treatment of DTC with RAI.
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Affiliation(s)
- Wendy Sacks
- 1 Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California
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21
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Thyroid Cancer. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Al-Qahtani KH, Al Asiri M, Tunio MA, Aljohani NJ, Bayoumi Y, Munir I, AlAyoubi A. Nasolacrimal duct obstruction following radioactive iodine 131 therapy in differentiated thyroid cancers: review of 19 cases. Clin Ophthalmol 2014; 8:2479-84. [PMID: 25525325 PMCID: PMC4266423 DOI: 10.2147/opth.s71708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Radioactive iodine 131 ((131)I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to (131)I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of (131)I therapy-acquired NLDO, its correlation to (131)I therapy doses, and the surgical treatment outcome of this rare side effect. METHODS From 2000-2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with (131)I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes. RESULTS Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39-72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual (131)I doses were 311.1±169.3 millicurie (mCi) (range: 150-600 mCi). The mean duration between the date of (131)I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5-20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age >45 years and (131)I therapy doses >150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively). CONCLUSION NLDO is an underestimated complication of (131)I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention.
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Affiliation(s)
- Khalid Hussain Al-Qahtani
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Advanced Head and Neck Oncology, King Saud University, Riyadh, Saudi Arabia
| | - Mushabbab Al Asiri
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mutahir A Tunio
- Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Naji J Aljohani
- Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Iqbal Munir
- Nuclear Medicine Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia
| | - Ayman AlAyoubi
- Clinical Ophthalmology, King Fahad Medical City, Riyadh, Saudi Arabia
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DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64:252-71. [PMID: 24890451 DOI: 10.3322/caac.21235] [Citation(s) in RCA: 2138] [Impact Index Per Article: 213.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER-Medicare linked databases; treatment-related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one-third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship.
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Affiliation(s)
- Carol E DeSantis
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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