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Monos S, Fritz C, Harris J, Romeo D, Ng JJ, Xu K, Cooperberg B, Moreira A, Rajasekaran K. Radioactive Iodine in Differentiated Thyroid Carcinoma: A Systematic AGREE II Clinical Practice Guideline Appraisal. Otolaryngol Head Neck Surg 2024; 170:20-33. [PMID: 37694597 DOI: 10.1002/ohn.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Identify and appraise clinical practice guidelines (CPGs) for radioactive iodine (RAI) indications in differentiated thyroid carcinoma (DTC), and the treatment for radioactive iodine refractory (RAI-R) DTC using the Appraisal of Guidelines for Research and Evaluation II tool. DATA SOURCES MEDLINE (Pubmed), Ovid (EMBASE), and Scopus. REVIEW METHODS A systematic literature search was conducted to identify CPGs addressing RAI in DTC. CPGs were appraised by 4 independent reviewers in 6 distinct areas of quality. Scaled domain scores were subsequently calculated for each domain. Intraclass correlation coefficients were calculated for each domain to assess interrater reliability. RESULTS Sixteen guidelines were found addressing RAI indications for DTC. Of these 16, 9 also addressed the treatment of RAI-R DTC. A further 6 unique guidelines were identified that exclusively address RAI-R DTC, bringing the total number of guidelines to 22. The American Thyroid Association (ATA) guidelines for adult thyroid cancer were the highest scoring with a mean score of 83.5%. Two guidelines scored >60% in 5 or more domains, qualifying as "high" quality: ATA and British Thyroid Association. The highest scoring domain was domain 4: clarity of presentation (80.4%) while the lowest scoring domain was domain 5: applicability (38.6%). CONCLUSION Of the 22 guidelines identified, only two were "high quality." CPGs exclusively addressing the treatment of RAI-R DTC were weak with most guidelines scoring in the "low" quality range. This report reveals an unmet need for rigorously developed guidelines addressing indications for RAI in DTC, as well as the treatment for RAI-R DTC.
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Affiliation(s)
- Stylianos Monos
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Christian Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacob Harris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic Romeo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinggang J Ng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katherine Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benjamin Cooperberg
- Department of Endocrinology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Gao RW, Foote RL, Garces YI, Ma DJ, Neben-Wittich M, Routman DM, Patel SH, Ko SJ, McGee LA, Bible KC, Chintakuntlawar AV, Ryder M, Morris JC, Van Abel KM, Rivera M, Abraha F, Lester SC. Outcomes and Patterns of Recurrence for Anaplastic Thyroid Cancer Treated with Comprehensive Chemoradiotherapy. Pract Radiat Oncol 2021; 12:113-119. [PMID: 34715395 DOI: 10.1016/j.prro.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 10/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE/OBJECTIVES Radiotherapy (RT) plays an important role in locoregional tumor control for anaplastic thyroid cancer (ATC). Due to its rarity, RT guidelines for ATC are lacking. We describe ATC patterns of nodal disease at presentation and progression and propose corresponding RT target volumes. MATERIALS/METHODS We identified all patients with ATC treated at our institution with definitive or adjuvant IMRT and concomitant chemotherapy from 2006 to 2020. We identified in-field, marginal, and out-of-field sites of locoregional recurrence and progression (LRR). RESULTS Forty-seven patients met inclusion. Median follow-up was 6.6 months (IQR: 1.9-19.6). Nodal levels involved at presentation included: IB (2.1%), II (23.4%), III (21.3%), IV (21.3%), V (12.8%), VI (34%), and mediastinal (6.4%). All patients received elective nodal RT to levels II-IV and VI. RT volumes also included: IA (23.4%), IB (44.7%), V (87.2%), retropharyngeal/retrostyloid (RP/RS) (27.7%), and mediastinal 1-6 (53.2%). Cumulative incidence of LRR at 3- and 12-months was 26.1% (95% CI: 15.9-42.8) and 35.7% (23.9-53.4). Isolated LRR risk at 3- and 12-months was 6.5% (2.2-19.8) and 8.9% (3.4-22.9). Fourteen (29.8%) patients experienced in-field LRR in the thyroid gland or postoperative tumor bed, II-IV, VI, and mediastinal 1 and 3A. Four (8.5%) patients had marginal LRRs, 3 of whom progressed in the mediastinum at 2, 3P, 4, and 6. Two (4.3%) patients experienced out-of-field LRRs. Throughout the pre-treatment and follow-up period, no patients had disease at IA and 1 (2.1%) patient each had disease at IB and RP/RS. No baseline or treatment characteristics, including RT dose (stratified by < or ≥66 Gy), were significant predictors of LRR on univariate analysis. CONCLUSIONS Isolated LRR risk in patients with ATC treated with comprehensive RT and chemotherapy is low. Aggressive multimodality therapy should be reserved for willing, fit patients with no or limited distant disease burden. When treating comprehensively, complete inclusion of mediastinal levels 1-6 may be warranted to avoid marginal disease progression. Omission of levels I and RP/RS can be considered.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | | | | | - Feven Abraha
- Biostatistics & Information, Mayo Clinic, Rochester, Minnesota
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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3
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Romesser PB, Sherman EJ, Whiting K, Ho ML, Shaha AR, Sabra MM, Riaz N, Waldenberg TE, Sabol CR, Ganly I, McBride SM, Fagin JA, Zhang Z, Tuttle RM, Wong RJ, Lee NY. Intensity-modulated radiation therapy and doxorubicin in thyroid cancer: A prospective phase 2 trial. Cancer 2021; 127:4161-4170. [PMID: 34293201 DOI: 10.1002/cncr.33804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/11/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of external-beam radiotherapy for locally advanced nonanaplastic thyroid cancer remains controversial. This prospective study evaluated the efficacy and tolerability of intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy in patients with locally advanced thyroid cancer. METHODS The authors conducted a nonrandomized phase 2 trial of IMRT with or without concurrent doxorubicin in patients with gross residual or unresectable nonanaplastic thyroid carcinoma (ClinicalTrials.gov identifier NCT01882816). The primary end point was 2-year locoregional progression-free survival (PFS). Secondary end points included overall survival (OS), safety, patient-reported outcomes, and functional outcomes. RESULTS Twenty-seven patients were enrolled: 12 (44.4%) with unresectable disease and 15 (55.6%) with gross residual disease. The median follow-up was 45.6 months (interquartile range, 42.0-51.6 months); the 2-year cumulative incidences of locoregional PFS and OS were 79.7% and 77.3%, respectively. The rate of grade 3 or higher acute and late toxicities was 33.4%. There were no significant functional differences 12 months after treatment (assessed objectively by the modified barium swallow study). Patient-reported quality of life in the experimental group was initially lower but returned to the baseline after 6 months and improved thereafter. In a post hoc analysis, concurrent chemotherapy with intensity-modulated radiation therapy (CC-IMRT) resulted in significantly less locoregional failure at 2 years (no failure vs 50%; P = .001), with higher rates of grade 2 or higher acute dermatitis, mucositis, and dysphagia but no difference in long-term toxicity, functionality, or patient-reported quality of life. CONCLUSIONS In light of the excellent locoregional control rates achieved with CC-IMRT and its acceptable toxicity profile as confirmed by functional assessments and patient-reported outcomes, CC-IMRT may be preferred over IMRT alone.
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Affiliation(s)
- Paul B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Karissa Whiting
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret L Ho
- Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashok R Shaha
- Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mona M Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Todd E Waldenberg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher R Sabol
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Head and Neck Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.,Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Abusabeib A, El Ansari W, Al Hassan MS, Petkar M, Mohamed S. First case of huge classic papillary thyroid cancer rupturing spontaneously leading to ischemic necrosis, perforation and inflammation of overlying skin: Case report and review of the literature. Int J Surg Case Rep 2021; 85:106136. [PMID: 34274758 PMCID: PMC8313845 DOI: 10.1016/j.ijscr.2021.106136] [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: 05/31/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. Classic PTC is of indolent nature, slow progression and favorable prognostic outcomes when treated. We present a huge mass, rapid progression, spontaneous rupture causing ischemia, necrosis and perforation of overlying skin. Systematic investigations are required using US, FNA and CT followed by surgical intervention is the mainstay of treatment. High risk patients must undergo RAI soon after surgery with semiannual then annual follow-up to assess any recurrence.
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Affiliation(s)
- Abdelrahman Abusabeib
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skovde, Skovde, Sweden.
| | - Mohamed S Al Hassan
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine & Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Sugad Mohamed
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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5
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Tian S, Switchenko JM, Fei T, Press RH, Abugideiri M, Saba NF, Owonikoko TK, Chen AY, Beitler JJ, Curran WJ, Gillespie TW, Higgins KA. Survival advantage of chemoradiotherapy in anaplastic thyroid carcinoma: Propensity score matched analysis with multiple subgroups. Head Neck 2019; 42:678-687. [PMID: 31845469 DOI: 10.1002/hed.26042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2019] [Accepted: 12/03/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We compared overall survival (OS) between radiation therapy (RT) and chemoradiotherapy (CRT) in patients with anaplastic thyroid carcinoma (ATC) using a large database. METHODS The National Cancer Data Base was queried for ATC patients diagnosed between 2004 and 2013 who received RT or CRT. Groups were balanced by propensity score matching (PSM) on nine relevant variables. OS was also examined in five paired subgroups given known patient heterogeneity. RESULTS Of 858 total patients, 575 received CRT and 283 received RT. CRT was associated with decreased risk of death (hazard ratio [HR] 0.66, P < .001), 1-year OS 25.5% vs 14.3%. A survival advantage to CRT was seen using PSM cohorts (HR 0.75, P = .006). Those receiving definitive surgery saw the greatest benefit to CRT over RT (HR 0.65, P = .009), 1-year OS 39.6% vs 20.4%. CONCLUSIONS CRT is associated with decreased risk of death in ATC; the magnitude of CRT vs RT benefit varied by subgroup.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics & Bioinformatics, Rollins School of Public Heath, Emory University, Atlanta, Georgia
| | - Teng Fei
- Department of Biostatistics & Bioinformatics, Rollins School of Public Heath, Emory University, Atlanta, Georgia
| | - Robert H Press
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mustafa Abugideiri
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amy Y Chen
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Theresa W Gillespie
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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6
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Goffredo P, Robinson TJ, Youngwirth LM, Roman SA, Sosa JA. Intensity-modulated radiation therapy use for the localized treatment of thyroid cancer: Nationwide practice patterns and outcomes. Endocrine 2016; 53:761-73. [PMID: 27025947 DOI: 10.1007/s12020-016-0937-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 03/18/2016] [Indexed: 12/13/2022]
Abstract
In the absence of randomized data, the optimal approach to adjuvant radiation therapy in locally advanced thyroid cancer remains unclear. We employed a large retrospective analysis to assess the best available evidence of a potential beneficial impact of intensity-modulated versus 3D-conformal radiotherapy (IMRT vs. 3D-CT). Retrospective analysis of adult thyroid cancer diagnosed between 2004 and 2011 within the National Cancer Database. Among patients treated with radiation therapy (N = 855), the use of IMRT (N = 437) increased among both comprehensive and academic centers (both p < 0.001), but not community hospitals (p = 0.43). Receipt of IMRT was associated with adverse clinical factors in multivariable analysis, including positive surgical margins, non-DTC histologies, and nodal metastases (all p < 0.001). IMRT use was associated with a significantly higher dose of radiation (60.7 vs. 52.4 Gy, p < 0.001). In multivariable analyses, receipt of IMRT demonstrated a trend toward improved overall survival (HR, 0.67; 95 % CI, 0.40-1.10; p = 0.115). This study presents the largest cohort to date examining receipt of IMRT in patients with locally advanced thyroid cancer and demonstrates an association between IMRT, treatment at a tertiary care center, higher total dose, and comparable or superior outcomes compared to patients treated with 3D conformal techniques despite more adverse disease features. In the absence of adequately powered prospective randomized trials, our retrospective analysis provides empirical evidence to support the use in these patients of dose escalation and IMRT, particularly at tertiary care centers.
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Affiliation(s)
- Paolo Goffredo
- Department of Surgery, University of Iowa, Iowa City, IA, USA
| | | | - Linda M Youngwirth
- Department of Surgery, Duke University Medical Center, DUMC #2945, Durham, NC, 27710, USA
| | - Sanziana A Roman
- Department of Surgery, Duke University Medical Center, DUMC #2945, Durham, NC, 27710, USA.
| | - Julie A Sosa
- Department of Surgery, Duke University Medical Center, DUMC #2945, Durham, NC, 27710, USA
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7
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The nuclear medicine therapy care coordination service: a model for radiologist-driven patient-centered care. Acad Radiol 2015; 22:771-8. [PMID: 25766086 DOI: 10.1016/j.acra.2015.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/27/2015] [Accepted: 01/27/2015] [Indexed: 11/21/2022]
Abstract
We developed a longitudinal care coordination service to proactively deliver high-quality and family-centered care in patients receiving radioiodine therapy for thyroid cancer. In an iterative, multidisciplinary team manner, a pretherapy consultation service, which included scripted interactions, documentation, and checklists for quality control, evolved over time into a robust patient-centered longitudinal care coordination nuclear medicine service. Radiation safety precautions, the rationale for therapy, and management of patient expectations were addressed through the initial consultation, and discharge and posttreatment care were managed during subsequent follow-up. The patient-physician relationship created during longitudinal nuclear medicine therapy care is one tool to help counteract the growing commoditization of radiology. This article describes the process that the nuclear medicine specialists in our department established to enhance radiologist value by providing both exceptional thyroid cancer treatment and continuity of care.
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Mangano A, Kim HY, Lianos GD, Roukos DH, Dionigi G. Targeted agents for advanced thyroid cancer: "knowledge is power" – the role of multikinase inhibitors. Future Oncol 2014; 10:2099-102. [DOI: 10.2217/fon.14.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Alberto Mangano
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Insubria University Varese-Como, Varese, Italy
- Department of Human Morphology & Surgical Sciences, Insubria University Varese-Como, Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Georgios D Lianos
- Department of General Surgery, Ioannina University Hospital, Ioannina University, Ioannina, Greece
- Centre for Biosystems & Genomic Network Medicine, Ioannina University, Ioannina, Greece
| | - Dimitrios H Roukos
- Department of General Surgery, Ioannina University Hospital, Ioannina University, Ioannina, Greece
- Centre for Biosystems & Genomic Network Medicine, Ioannina University, Ioannina, Greece
| | - Gianlorenzo Dionigi
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Insubria University Varese-Como, Varese, Italy
- Department of Human Morphology & Surgical Sciences, Insubria University Varese-Como, Varese, Italy
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9
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Yang X, Lv W, Shi R, Cheng S, Zhang J, Xu Z. The clinical implications of Crk-like adaptor protein expression in papillary thyroid microcarcinoma. Tumour Biol 2014; 35:12435-40. [PMID: 25185652 DOI: 10.1007/s13277-014-2561-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/26/2014] [Indexed: 12/31/2022] Open
Abstract
Papillary thyroid microcarcinoma (PMC) is the most common subtype of thyroid carcinomas with satisfactory prognosis. Crk-like (CrkL) adaptor protein was identified in the development of many carcinomas. However, the clinical implications of CrkL protein in PMC were still unknown. Here, we conducted immunohistochemistry to test and analyze CrkL expression in papillary thyroid carcinoma (PTC) (50 cases), PMC (50 cases), and nodular goiter (50 cases), and then western blot further identified the expression of CrkL proteins. In our present study, the positive rate and the mean optical density (MOD) value of CrkL expression in PTC and PMC tissues were statistically significantly different, compared with nodular goiter (p = 0.021, 0.037) and normal thyroid tissues (p = 0.003, 0.009), respectively. In addition, CrkL expression was not associated with age, gender, and tumor number. Conversely, significant differences between CrkL expression and metastasis (p < 0.01) and violation of capsule (p < 0.01) were observed. Notably, western blot indeed identified that the metastasis group of either PTC or PMC tissues had about twofold increased expression of CrkL compared with their non-metastasis groups (p < 0.05). In conclusion, CrkL is highly expressed in papillary thyroid carcinoma and papillary thyroid microcarcinoma and closely correlated to metastasis. Therefore, it is essential to carry out neck lymph node clearance in patients with papillary thyroid microcarcinoma.
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Affiliation(s)
- Xiangshan Yang
- Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong, China
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10
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Yom SS, Cohen E. The ACR appropriateness criteria® for thyroid carcinoma: searching for consensus in a rapidly evolving area. Oral Oncol 2014; 50:575-6. [PMID: 24824114 DOI: 10.1016/j.oraloncology.2013.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Sue S Yom
- Associate Professor of Radiation Oncology and Otolaryngology-Head and Neck Surgery, University of California, San Francisco, United States
| | - Ezra Cohen
- Associate Professor of Medicine, University of Chicago, United States
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