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Bhuvana J, Shivhare V, Rath S, Parikh A, Kunikullaya US. The current role of adjuvant radiotherapy in management of medullary thyroid carcinoma: A single institute analysis. J Cancer Res Ther 2024:01363817-990000000-00104. [PMID: 39207088 DOI: 10.4103/jcrt.jcrt_1174_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2024]
Abstract
OBJECTIVES Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival. MATERIALS AND METHODS We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan-Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes. RESULTS Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3-70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions. CONCLUSION Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.
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Affiliation(s)
- J Bhuvana
- Department of Radiation Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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2
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Rajabi S, Hedayati M. Medullary Thyroid Cancer: Clinical Characteristics and New Insights into Therapeutic Strategies Targeting Tyrosine Kinases. Mol Diagn Ther 2018; 21:607-620. [PMID: 28698976 DOI: 10.1007/s40291-017-0289-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a hyperplasia of thyroid C-cells, accounting for 5-10% of all thyroid cancers. MTCs may appear as sporadic or hereditary forms, and several molecules and signaling pathways have been found to function defectively in MTC cells. Tyrosine kinases are the most well-studied molecules that have abnormal function in these tumor cells. Due to their limited response, chemotherapeutic agents and radiation therapy are not effective in treating patients with advanced metastatic MTC. In the past decade, significant attention has been given to the utilization of multikinase inhibitors as targeted therapeutic agents for treating MTC patients, with the most promising results arising from the study of tyrosine kinase inhibitors, which generally bind to the ATP binding sites of these kinases. Two drugs-vandetanib and cabozantinib-are approved for the treatment of aggressive advanced MTC; however, the potential for toxicities and adverse effects of these agents on patient quality of life need to be considered against any therapeutic gain. According to recent data, it appears that inhibition of only one receptor or molecule in a pathway is not as effective as simultaneous inhibition of different pathways, indicating the need to use combination therapy. The main purpose of this review is to describe the clinical characteristics, molecular mechanisms, and current molecular and targeted therapeutic strategies active in clinical trials for advanced MTC treatment.
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Affiliation(s)
- Sadegh Rajabi
- Department of Clinical Biochemistry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Angelousi A, Settas N, Faucz FR, Lyssikatos C, Quezado M, Nasiri-Ansari N, Stratakis CA, Kassi E. Medullary thyroid cancer, leukemia, mesothelioma and meningioma associated with germline APC and RASAL1 variants: a new syndrome? Hormones (Athens) 2017. [PMID: 29518763 PMCID: PMC6341468 DOI: 10.14310/horm.2002.1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor hereditary in 35% of cases. The most common syndromic form is in the context of the multiple endocrine neoplasia type 2 (MEN 2) syndromes in association with other tumors and due to germline RET mutations. We describe a 57-year-old female patient diagnosed with sporadic MTC. The patient had a history of other neoplasias, such as acute myeloid leukemia, for which she had received chemotherapy, and two other solid tumors, peritoneal mesothelioma and meningioma. Genetic analyses were carried out including whole exome and Sanger sequencing (WES and SS) and loss-of-heterozygosity (LOH) testing for the respective loci. Immunohistochemistry (IHC) was used for the detection of proteins of interest. WES showed two germline variants in the APC and RASAL1 genes confirmed by SS. In MTC tissue only there was a RETvariant identified by SS; germline studies did not show any RETsequence changes. The pattern of tumors in this patient is unusual for either one of the APC- orRASAL1-associated neoplasms and her non-MEN 2-associated MTC contained a RET variant like other sporadic MTCs. As in other patients with more than one genetic variant predisposing to tumors, it is possible that this case represents a unique association.
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Affiliation(s)
- Anna Angelousi
- 1st Department of Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Insitutes of Health (NIH), Bethesda, USA
| | - Nikolaos Settas
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Insitutes of Health (NIH), Bethesda, USA
| | - Fabio R Faucz
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Insitutes of Health (NIH), Bethesda, USA
| | - Charalampos Lyssikatos
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Insitutes of Health (NIH), Bethesda, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute (NCI), NIH, Bethesda, USA
| | - Narjes Nasiri-Ansari
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine A Stratakis
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Insitutes of Health (NIH), Bethesda, USA
| | - Eva Kassi
- 1st Department of Internal Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.
- Department of Biological Chemistry, National and Kapodistrian University of Athens, Athens, Greece.
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Wang Z, Kang J, Deng X, Guo B, Wu B, Fan Y. Knockdown of GATAD2A suppresses cell proliferation in thyroid cancer in vitro. Oncol Rep 2017; 37:2147-2152. [PMID: 28260108 DOI: 10.3892/or.2017.5436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/04/2017] [Indexed: 11/05/2022] Open
Abstract
GATAD2A (GATA zinc finger domain containing 2A), is a subunit of NuRP (nucleosome remodeling and histone deacetylation) which plays key roles in tumor growth inhibition and embryonic development. However, its role in thyroid cancer remains unclear. In our study, we established two thyroid cancer cell lines by lentivirus-delivered short hairpin (shRNA) to knockdown the expression of GATAD2A. Then loss-of-function assays indicated that knockdown of GATAD2A decreased the ability of cell proliferation and colony formation in thyroid cancer cells by MTT and colony formation assay, respectively. Moreover, cell cycle assay by flow cytometry revealed that the percentage of cells in G0/G1 phase was significantly decreased in GATAD2A knockdown cells accompanied by increase of cells in G2/M phase. Furthermore, inhibition of GATAD2A promoted cell apoptosis via elevating the expression of caspase-3 and PARP cleavage using Annexin V/7-AAD double staining and western blotting. In conclusion, GATAD2A is an essential factor in thyroid cancer cell growth and apoptosis, and may be a potential therapeutic biomarker in thyroid cancer.
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Affiliation(s)
- Zongping Wang
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Jie Kang
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Xianzhao Deng
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Bomin Guo
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Bo Wu
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Youben Fan
- Department of General Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P.R. China
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Abstract
Thyroid cancer is rapidly increasing in incidence, but the mortality rate remains flat. Debate has arisen over the need to detect or treat most thyroid cancers early, given their favorable natural history. The appropriate extent of surgery for thyroid cancer is also controversial: some researchers advocate partial and others total thyroidectomy; some advocate prophylactic central cervical lymph node dissection, whereas others only rarely recommend lymphadenectomy. Although radioactive iodine is effective, its appropriate use and dosage remain controversial. In addition, molecular analysis of thyroid cancer is frequently used for diagnostic purposes involving preoperative fine-needle biopsy specimens as well as to define targetable pathways altered in the disease to guide clinical trials of drug therapy for advanced thyroid cancers.
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Affiliation(s)
- Tobias Carling
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510; ;
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6
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Batista RL, Toscanini AC, Brandão LG, Cunha-Neto MBC. False positive results using calcitonin as a screening method for medullary thyroid carcinoma. Indian J Endocrinol Metab 2013; 17:524-528. [PMID: 23869316 PMCID: PMC3712390 DOI: 10.4103/2230-8210.111677] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The role of serum calcitonin as part of the evaluation of thyroid nodules has been widely discussed in literature. However there still is no consensus of measurement of calcitonin in the initial evaluation of a patient with thyroid nodule. Problems concerning cost-benefit, lab methods, false positive and low prevalence of medullary thyroid carcinoma (MTC) are factors that limit this approach. We have illustrated two cases where serum calcitonin was used in the evaluation of thyroid nodule and rates proved to be high. A stimulation test was performed, using calcium as secretagogue, and calcitonin hyper-stimulation was confirmed, but anatomopathologic examination did not evidence medullar neoplasia. Anatomopathologic diagnosis detected Hashimoto thyroiditis in one case and adenomatous goiter plus an occult papillary thyroid carcinoma in the other one. Recommendation for routine use of serum calcitonin in the initial diagnostic evaluation of a thyroid nodule, followed by a confirming stimulation test if basal serum calcitonin is showed to be high, is the most currently recommended approach, but questions concerning cost-benefit and possibility of diagnosis error make the validity of this recommendation discussible.
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Affiliation(s)
- Rafael Loch Batista
- Department of Functional Neurosurgery, Institute of Psychiatry, University of Sao Paulo, USP, Brazil
| | - Andrea Cecilia Toscanini
- Department of Functional Neurosurgery, Institute of Psychiatry, University of Sao Paulo, USP, Brazil
| | - Lenine Garcia Brandão
- Department of Surgery, Division of Head and Neck Surgery, Faculty of Medicine, University of Sao Paulo, USP, Brazil
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7
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Koga K, Hattori Y, Komori M, Narishima R, Yamasaki M, Hakoshima M, Fukui T, Maitani Y. Combination of RET siRNA and irinotecan inhibited the growth of medullary thyroid carcinoma TT cells and xenografts via apoptosis. Cancer Sci 2010; 101:941-7. [PMID: 20704575 PMCID: PMC11159175 DOI: 10.1111/j.1349-7006.2009.01484.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Medullary thyroid carcinoma (MTC) is a rare endocrine tumor that frequently metastasizes, and treatment with irinotecan (CPT-11) is limited because of side effects. Mutations in the Rearranged during transfection (RET) proto-oncogene are considered the causative event of MTC. The objective of this study was to examine whether small interfering RNA (siRNA) and its combined treatment with CPT-11 could inhibit MTC cell growth in vitro and in vivo. The transfection of RET siRNA suppressed RET expression, reduced proliferation, and increased caspase-3/7 activity via the down-regulation of Bcl-2 expression. Combined treatments with CPT-11 or SN-38 significantly increased caspase 3/7 activity compared with RET siRNA, CPT-11 or SN-38 treatment alone. Importantly, intratumoral injection of RET siRNA along with intravenous injection of CPT-11 significantly inhibited the tumor growth of MTC xenografts via an increased apoptotic effect. These findings that RET siRNA enhanced sensitivity for CPT-11 will provide a novel strategy for the treatment of MTC with RET mutation.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/therapeutic use
- Apoptosis/drug effects
- Apoptosis/genetics
- Camptothecin/analogs & derivatives
- Camptothecin/pharmacology
- Camptothecin/therapeutic use
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/metabolism
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- Caspase 3/genetics
- Caspase 3/metabolism
- Cell Cycle/genetics
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Down-Regulation
- Female
- Humans
- Irinotecan
- Mice
- Mice, Inbred ICR
- Mice, Nude
- Proto-Oncogene Mas
- Proto-Oncogene Proteins c-ret/genetics
- Proto-Oncogenes
- RNA, Small Interfering/genetics
- RNA, Small Interfering/metabolism
- RNA, Small Interfering/pharmacology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Kimiko Koga
- Institute of Medicinal Chemistry, Hoshi University, Shinagawa-ku, Tokyo, Japan
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8
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Koga K, Hattori Y, Komori M, Narishima R, Yamasaki M, Hakoshima M, Fukui T, Maitani Y. Combination of RET siRNA and irinotecan inhibited the growth of medullary thyroid carcinoma TT cells and xenografts viaapoptosis. Cancer Sci 2010. [DOI: 10.1111/j.1349-7006.2010.01484.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Correia-Deur JEM, Toledo RA, Imazawa AT, Lourenço DM, Ezabella MCL, Tavares MR, Toledo SPA. Sporadic medullary thyroid carcinoma: clinical data from a university hospital. Clinics (Sao Paulo) 2009; 64:379-86. [PMID: 19488601 PMCID: PMC2694239 DOI: 10.1590/s1807-59322009000500002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 01/28/2009] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Medullary thyroid carcinoma may occur in a sporadic (s-medullary thyroid carcinoma, 75%) or in a multiple endocrine neoplasia type 2 form (MEN2, 25%). These clinical forms differ in many ways, as s-medullary thyroid carcinoma cases are RET-negative in the germline and are typically diagnosed later than medullary thyroid carcinoma in MEN2 patients. In this study, a set of cases with s-medullary thyroid carcinoma are documented and explored. PURPOSE To document the phenotypes observed in s-medullary thyroid carcinoma cases from a university group and to attempt to improve earlier diagnosis of s-medullary thyroid carcinoma. Some procedures for diagnostics are also recommended. METHOD Patients (n=26) with apparent s-medullary thyroid carcinoma were studied. Their clinical data were reviewed and peripheral blood was collected and screened for RET germline mutations. RESULTS The average age at diagnosis was 43.9 years (+/- 10.82 SD) and did not differ between males and females. Calcitonin levels were increased in all cases. Three patients presented values that were 100-fold greater than the normal upper limit. Most (61.54%) had values that were 20-fold below this limit. Carcinoembryonic antigen levels were high in 70.6% of cases. There was no significant association between age at diagnosis, basal calcitonin levels or time of disease onset with thyroid tumor size (0.6-15 cm). Routine thyroid cytology yielded disappointing diagnostic accuracy (46.7%) in this set of cases. After total thyroidectomy associated with extensive cervical lymph node resection, calcitonin values remained lower than 5 pg/mL for at least 12 months in eight of the cases (30.8%). Immunocyto- and histochemistry for calcitonin were positive in all analyzed cases. None of the 26 cases presented germline mutations in the classical hotspots of the RET proto-oncogene. CONCLUSION Our cases were identified late. The basal calcitonin measurements and immunostaining for calcitonin were highly useful for diagnosing s-medullary thyroid carcinoma. The rate of complete patient recovery was low, and none of the parameters analyzed were useful predictors of the thyroid tumor size. Our findings support previous recommendations for routine serum calcitonin evaluation and immunostaining analysis involving single thyroid nodules.
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Affiliation(s)
- Joya Emilie M. Correia-Deur
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
| | - Rodrigo A. Toledo
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
- , Tel.: 55 11 3061.7252
| | - Alice T. Imazawa
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
| | - Delmar M. Lourenço
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
| | - Marilza C. L. Ezabella
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
| | - Marcos R. Tavares
- Departamento de Cirurgia de Cabeça e Pescoço, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | - Sergio P. A. Toledo
- Unidade de Endocrinologia Genética, Laboratórios de Investigação Médica (LIM-25), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo - São Paulo/SP, Brazil
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Khatua S, Bilodeau LL. Chronic diarrhea and facial dysmorphism in children--a clue to men 2B syndrome: a case report. Pediatr Hematol Oncol 2008; 25:147-53. [PMID: 18363182 DOI: 10.1080/08880010701884709] [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: 02/04/2023]
Abstract
Medullary thyroid cancer (MTC) is a highly malignant tumor of the thyroid gland in children, rarely diagnosed and treated by pediatric oncologists. The authors describe a 9-year-old male who presented with facial dysmorphism and history of chronic diarrhea before being diagnosed with advanced MTC. Familiarity with its clinical variants, associated RET protooncogene mutation and its clinical implication, can lead to early identification of this aggressive tumor. To date, surgery remains the only definitive therapy, with continuing dismal prognosis in metastatic disease. However, evolving newer therapeutic strategies like tyrosine kinase inhibitors and pretargeted radioimmunotherapy (pRAIT) may provide hope to children with this aggressive tumor.
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Affiliation(s)
- Soumen Khatua
- Department of Pediatrics, University School of Medicine, Las Vegas, Nevada 89135, USA.
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11
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Kosowicz J, Mikołajczak R, Czepczyński R, Ziemnicka K, Gryczyńska M, Sowiński J. Two Peptide Receptor Ligands 99mTc-EDDA/HYNIC-Tyr3-Octreotide and 99mTc-EDDA/HYNIC-DGlu-Octagastrin for Scintigraphy of Medullary Thyroid Carcinoma. Cancer Biother Radiopharm 2007; 22:613-28. [DOI: 10.1089/cbr.2006.368] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jerzy Kosowicz
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Maria Gryczyńska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Sowiński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
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12
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Czepczyński R, Parisella MG, Kosowicz J, Mikołajczak R, Ziemnicka K, Gryczyńska M, Sowiński J, Signore A. Somatostatin receptor scintigraphy using 99mTc-EDDA/HYNIC-TOC in patients with medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 2007; 34:1635-45. [PMID: 17530247 DOI: 10.1007/s00259-007-0479-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 04/16/2007] [Indexed: 12/31/2022]
Abstract
PURPOSE Several new somatostatin analogues have been developed for the diagnosis and therapy of different tumours. Since somatostatin receptors are often over-expressed in medullary thyroid carcinoma (MTC), the aim of our study was to evaluate the utility of scintigraphy with the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC in MTC in comparison with other diagnostic techniques. METHODS Forty-five patients with MTC, aged 14-83 years, were investigated. Scintigraphy using (99m)Tc-EDDA/HYNIC-TOC (Tektrotyd) was performed 2 and 4 h post injection of 740 MBq (20 mCi) of the tracer. Other imaging techniques were also applied and analysed in individual cases (ultrasonography, computed tomography, (99m)Tc(V)-DMSA, (131)I-MIBG, (99m)Tc-MDP, (111)In-DTPA-octreotide and (18)F-FDG-PET) and compared with (99m)Tc-EDDA/HYNIC-TOC. RESULTS In group 1 (eight patients before thyroidectomy), uptake of the tracer was found in the primary tumours. In group 2 (six patients with remission), a false positive result was found in one patient; in the remaining five patients, no pathological foci were visualised. In group 3 (31 patients with post-surgical hypercalcitoninaemia), scintigraphy was true positive in 23 patients (74.2%): uptake in the thyroid bed was found in five patients, in the lymph nodes in 18 and in bone metastases in four. Using (99m)Tc-EDDA/HYNIC-TOC scintigraphy, the overall sensitivity was 79.5%, specificity 83.3%, accuracy 80.0%, positive predictive value 96.9% and negative predictive value 38.5%. CONCLUSION (99m)Tc-EDDA/HYNIC-TOC is clinically useful for scintigraphy in the follow-up of patients with MTC. It can be used in clinical practice for preoperative evaluation, for localisation of local recurrence or distant metastases and particularly for therapy decision making.
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Affiliation(s)
- Rafał Czepczyński
- Department of Endocrinology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznań, Poland.
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13
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Messina M, Robinson BG. Technology insight: gene therapy and its potential role in the treatment of medullary thyroid carcinoma. ACTA ACUST UNITED AC 2007; 3:290-301. [PMID: 17315037 DOI: 10.1038/ncpendmet0420] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 11/01/2006] [Indexed: 12/25/2022]
Abstract
Metastatic medullary thyroid cancer (MTC) responds poorly to conventional treatments with chemotherapy and radiotherapy. Gene therapy--the transfer of genetic material for therapeutic purposes--might have therapeutic potential for patients with progressive metastatic MTC that is incurable by conventional treatments. To date, a number of gene-therapy strategies have been explored, primarily those that use replication-deficient adenovirus vectors to transfer therapeutic genes to tumor cells. Tissue-specific expression of the promoter for calcitonin and calcitonin-related polypeptide alpha has allowed therapeutic genes to be specifically expressed in calcitonin-secreting cells and in the MTC tumors derived from them; such tissue-specific expression contributes to improved safety of gene therapies and has the potential to increase their therapeutic index. In addition, the identification of an MTC-specific peptide ligand raises the possibility of developing an MTC-selective vector. In this article, we have described the exciting area of gene therapy in the management of MTC with a focus on preclinical in vitro and in vivo MTC models.
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Affiliation(s)
- Marinella Messina
- Cancer Genetics Unit of Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
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14
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Stadler G, Wieser M, Steindl F, Grillari J, Katinger H, Pfragner R, Voglauer R. Development of standardized cell culture conditions for tumor cells with potential clinical application. Cytotherapy 2007; 9:488-98. [PMID: 17786610 DOI: 10.1080/14653240701385836] [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: 10/22/2022]
Abstract
BACKGROUND Tumor cell lines have enormous value for the study of different aspects of cancer biology and have also recently gained great importance in autologous cell-based anti-tumor therapies. However, the use of these cells is still limited because in vitro growth is hampered by suboptimal culture conditions and current media contain fetal bovine serum (FBS), which poses serious safety concerns regarding clinical application. METHODS To address this drawback, we aimed to develop a strategy for optimization of the culture medium for human medullary thyroid carcinoma (MTC) cell lines as a model system. We combined the general cell screening system (GCSS), which continuously measured the growth behavior of cells in a 96-well plate format, with statistically based experimental designs. RESULTS The results obtained clearly demonstrated that, just by changing the composition of the basal medium, a significantly enhanced growth rate could be observed, and by subsequent addition of several substances a serum-free cell culture medium could be developed. This medium allowed the propagation of two MTC cell lines comparable with conventionally used serum-supplemented medium. DISCUSSION We present a fast and easy way to screen for substances that are essential for tumor cell growth in vitro. Furthermore, these tumor cells can be adapted to culture conditions that allow the use of the cells in safe cell-based therapies. This is of utmost importance because of increasing regulatory requirements.
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Affiliation(s)
- G Stadler
- Institute of Applied Microbiology, Department of Biotechnology, University of Natural Resources and Applied Life Sciences, Vienna, Austria
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Pelizzo MR, Boschin IM, Bernante P, Toniato A, Piotto A, Pagetta C, Nibale O, Rampin L, Muzzio PC, Rubello D. Natural history, diagnosis, treatment and outcome of medullary thyroid cancer: 37 years experience on 157 patients. Eur J Surg Oncol 2006; 33:493-7. [PMID: 17125960 DOI: 10.1016/j.ejso.2006.10.021] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 10/11/2006] [Indexed: 11/25/2022] Open
Abstract
AIM The analysis of a 37-year retrospective study on diagnosis, prognostic variables, treatment and outcome of a large group of medullary thyroid cancer (MTC) patients was conducted, in order to plan a possible evidence-based management process. METHODS Between Jan 1967 to Dec 2004, 157 consecutive MTC patients underwent surgery in our centre: 60 males and 97 females, mean age 47.3 years (range 6-79). Total thyroidectomy was performed in 143 patients (91.1%); central compartment (CC) node dissection (level VI) in 41 patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 82 patients. Subtotal thyroidectomy was initially performed in 14 cases: 10 of them were re-operated because of persistence of elevated serum calcitonin levels. RESULTS After a median post-surgical follow-up of 68 months (range 2-440 months), 42.9% of patients were living disease-free, 39.8% were living with disease, 3.1% were deceased due to causes different from MTC, and 3.2% were deceased due to MTC. The overall 10-year survival rate was 72%. At uni-variate statistical analysis (a) patient's age at initial treatment (>45 years; >/=45 years), (b) sporadic vs. hereditary MTC, (c) disease stage, and (d) the extent of surgical approach resulted as significant variables. Instead, at multivariate statistical analysis, only (a) patient's age at initial diagnosis, (b) disease stage, and (c) the extent of surgery resulted as significant and independent prognostic variables influencing survival. CONCLUSION The presence of lymph node and distant metastases at first diagnosis significantly worsened prognosis and survival rate in our series. Early diagnosis of MTC is very important, allowing complete surgical cure in Stages I and II patients. Due to the relatively bad prognosis of MTC, especially for disease Stages III and IV, it appears reasonable to recommend radical surgery including total thyroidectomy plus CC lymphoadenectomy as the treatment of choice, plus LC lymphoadenectomy in patients with palpable and/or ultrasound enlarged neck lymph nodes.
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Affiliation(s)
- M R Pelizzo
- Department of Medical and Surgical Sciences, Institute of Surgical Pathology, University of Padova, Padova, Italy
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Falchetti A, Marini F, Tonelli F, Brandi ML. Lessons from genes mutated in multiple endocrine neoplasia (MEN) syndromes. ANNALES D'ENDOCRINOLOGIE 2005; 66:195-205. [PMID: 15988380 DOI: 10.1016/s0003-4266(05)81751-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multiple endocrine neoplasia (MEN) types 1 and 2 syndromes are rare hereditary cancer syndromes expressing a variety of endocrine and non-endocrine neoplasias and lesions. The improving of both molecular and clinical genetics knowledge helps health care providers in the whole spectrum of the clinical managements of MEN patients. The MEN1 gene, a tumour suppressor gene, is responsible of MEN1 syndrome, and is probably involved in the regulation of several cell functions, including DNA replication and repair and transcriptional machinery. RET proto-oncogene encodes for a receptor tyrosine kinase protein whose expression is fundamental for appropriate migration, development and differentiation of neuroendocrine cells originating from neural crest. Currently, DNA testing makes possible the early identification of germline mutation in asymptomatic mutant gene carriers in both MEN syndromes. Consequently, the combination of new genetic and diagnostic tools could permit a precocious detection of MEN-associated neoplasms, and in particular the identification of a strong genotype-phenotype correlations in MEN2 syndrome demonstrates an improving outcome and quality of life for affected subjects.
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Affiliation(s)
- A Falchetti
- Department of Internal Medicine and Clinical Physiopathology, University of Florence, Florence, Italy
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17
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Wasenius VM, Hemmer S, Karjalainen-Lindsberg ML, Nupponen NN, Franssila K, Joensuu H. MET receptor tyrosine kinase sequence alterations in differentiated thyroid carcinoma. Am J Surg Pathol 2005; 29:544-9. [PMID: 15767811 DOI: 10.1097/01.pas.0000156103.37756.e2] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Activating mutations affecting the MET receptor tyrosine kinase are present in several types of human cancer, particularly in papillary renal cell carcinoma. Papillary thyroid carcinomas commonly express high levels of MET mRNA and protein, suggesting that increased MET signaling may be of importance in the molecular pathogenesis of differentiated thyroid carcinoma. To evaluate the role of MET mutations in thyroid carcinoma, we screened MET exons 2 to 21 for mutations in sporadic papillary, follicular, medullary, and anaplastic thyroid carcinomas using denaturing high-performance chromatography. A missense MET sequence alteration T1010I, located in exon 14 encoding for the juxtamembrane domain of MET, was found in 6 (6%) of the 104 thyroid carcinomas examined, whereas all 92 goiter samples had wild-type exon 14 (P = 0.031). Three (6%) of the 53 papillary, 2 (10%) of the 21 follicular, 1 (8%) of the 13 medullary, and none of the 17 anaplastic carcinomas studied had MET(T1010I). Four of the 6 T1010I sequence alterations were present also in the germline. MET protein expression showed no apparent association with the presence of MET(T1010I), and the clinical features of the patients with cancer with MET(T1010I) were similar to those of patients whose cancer did not harbor MET(T1010I). We conclude that MET(T1010I) sequence alteration is relatively frequent in differentiated thyroid carcinoma. The clinical and the molecular pathologic significance of this MET sequence alteration is not known.
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MESH Headings
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Aged
- Biomarkers, Tumor/metabolism
- Carcinoma/genetics
- Carcinoma/metabolism
- Carcinoma/pathology
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Chromatography, High Pressure Liquid
- DNA Mutational Analysis
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Female
- Germ-Line Mutation
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Polymerase Chain Reaction
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-met
- Receptors, Growth Factor/genetics
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/metabolism
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Affiliation(s)
- Veli-Matti Wasenius
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
Neuroendocrine tumors (NETs) constitute a heterogeneous group of neoplasms that originate from endocrine glands such as the pituitary, the parathyroids, and the (neuroendocrine) adrenal, as well as endocrine islets within glandular tissue (thyroid or pancreatic) and cells dispersed between exocrine cells, such as endocrine cells of the digestive (gastroenteropancreatic) and respiratory tracts. Conventionally, NETs may present with a wide variety of functional or nonfunctional endocrine syndromes and may be familial and have other associated tumors. Assessment of specific or general tumor markers offers high sensitivity in establishing the diagnosis and can also have prognostic significance. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogs and metaiodobenzylguanidine. Successful treatment of disseminated NETs requires a multimodal approach; radical tumor surgery may be curative but is rarely possible. Well-differentiated and slow-growing gastroenteropancreatic tumors should be treated with somatostatin analogs or alpha-interferon, with chemotherapy being reserved for poorly differentiated and progressive tumors. Therapy with radionuclides may be used for tumors exhibiting uptake to a diagnostic scan, either after surgery to eradicate microscopic residual disease or later if conventional treatment or biotherapy fails. Maintenance of the quality of life should be a priority, particularly because patients with disseminated disease may experience prolonged survival.
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Affiliation(s)
- Gregory A Kaltsas
- Department of Endocrinology, St Bartholomew's Hospital, London EC1A 7BE, United Kingdom
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