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Pitoia F, Scheffel RS, Califano I, Gauna A, Tala H, Vaisman F, Gonzalez AR, Hoff AO, Maia AL. Management of radioiodine refractory differentiated thyroid cancer: the Latin American perspective. Rev Endocr Metab Disord 2024; 25:109-121. [PMID: 37380825 DOI: 10.1007/s11154-023-09818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Radioiodine (RAI) refractory differentiated thyroid cancer is an uncommon and challenging situation that requires a multidisciplinary approach to therapeutic strategies. The definition of RAI-refractoriness is usually a clear situation in specialized centers. However, the right moment for initiation of multikinase inhibitors (MKI), the time and availability for genomic testing, and the possibility of prescribing MKI and selective kinase inhibitors differ worldwide.Latin America (LA) refers to the territories of the world that stretch across two regions: North America (including Central America and the Caribbean) and South America, containing 8.5% of the world's population. In this manuscript, we critically review the current standard approach recommended for patients with RAI refractory differentiated thyroid cancer, emphasizing the challenges faced in LA. To achieve this objective, the Latin American Thyroid Society (LATS) convened a panel of experts from Brazil, Argentina, Chile, and Colombia. Access to MKI compounds continues to be a challenge in all LA countries. This is true not only for MKI but also for the new selective tyrosine kinase inhibitor, which will also require genomic testing, that is not widely available. Thus, as precision medicine advances, significant disparities will be made more evident, and despite efforts to improve coverage and reimbursement, molecular-based precision medicine remains inaccessible to most of the LA population. Efforts should be undertaken to alleviate the discrepancies between the current state-of-the-art care for RAI-refractory differentiated thyroid cancer and the present situation in Latin America.
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Affiliation(s)
- Fabian Pitoia
- Hospital de Clínicas José de San Martín - University of Buenos Aires, Buenos Aires, Argentina
| | - Rafael Selbach Scheffel
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ines Califano
- Endocrinology Division, Instituto de Oncología AH Roffo, University of Buenos Aires, Buenos Aires, Argentina
| | - Alicia Gauna
- Endocrinology Division, Hospital Ramos Mejía, Gobierno Ciudad de Buenos Aires, Argentina
| | - Hernán Tala
- Centro de tiroides, Facultad de Medicina Clínica Alemana, Clínica Alemana de Santiago, Universidad del desarrollo, Santiago, Chile
| | - Fernanda Vaisman
- Onco endocrinology Service, Endocrinology Service, Faculdade de Medicina, Instituto Nacional do Cancer (INCa), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alejandro Roman Gonzalez
- Deparment of Internal Medicine, Endocrine Section, Universidad de Antioquia. Hospital Universitario San Vicente Fundación. Medellin, Medellín, Colombia
| | - Ana Oliveira Hoff
- Endocrine Oncology Unit, Instituto do Cancer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Medical School, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, Porto Alegre, RS, 2350 - CEP 90035-003, Brazil.
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Jager EC, Broekman KE, Kruijff S, Links TP. State of the art and future directions in the systemic treatment of medullary thyroid cancer. Curr Opin Oncol 2022; 34:1-8. [PMID: 34669647 DOI: 10.1097/cco.0000000000000798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Systemic treatment is the only therapeutic option for patients with progressive, metastatic medullary thyroid cancer (MTC). Since the discovery of the rearranged during transfection (RET) proto-oncogene (100% hereditary, 60-90% sporadic MTC), research has focused on finding effective systemic therapies to target this mutation. This review surveys recent findings. RECENT FINDINGS Multikinase inhibitors are systemic agents targeting angiogenesis, inhibiting growth of tumor cells and cells in the tumor environment and healthy endothelium. In the phase III EXAM and ZETA trials, cabozantinib and vandetanib showed progression-free survival benefit, without evidence of prolonged overall survival. Selpercatinib and pralsetinib are kinase inhibitors with high specificity for RET; phase I and II studies showed overall response rates of 73% and 71% in first line, and 69% and 60% in second line treatment, respectively. Although resistance mechanisms to mutation-driven therapy will be a challenge in the future, phase III studies are ongoing and neo-adjuvant therapy with selpercatinib is being studied. SUMMARY The development of selective RET-inhibitors has expanded the therapeutic arsenal to control tumor growth in progressive MTC, with fewer adverse effects than multikinase inhibitors. Future studies should confirm their effectiveness, study neo-adjuvant strategies, and tackle resistance to these inhibitors, ultimately to improve patient outcomes.
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Affiliation(s)
| | | | - Schelto Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Mantsopoulos K, Mueller SK, Pavel M, Kuwert T, Meidenbauer N, Fietkau R, Sievert M, Iro H. [Treatment strategy by radioiodine refractory differentiated thyroid cancer]. Laryngorhinootologie 2021; 101:298-303. [PMID: 34583388 DOI: 10.1055/a-1580-7327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traditionally, the multimodal therapy concept for differentiated thyroid carcinomas consists of thyroidectomy with neck dissection (for cN + neck) and adjuvant radioiodine ablation with subsequent risk-adapted TSH suppression. The extent of radioiodine uptake in metastatic thyroid carcinomas plays a significant role is significant in terms of prognosis. Radioiodine refractory lesions are characterized by the lack of radioiodine uptake in combination with the lack of decrease in the tumor marker thyroglobulin as well as signs of progression on imaging. Due to the mostly indolent course over a long period of time, a wait-and-see strategy in combination with local management of distant metastase symptom relief appears to be primarily sufficient. By evidence for change in tumor dynamics, the need for a multi-tyrosine kinase inhibitor (sorafenib, lenvatinib)-based systemic therapy should be thoroughly evaluated. These substances are mostly associated with an unfavorable side-effect profile (diarrhea, rash, arterial hypertension, local wound healing disorders), which leads to a non-negligible rate of treatment-associated morbidity and a high number of treatment interruptions. For this reason, two selective RET inhibitors (selpercatinib, pralsetinib) for differentiated thyroid carcinomas were approved by the FDA in 2020. A new perspective for the future would be the variable re-differentiation strategies, which aim to increase the sensitivity of tumor cells to radioiodine.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina K Mueller
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marianne Pavel
- Department of Medicine I, Lead Division of Endocrinology & Neuroendocrine Tumors, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Torsten Kuwert
- Nuclear Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Norbert Meidenbauer
- Department of Medicine V, Haematology and Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matti Sievert
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Blossey RD, Kleine-Döpke D, Ringe KI, Pöhnert D, Ringe B, Klempnauer J, Beetz O. Recurrent Hurthle cell thyroid carcinoma does not preclude long-term survival: a case report and review of the literature. J Med Case Rep 2021; 15:399. [PMID: 34376229 PMCID: PMC8356425 DOI: 10.1186/s13256-021-02987-z] [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: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Follicular thyroid carcinoma is the second most common malignancy of the thyroid gland. In 2016, the so-called Hurthle cell thyroid carcinoma, formerly known as the oxyphilic variant of the follicular thyroid carcinoma, was reclassified by the World Health Organization as a separate pathological entity, which accounts for approximately 3% of all thyroid cancers. Although Hurthle cell thyroid carcinomas are known for their more aggressive tumor biology, metastases are observed in a minority of cases, and long-term survival can be expected. However, disseminated disease is often associated with poor outcome. Case presentation In the presented case, a 63-year-old Caucasian female was incidentally diagnosed with Hurthle cell thyroid carcinoma after undergoing hemithyroidectomy for a nodular goiter. Following completion thyroidectomy, two courses of radioactive iodine therapy were administered. After 4 years of uneventful follow-up, the patient gradually developed metastases in five different organs, with the majority representing unusual sites, such as heart, kidney, and pancreas over a course of 14 years. The lesions were either treated with radioactive iodine therapy or removed surgically, depending on iodine avidity. Conclusion Follicular and Hurthle cell thyroid carcinoma are known to potentially spread hematogenously to typical sites, such as lung or bones, however; unusual metastatic sites as presented in our case can also be observed. A search of the literature revealed only scattered reports on patients with multiple metastases in unusual locations. Furthermore, the observed long-term survival of our patient is contradictory to the existing data. As demonstrated, recurrent disease may appear years after the initial diagnosis, emphasizing the importance of consistent aftercare. Radioactive iodine therapy, extracorporeal radiation therapy, and surgical metastasectomy are central therapeutic components. In summary, our case exemplifies that thorough aftercare and aggressive treatment enables long-term survival even in recurrent Hurthle cell thyroid carcinoma displaying unusual multisite metastases.
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Affiliation(s)
- Richard David Blossey
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany.
| | - Dennis Kleine-Döpke
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany
| | - Kristina Imeen Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Daniel Pöhnert
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany
| | - Bastian Ringe
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany
| | - Jürgen Klempnauer
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany
| | - Oliver Beetz
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Lower Saxony, Germany
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Mauri G, Hegedüs L, Bandula S, Cazzato RL, Czarniecka A, Dudeck O, Fugazzola L, Netea-Maier R, Russ G, Wallin G, Papini E. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J 2021; 10:185-197. [PMID: 34178704 PMCID: PMC8215982 DOI: 10.1159/000516469] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 12/15/2022] Open
Abstract
The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
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Affiliation(s)
- Giovanni Mauri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- *Laszlo Hegedüs,
| | - Steven Bandula
- Interventional Oncology Service, University College Hospital, London, United Kingdom
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Oliver Dudeck
- Center for Microtherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Romana Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gilles Russ
- Thyroid and Endocrine Tumors Unit, La Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Göran Wallin
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Enrico Papini
- Department of Endocrinology & Metabolism, Ospedale Regina Apostolorum, Albano, Italy
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Nervo A, Ragni A, Retta F, Calandri M, Gazzera C, Gallo M, Piovesan A, Arvat E. Interventional Radiology Approaches for Liver Metastases from Thyroid Cancer: A Case Series and Overview of the Literature. J Gastrointest Cancer 2021; 52:823-832. [PMID: 33999355 PMCID: PMC8376701 DOI: 10.1007/s12029-021-00646-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
Background Liver metastases (LMs) from thyroid cancer (TC) are relatively uncommon in clinical practice and their management is challenging. Interventional radiology loco-regional treatments (LRTs), including radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE), have been successfully employed to treat LMs from various types of cancer. Methods We analyzed the role of LRTs in the management of unresectable LMs from differentiated and medullary TCs performed at our institution from 2015 to 2020. A review of the available English literature regarding this topic was also performed. Results Six hepatic LRTs were performed in 4 TC patients with LMs, in 2 cases after the start of treatment with a tyrosine kinase inhibitor (TKI). A partial response was obtained in 2 patients; the diameter of the largest targeted lesion was 18 mm in both of them. The remaining procedures were performed on larger lesions and a stable disease was achieved in all but one case. Acute LRT-related complications were transient and mild. In literature, the largest studies were focused on TACE in LMs from MTC, showing good tolerance and remarkable disease control, especially in case of limited liver tumour involvement. Conclusion LRTs for LMs represent a valuable option for the treatment of metastatic TC in case of isolated hepatic progression or for symptoms relief, also after the start of TKI treatment as part of a multimodal approach. The best disease control is obtained when hepatic metastatic burden is limited. These procedures are generally well tolerated; however, a cautious multidisciplinary selection of the candidates is mandatory.
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Affiliation(s)
- Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Calandri
- Diagnostic Imaging and Interventional Radiology Department, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Carlo Gazzera
- Diagnostic Imaging and Interventional Radiology Department, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
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Colombo C, Giancola N, Fugazzola L. Personalized treatment for differentiated thyroid cancer: current data and new perspectives. Minerva Endocrinol (Torino) 2020; 46:62-89. [PMID: 33213119 DOI: 10.23736/s2724-6507.20.03342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More conservative and personalized treatment options have been developed in recent years to face the rising diagnosis of low-risk differentiated thyroid carcinoma (DTC). The present review describes the change towards a more risk-adapted management either in the treatment or in the follow-up of DTC. Particular attention is given to the innovations introduced by the latest guidelines for low-risk tumors, starting from the most appropriate extension of surgery up to the postoperative management. The emerging role of active surveillance for low-risk microcarcinoma is discussed, as well as the development of percutaneous strategies in the setting of malignant thyroid disease. The recent use of approved new systemic target therapies for advanced radioiodine refractory thyroid cancer is reported, together with the description of new compounds in trial. Finally, we provide some considerations to improve the risk evaluation in a presurgical setting, especially related to the rising role of genetics, to enable better risk-based cancer management and personalized treatment choices.
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Affiliation(s)
- Carla Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy -
| | - Noemi Giancola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Yoon JH, Jeon MJ, Kim M, Hong AR, Kim HK, Shin DY, Kim BH, Kim WB, Shong YK, Kang HC. Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea. PLoS One 2020; 15:e0238207. [PMID: 32841270 PMCID: PMC7447021 DOI: 10.1371/journal.pone.0238207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Although infrequent, distant metastasis from differentiated thyroid cancer is the main cause of mortality in patients and mostly involves the lung, bone, and brain. Distant metastases to other sites in differentiated thyroid cancer patients are rare, thus, the clinical course of unusual metastases has not been adequately researched. In the present study, the clinico-pathological findings and treatment outcomes of unusual metastases in differentiated thyroid cancer patients in Korea were evaluated. Patients and methods We retrospectively reviewed the medical records of differentiated thyroid cancer patients with unusual metastases in four Korean tertiary hospitals (Chonnam National University Hwasun Hospital, Asan Medical Center, Busan National University Hospital, Severance Hospital). Unusual metastases were diagnosed using (1) cytology or histology and/or (2) imaging studies including fluorodeoxyglucose F 18 positron emission tomography/computed tomography and/or iodine 131 whole body scans with simultaneously elevated serum levels of thyroglobulin. The pathological findings of primary thyroid cancer, diagnostic method for unusual metastases, and treatment responses of unusual metastases were examined. Results In all, 25 unusual metastatic foci of 19 patients were analyzed; 13 patients (68.4%) had papillary thyroid carcinoma including 4 follicular variant papillary thyroid carcinomas. The median time interval between the first diagnosis of primary thyroid cancer and unusual metastases diagnosis was 110 months (11.0–138.0 months). Only 4 patients (21.1%) had synchronous unusual metastases and 6 patients (31.6%) were symptomatic. Unusual metastases included 19 metastases to solid organs (6 to kidney, 5 to liver, 4 to pancreas, 3 to adrenal gland, and 1 to ovary) and 6 to the skin and muscles. Unusual metastases were pathologically proven in 10 patients (52.6%) and 11 of 16 patients (68.8%) who received iodine 131 whole body scans had radioiodine-refractory differentiated thyroid cancer. Among 5 patients treated with tyrosine kinase inhibitors, 4 treated with lenvatinib showed stable disease or a partial response at the first treatment response. Six patients (31.6%) died due to disease progression during the median 20.0-month follow-up period (11.0–55.0 months). Conclusion Unusual metastases from differentiated thyroid cancer are thought to be underestimated due to disease rarity and their metachronous nature with other distant metastases. The most of unusual metastases in differentiated thyroid cancer patients are existed with usual distant metastasis and clinical outcomes of those could not be significantly different from the prognosis of usual distant metastasis.
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Affiliation(s)
- Jee Hee Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - A. Ram Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho-Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
- * E-mail:
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Ilanchezhian M, Khan S, Okafor C, Glod J, Del Rivero J. Update on the Treatment of Medullary Thyroid Carcinoma in Patients with Multiple Endocrine Neoplasia Type 2. Horm Metab Res 2020; 52:588-597. [PMID: 32299110 DOI: 10.1055/a-1145-8479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Medullary Thyroid Carcinoma (MTC) is a rare neuroendocrine cancer that accounts for 1-2% of thyroid cancers in the United States (U.S.). While most cases are sporadic, 25% of MTC cases are hereditary. These hereditary cases occur in the setting of Multiple Endocrine Neoplasia Type 2A (MEN2A) or 2B (MEN2B) driven by mutations in the Rearranged during Transfection RET proto-oncogene. This article discusses hereditary MTC in the setting of MEN2 and the treatment options available for it. The first line treatment for this disease is typically a total thyroidectomy and tyrosine kinase inhibitors. Two tyrosine kinase inhibitors, vandetanib and cabozantinib, have been approved for treatment of advanced MTC, but options beyond those are limited. However, several promising treatments are being studied, which are discussed in this review.
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Affiliation(s)
- Maran Ilanchezhian
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Sophia Khan
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christian Okafor
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - John Glod
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Jaydira Del Rivero
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Piantanida E, Ippolito S, Gallo D, Masiello E, Premoli P, Cusini C, Rosetti S, Sabatino J, Segato S, Trimarchi F, Bartalena L, Tanda ML. The interplay between thyroid and liver: implications for clinical practice. J Endocrinol Invest 2020; 43:885-899. [PMID: 32166702 DOI: 10.1007/s40618-020-01208-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/27/2020] [Indexed: 02/07/2023]
Abstract
A complex relationship exists between thyroid and liver in health and disease. Liver plays an essential physiological role in thyroid hormone activation and inactivation, transport, and metabolism. Conversely, thyroid hormones affect activities of hepatocytes and hepatic metabolism. Serum liver enzyme abnormalities observed in hypothyroidism may be related to impaired lipid metabolism, hepatic steatosis or hypothyroidism-induced myopathy. Severe hypothyroidism may have biochemical and clinical features, such as hyperammonemia and ascites, mimicking those of liver failure. Liver function tests are frequently abnormal also in hyperthyroidism, due to oxidative stress, cholestasis, or enhanced osteoblastic activity. Antithyroid drug-associated hepatotoxicity is a rare event, likely related mainly to an idiosyncratic mechanism, ranging from a mild hepatocellular damage to liver failure. Propylthiouracil-induced liver damage is usually more severe than that caused by methimazole. On the other hand, thyroid abnormalities can be found in liver diseases, such as chronic hepatitis C, liver cirrhosis, hepatocellular carcinoma, and cholangiocarcinoma. In particular, autoimmune thyroid diseases are frequently found in patients with hepatitis C virus infection. These patients, especially if thyroid autoimmunity preexists, are at risk of hypothyroidism or, less frequently, thyrotoxicosis, during and after treatment with interpheron-alpha alone or in combination with ribavirin, commonly used before the introduction of new antiviral drugs. The present review summarizes both liver abnormalities related to thyroid disorders and their treatment, and thyroid abnormalities related to liver diseases and their treatment.
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Affiliation(s)
- E Piantanida
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy.
| | - S Ippolito
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - D Gallo
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - E Masiello
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - P Premoli
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - C Cusini
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - S Rosetti
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - J Sabatino
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
| | - S Segato
- Gastroenterology and Gastrointestinal Endoscopic Unit, Department of Specialistic Medicine, ASST Dei Sette Laghi, Varese, Italy
| | - F Trimarchi
- Accademia Peloritana Dei Pericolanti, University of Messina, Messina, Italy
| | - L Bartalena
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy.
| | - M L Tanda
- Endocrine Unit, Department of Medicine and Surgery, Ospedale Di Circolo, ASST Dei Sette Laghi, University of Insubria, Viale Borri, 57, Varese, Italy
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11
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Larouche V, Akirov A, Thomas CM, Krzyzanowska MK, Ezzat S. A primer on the genetics of medullary thyroid cancer. ACTA ACUST UNITED AC 2019; 26:389-394. [PMID: 31896937 DOI: 10.3747/co.26.5553] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medullary thyroid cancer is a rare type of neuroendocrine tumour that arises from the parafollicular cells (C cells) of the thyroid gland. It accounts for 3%-5% of thyroid cancer cases. Close to 25% of cases are familial, and 75% are considered sporadic. Familial cases are associated with a germline RET mutation; 43%-65% of sporadic cases harbour a somatic event in the gene. Germline RET mutations are associated with the autosomal-dominant inherited multiple endocrine neoplasia (men) 2a and 2b syndromes and the isolated familial medullary thyroid cancer syndrome. More than 100 RET codon mutations have been reported to date, with genotype-phenotype correlations that include the extent and aggressiveness of the medullary thyroid cancer and the presence of other features of the men2 syndromes. The latter include pheochromocytoma-paraganglioma, hyperparathyroidism, cutaneous lichen amyloidosis, and Hirschsprung disease. In this narrative review, we focus on RET proto-oncogene physiology and pathogenesis induced by germline and somatic RET mutations, the genotype-phenotype correlation, and the management and follow-up of patients with germline-mutated medullary thyroid cancer.
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Affiliation(s)
- V Larouche
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON.,Division of Endocrinology and Metabolism, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC
| | - A Akirov
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON.,Institute of Endocrinology, Beilinson Hospital, Petach Tikva.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C M Thomas
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - M K Krzyzanowska
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON
| | - S Ezzat
- Endocrine Oncology Site Group, Princess Margaret Cancer Centre, Toronto, ON
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12
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Multimodal therapy of advanced differentiated thyroid cancer, with emphasis on the role of radioiodine. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00351-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Giovanella L, Scappaticcio L. Radioiodine therapy of advanced differentiated thyroid cancer: clinical considerations and multidisciplinary approach. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:229-234. [DOI: 10.23736/s1824-4785.19.03190-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Long-Term Outcomes After Hepatic and Pancreatic Resections for Metastases from Thyroid Cancer: a Systematic Review of the Literature. J Gastrointest Cancer 2019; 50:9-15. [PMID: 30618003 DOI: 10.1007/s12029-018-00196-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver and pancreatic metastases from thyroid cancer (TC). METHODS A systematic search of three electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. RESULTS A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE 23.8, 95% CI 13.3-106.7) for the entire cohort and the mean overall survival was 37.6 months (SE 8, 95% CI 22-53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. CONCLUSIONS Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long-term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies, whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.
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15
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Jayarangaiah A, Sidhu G, Brown J, Barrett-Campbell O, Bahtiyar G, Youssef I, Arora S, Skwiersky S, McFarlane SI. Therapeutic options for advanced thyroid cancer. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2019; 5:26-34. [PMID: 31709422 PMCID: PMC6839707 DOI: 10.17352/ijcem.000040] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thyroid cancer can be largely classified as well-differentiated, poorly differentiated, medullary and anaplastic. Differentiated thyroid cancer (DTC) includes follicular and papillary subtypes, with the incidence of papillary thyroid cancer (PTC) on the rise. The mainstay of treatment for DTC includes a combination of surgery, radioactive iodine (RAI) and levothyroxine suppression. DTC portends a favorable prognosis, even in the presence of distant metastases, with a 50% rate of 5-year survival largely due to tumor cell's sensitivity to RAI therapy influencing disease outcome. In radioactive iodine refractory differentiated thyroid cancer (RAI-refractory DTC) there is a lower survival rate prompting the use of other therapeutic options available. RAI refractoriness is more common in older patients (age >40), large metastases and lesions that are fluorodeoxyglucose (FDG) avid on position emission tomography (PET). Over the past decade, Identification of genetic mutations in the signaling pathway involved in thyroid tumorigenesis has led to the approval of tyrosine kinase inhibitors (TKIs); Sorafenib and Lenvatinib in RAI-refractory DTC. Similarly, metastatic medullary thyroid cancer (MTC) implies an unfavorable 10-year survival rate of only 20% as the principal treatment options focuses on loco regional control via surgical and/or non-surgical options. The approval of TKIs such as Cabozantinib and Vandetanib has introduced an encouraging, novel, systemic therapeutic option for metastatic MTC. Lastly, anaplastic thyroid cancer (ATC) carries the worst prognosis with high recurrence rates. Treatment includes surgery, chemotherapy and external beam radiation. The FDA recently approved Dabrafenib plus trametinib for BRAF V600E mutated ATC. Considering the modality of chemotherapy and the expanding field of targeted therapies, the role of the oncologist and interaction with endocrinologist in the management of thyroid cancer needs further clarification aiming at collaborative management plans more than ever. This review summarizes the key phase III trials that led to the approval of TKIs in the treatment of DTC and metastatic MTC. Additionally, the review aims to clarify the patient selection criteria for initiation of TKIs and examine the implications, considerations and adverse effects prior to utilizing targeted therapy. Clinical trials are ongoing with promising results and may contribute to the addition of several targeted molecules and immune check point inhibitors to the therapeutic armamentarium for RAI-refractory DTC, medullary and anaplastic thyroid cancer.
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Affiliation(s)
- Apoorva Jayarangaiah
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein School of Medicine, New York, USA
| | - Gurinder Sidhu
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Jordonna Brown
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Odeth Barrett-Campbell
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Gul Bahtiyar
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Irini Youssef
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Shalini Arora
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York, USA
| | - Samara Skwiersky
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Samy I McFarlane
- Divisions of Endocrinology and Hematology-Oncology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA,Corresponding author: Samy I McFarlane, MD, MPH, MBA, FACP, Distinguished Teaching Professor and Associate Dean, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York-Downstate Medical Center, 450 Clarkson Avenue, Box 50, Brooklyn, New York, 11203, USA, Tel: 718-270-3711; Fax: 718-270-6358;
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16
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Saito Y, Sugino K, Takami H, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Kawakubo H, Ito K, Kitagawa Y. Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors. World J Surg 2018; 42:3632-3637. [PMID: 29766229 DOI: 10.1007/s00268-018-4676-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs. METHODS We retrospectively analyzed clinical features of 29 patients (mean age 67.8 years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017. RESULTS All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8 months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively. CONCLUSIONS Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Papillary, Follicular/drug therapy
- Carcinoma, Papillary, Follicular/mortality
- Carcinoma, Papillary, Follicular/pathology
- Female
- Humans
- Liver Neoplasms/drug therapy
- Liver Neoplasms/mortality
- Liver Neoplasms/secondary
- Male
- Middle Aged
- Phenylurea Compounds/therapeutic use
- Protein-Tyrosine Kinases/therapeutic use
- Quinolines/therapeutic use
- Retrospective Studies
- Thyroid Cancer, Papillary/drug therapy
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Cazzato RL, Garnon J, Koch G, Shaygi B, Tsoumakidou G, Caudrelier J, Boatta E, Buy X, Palussiere J, Gangi A. Current role of interventional radiology in the management of visceral and bone metastases from thyroid cancer. Gland Surg 2018; 7:80-88. [PMID: 29770304 DOI: 10.21037/gs.2017.12.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The metastatic disease from thyroid cancer represents a complex clinical scenario, which mandates a case-based multi-disciplinary approach in tertiary referral centers. Direct localised treatments such as minimally invasive interventional radiology procedures can play a vital role in providing a timely palliative or curative treatment in accordance with the patients' clinical status. In this narrative review, we present the current status of interventional radiology treatments for the management of thyroid cancer distant metastases.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Behnam Shaygi
- Department of Interventional Radiology, Royal Devon and Exeter Hospital, NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Emanuele Boatta
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
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18
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Zhou J, Luo Y, Ma BY, Ling WW, Zhu XL. Contrast-enhanced ultrasound diagnosis of hepatic metastasis of concurrent medullary-papillary thyroid carcinoma: A case report. Medicine (Baltimore) 2017; 96:e9065. [PMID: 29390301 PMCID: PMC5815713 DOI: 10.1097/md.0000000000009065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Co-occurrence of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC) in the same thyroid gland with liver metastasis is a rare condition. To our knowledge, the utility of contrast-enhanced ultrasound (CEUS) to diagnose it is much less. PATIENT CONCERNS A 33-year-old female was referred to our hospital due to the increase in plasma calcitonin concentration and carcino-embryonic antigen 12 months after her total thyroidectomy. To find metastasis, she received laboratory tests, gray-scale US, and CEUS. In our paper, ethical approval was not necessary, as this article is a case report, which is based on the clinical information of the patient. Because our case does not refer to the patient's privacy, informed consent is not necessary. DIAGNOSES Gray-scale abdominal ultrasound image demonstrated a mildly hyperechoic nodule in the liver. In CEUS, the nodules were hyperenhanced in the arterial phase. In the late arterial phase, the enhancement was washed out quickly. The nodules presented hypoenhancement in the portal and parenchymal phase, which conformed to the hepatic metastasis. INTERVENTIONS The patient received thyroid and liver surgery. OUTCOMES She was free of disease for 10 months at the time of this report. LESSONS In this case, liver metastases from MTC can be detected and characterized reliably as hypoenhancing lesions during the portal venous and late phases of CEUS, washing out starts early, and is marked. We suspect MTC is a kind of tumor that tends to have rich blood supply and consider contrast-enhanced ultrasound as a suitable method for the follow-up of patients with MTC.
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Affiliation(s)
| | | | | | | | - Xiang Lan Zhu
- Department of Pathology, The West China Hospital of Sichuan University, Chengdu, China
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19
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Ibrahim EY, Busaidy NL. Treatment and surveillance of advanced, metastatic iodine-resistant differentiated thyroid cancer. Curr Opin Oncol 2017; 29:151-158. [PMID: 28141684 DOI: 10.1097/cco.0000000000000349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This review will focus on the management and treatment of metastatic thyroid cancer that is radioactive iodine refractory and review the new drugs and their mechanism of actions as well as their adverse events. RECENT FINDINGS Until recently, there were no efficacious therapeutic modalities for these patients. With advancement in knowledge and research of the molecular aberrations and oncogenic mutations in thyroid cancer as well as further understanding the role of angiogenesis in tumor growth molecular pathogenesis, novel targeted therapies are available for these patients. Some of these drugs have successfully prolonged progression free survival and are now Food and Drug Administration approved. Additional agents are approved for the treatment of other types of cancers and are currently under investigation for differentiated thyroid cancer treatment. SUMMARY Differentiated thyroid cancer (papillary and follicular) is the most common endocrine malignancy. It is generally known to have an excellent prognosis and patients are usually cured with the conventional primary treatments including surgery, radioactive iodine, and thyroid stimulating hormone suppression. A minor proportion of patients do not fully recover mainly because they develop radioactive iodine-resistant disease. These patients have few treatment options, which we aimed to describe here.
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Affiliation(s)
- Eiman Y Ibrahim
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas - M.D. Anderson Cancer Center, Houston, Texas, USA
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20
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Hadoux J, Schlumberger M. Chemotherapy and tyrosine-kinase inhibitors for medullary thyroid cancer. Best Pract Res Clin Endocrinol Metab 2017; 31:335-347. [PMID: 28911729 DOI: 10.1016/j.beem.2017.04.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Medullary thyroid cancer (MTC) represents 3% of all clinical thyroid cancers and arises from thyroid C cells that produce calcitonin. Locally advanced or metastatic MTC requires a careful work-up including measurement of serum calcitonin and carcinoembryonic antigen, determination of their doubling time and comprehensive imaging to determine the extent of the disease, its aggressiveness, and the need for treatment. Cytotoxic chemotherapy can control tumor burden in some patients with response rates of around 20% in old series. For the last 10 years, systemic therapy for MTC patients with large tumor burden and documented progression of the disease has involved the use of tyrosine kinase inhibitors targeting VEGFR and ret. Progression-free survival benefits have been demonstrated for both vandetanib and cabozantinib, as compared to placebo. Although these molecules are effective, they also have specific toxicity profiles which require a thorough clinical management in specialized centers. In the present review, we describe the work-up and treatment modalities of patients with advanced or metastatic medullary thyroid cancer with a focus on chemotherapy and targeted therapy results.
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Affiliation(s)
- Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Université Paris Saclay, 114 rue Edouard Vaillant, 94800 Villejuif, France.
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21
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Grozinsky-Glasberg S, Bloom AI, Lev-Cohain N, Klimov A, Besiso H, Gross DJ. The role of hepatic trans-arterial chemoembolization in metastatic medullary thyroid carcinoma: a specialist center experience and review of the literature. Eur J Endocrinol 2017; 176:463-470. [PMID: 28100632 DOI: 10.1530/eje-16-0960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/12/2017] [Accepted: 01/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver metastases are relatively common in patients with metastatic medullary thyroid carcinoma (MTC), carrying a negative impact on disease prognosis. The options for selective therapy of liver metastases in MTC patients are limited to catheter-guided procedures such as trans-arterial chemoembolization (TACE). Data regarding the effectiveness and safety of this procedure in MTC are limited. AIM To explore the clinical outcome, survival and safety profile of TACE for liver metastases in a group of MTC patients. METHODS Retrospective case series of patients treated at a single tertiary University Medical Center from 2005 to 2015. RESULTS Seven consecutive patients (mean age 64.5 ± 10.9 years, 5 females) with histologically confirmed MTC with liver metastases were included. Metastatic involvement of the liver was less than 50% of the liver volume in all patients. The median size of the largest liver lesion was 40 ± 6.9 mm. The patients underwent in total 20 sessions of TACE. Clinical improvement as well as tumor response (PR) were observed in all patients. The median time to tumor progression was 38 months (range 8-126). Three patients were still alive at the end of the follow-up period (a median overall survival rate of 57 ± 44 months). CONCLUSION TACE in MTC patients with hepatic metastases is usually well tolerated and induces both clinical improvement and tumor response for prolonged periods of time in the majority of patients. This therapeutic option should always be considered, irrespective of the presence of extrahepatic metastasis.
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Affiliation(s)
- S Grozinsky-Glasberg
- Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine
| | - A I Bloom
- Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Lev-Cohain
- Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Klimov
- Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - H Besiso
- Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine
| | - D J Gross
- Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine
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Isolated Liver Metastasis in Hürthle Cell Thyroid Cancer Treated with Microwave Ablation. Case Rep Endocrinol 2017; 2017:2790741. [PMID: 28163939 PMCID: PMC5253501 DOI: 10.1155/2017/2790741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/25/2016] [Indexed: 12/23/2022] Open
Abstract
Hürthle cell thyroid cancer (HCTC) is a less common form of differentiated thyroid cancer. It rarely metastasizes to the liver, and when it does, the metastasis is almost never isolated. Here we report a 62-year-old male with widely invasive Hürthle cell thyroid cancer, who underwent total thyroidectomy and received adjuvant treatment with I-131 with posttreatment scan showing no evidence of metastatic disease. His thyroglobulin however continued to rise after that and eventually an isolated liver metastasis was identified. He underwent laparoscopic microwave ablation of the liver metastasis, with dramatic decline in thyroglobulin and no structural disease identified to date. This case highlights the rare occurrence of isolated liver metastasis from HCTC and also illustrates the utility of thermoablation as an alternative to surgical resection in the treatment of small isolated liver metastases from HCTC.
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Tumino D, Frasca F, Newbold K. Updates on the Management of Advanced, Metastatic, and Radioiodine Refractory Differentiated Thyroid Cancer. Front Endocrinol (Lausanne) 2017; 8:312. [PMID: 29209273 PMCID: PMC5702018 DOI: 10.3389/fendo.2017.00312] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/27/2017] [Indexed: 11/25/2022] Open
Abstract
Differentiated thyroid cancer (DTC) accounts for 95% of all thyroid cancers and is generally an indolent tumor, treated effectively with surgery, radioactive iodine, and thyroid-stimulating hormone suppressive therapy. However, 5-10% of patients have advanced disease, with aerodigestive tract invasion, distant metastases, or radioiodine refractory disease, with poor prognosis. This review focuses on the approaches for treating advanced DTC, including management of gross extra-thyroidal extension, recurrent loco-regional or distant metastatic disease, the role of external beam radiation therapy and systemic treatment. Locally ablative treatment modalities, including surgery, radiation therapy, and thermal ablation are evolving and can be used in selected patients. In recent years, new therapeutic agents with molecular targets have become available and two multi-kinase inhibitors, Sorafenib and Lenvatinib, have been licensed for iodine refractory DTC showing an advantage in terms of progression-free survival, although an impact on overall survival has not been proven yet. Management of advanced thyroid cancer can be challenging but a multidisciplinary approach can significantly improve outcomes for this patient population.
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Affiliation(s)
- Dario Tumino
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Francesco Frasca
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Catania, Italy
| | - Kate Newbold
- Clinical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
- *Correspondence: Kate Newbold,
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Ng-Cheng-Hin B, Newbold KL. The Management of Medullary Thyroid Carcinoma in the Era of Targeted Therapy. EUROPEAN ENDOCRINOLOGY 2016; 12:39-43. [PMID: 29632588 PMCID: PMC5813459 DOI: 10.17925/ee.2016.12.01.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/09/2016] [Indexed: 11/24/2022]
Abstract
Medullary thyroid cancer (MTC) is a rare cancer comprising approximately 5% of all thyroid cancers. The majority arises sporadically but around 25% are hereditary forming part of the Multiple Endocrine Neoplasia (MEN) type 2 syndromes. The initial management is surgical, the extent of resection determined by radiological stage, presence of and specific REarranged during Transfection (RET) oncogene mutation and level of serum calcitonin. External beam radiotherapy may be utilised in the adjuvant setting to improve local control rates. Conventional cytotoxic agents remain essentially futile in the management of advanced MTC with response rates of around 15-20% at best. Over the last decade, alongside a greater understanding of the molecular pathogenesis of MTC we have seen the development of small molecule agents including tyrosine kinase inhibitors targeting vascular endothelial growth factor receptors (VEGFRs) and RET with activity in advanced MTC. This review will examine the evidence for this therapeutic approach, when to consider initiating and how to manage toxicities arising from such therapies in the treatment of advanced MTC.
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Affiliation(s)
- Brian Ng-Cheng-Hin
- NIHR Royal Marsden Hospital and Institute of Cancer Research BRC, London, UK
| | - Kate L Newbold
- NIHR Royal Marsden Hospital and Institute of Cancer Research BRC, London, UK
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8589] [Impact Index Per Article: 1073.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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26
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Hadoux J, Pacini F, Tuttle RM, Schlumberger M. Management of advanced medullary thyroid cancer. Lancet Diabetes Endocrinol 2016; 4:64-71. [PMID: 26608066 DOI: 10.1016/s2213-8587(15)00337-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/21/2015] [Accepted: 09/02/2015] [Indexed: 02/05/2023]
Abstract
Medullary thyroid cancer arises from calcitonin-producing C-cells and accounts for 3-5% of all thyroid cancers. The discovery of a locally advanced medullary thyroid cancer that is not amenable to surgery or of distant metastases needs careful work-up, including measurement of serum calcitonin and carcinoembryonic antigen (and their doubling times), in addition to comprehensive imaging to determine the extent of the disease, its aggressiveness, and the need for any treatment. In the past, cytotoxic chemotherapy was used for treatment but produced little benefit. For the past 10 years, tyrosine kinase inhibitors targeting vascular endothelial growth factor receptors and RET (rearranged during transfection) have been used when a systemic therapy is indicated for large tumour burden and documented disease progression. Vandetanib and cabozantinib have shown benefits on progression-free survival compared with placebo in this setting, but their toxic effect profiles need thorough clinical management in specialised centres. This Review describes the management and treatment of patients with advanced medullary thyroid cancer with emphasis on current targeted therapies and perspectives to improve patient care. Most treatment responses are transient, emphasising that mechanisms of resistance need to be better understood and that the efficacy of treatment approaches should be improved with combination therapies or other drugs that might be more potent or target other pathways, including immunotherapy.
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Affiliation(s)
- Julien Hadoux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Sud, Villejuif, France
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Via Bracci, Siena, Italy
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris Sud, Villejuif, France.
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Vaisman F, Carvalho DP, Vaisman M. A new appraisal of iodine refractory thyroid cancer. Endocr Relat Cancer 2015; 22:R301-10. [PMID: 26307020 DOI: 10.1530/erc-15-0300] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/12/2022]
Abstract
Thyroid cancer incidence is increasing all over the world - mostly due to an increase in the detection of small tumors that were previously undetected. A small percentage of these tumors lose the ability to uptake and/or to respond to radioiodine (RAI) therapy, especially in metastatic patients. There are several new therapeutic options that have emerged in the last 5 years to treat RAI refractory thyroid cancer patients, however, it is very important to properly identify RAI refractory patients and to clarify those appropriate for these treatments. In this review, we discuss the RAI refractory definitions and the criteria that have been suggested based on RAI uptake in the post therapy scan, as well as the response after RAI therapy and the possible molecular mechanisms involved in this process. We offer a review of the therapeutic options available at the moment and the therapeutic considerations based on a patient's individualized personal characteristics, primary tumor histology, tumor burden and location and velocity of lesion growth.
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Affiliation(s)
- Fernanda Vaisman
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Denise P Carvalho
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Mario Vaisman
- Endocrinology ServiceNational Cancer Institute, Brazil Praça da Cruz Vermelha, 23, 8° Floor, Centro, Rio de Janeiro, Rio de Janeiro, 20230-130, BrazilLaboratório de Fosiologia Endócrina Doris RosentalInstituto de Biofísica, Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, BrazilEndocrinology ServiceFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil Rua Prof. Rodolpho Paulo Rocco, 255, 9° Floor, HUCFF, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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Viola D, Cappagli V, Matrone A, Mazzeo S, Elisei R. Cabozantinib: an orphan drug for thyroid cancer. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1112789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Links TP, Verbeek HHG, Hofstra RMW, Plukker JTM. Endocrine tumours: progressive metastatic medullary thyroid carcinoma: first- and second-line strategies. Eur J Endocrinol 2015; 172:R241-51. [PMID: 25627652 DOI: 10.1530/eje-14-0726] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022]
Abstract
The treatment for metastasised medullary thyroid cancer is still a topic of discussion. One of the main challenges remains to find effective adjuvant and palliative options for patients with metastatic disease. The diagnostic and treatment strategies for this tumour are discussed and possible new developments commented. Approaches that target rearranged during transfection (RET) are preferable to those that target RET downstream proteins as, theoretically, blocking RET downstream targets will block only one of the many pathways activated by RET. Combining several agents would seem to be more promising, in particular agents that target RET with those that independently target RET signalling pathways or the more general mechanism of tumour progression.
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Affiliation(s)
- Thera P Links
- Department of EndocrinologyUniversity Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The NetherlandsDepartment of GeneticsErasmus Medical Centre, Rotterdam, The NetherlandsDepartment of Surgical OncologyUniversity Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans H G Verbeek
- Department of EndocrinologyUniversity Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The NetherlandsDepartment of GeneticsErasmus Medical Centre, Rotterdam, The NetherlandsDepartment of Surgical OncologyUniversity Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert M W Hofstra
- Department of EndocrinologyUniversity Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The NetherlandsDepartment of GeneticsErasmus Medical Centre, Rotterdam, The NetherlandsDepartment of Surgical OncologyUniversity Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - John Th M Plukker
- Department of EndocrinologyUniversity Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The NetherlandsDepartment of GeneticsErasmus Medical Centre, Rotterdam, The NetherlandsDepartment of Surgical OncologyUniversity Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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30
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1289] [Impact Index Per Article: 143.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Klein Hesselink EN, Steenvoorden D, Kapiteijn E, Corssmit EP, van der Horst-Schrivers ANA, Lefrandt JD, Links TP, Dekkers OM. Therapy of endocrine disease: response and toxicity of small-molecule tyrosine kinase inhibitors in patients with thyroid carcinoma: a systematic review and meta-analysis. Eur J Endocrinol 2015; 172:R215-25. [PMID: 25572389 DOI: 10.1530/eje-14-0788] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Many tyrosine kinase inhibitors (TKIs) have been studied in patients with thyroid carcinoma (TC). However, the effect and toxicity of various TKIs in differentiated TC (DTC) and medullary TC (MTC) patients have not been directly compared. The aim of the present systematic review and meta-analysis was to systematically summarize response and toxicity of TKIs in TC patients. METHODS All major databases were systematically searched for publications on TKIs in TC. Primary endpoint was objective response; secondary endpoints were clinical benefit, percentage TKI dose reduction/discontinuation, hand-foot syndrome, diarrhea, and nausea/vomiting. Meta-analysis was performed using an exact likelihood approach and a logistic regression. Pooled percentages and 95% CIs were reported. RESULTS In total, 22 publications were included. For DTC patients, gefitinib induced no objective responses. Pooled percentage was highest for pazopanib, 49 (95% CI 33-64)%, and was 17 (95% CI 12-24)% for sorafenib. For MTC, gefitinib and imatinib induced no objective responses, whereas sunitinib induced objective response in 43 (95% CI 14-77)%. For vandetanib and cabozantinib, these numbers were 40 (95% CI 34-46)% and 27 (95% CI 22-32)% respectively. Clinical benefit was found in 53 (95% CI 48-59)% of DTC patients on sorafenib, and in 84 (95% CI 79-88)% and 55 (95% CI 49-61)% of MTC patients on vandetanib and cabozantinib respectively. All TKIs were associated with considerable toxicity. CONCLUSION The currently studied TKIs show a modest response, while side effects are not negligible. Therefore, we suggest to solely consider TKIs in TC patients with rapid progressive disease, for whom the benefits of treatment outweigh toxicity.
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Affiliation(s)
- E N Klein Hesselink
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - D Steenvoorden
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - E Kapiteijn
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - E P Corssmit
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - A N A van der Horst-Schrivers
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - J D Lefrandt
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - T P Links
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - O M Dekkers
- Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands Department of EndocrinologyDepartment of Internal MedicineDivision of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartments of EndocrinologyMedical OncologyClinical EpidemiologyC7-99, Leiden University Medical Center, University of Leiden, PO Box 9600, 2300 RC Leiden, The Netherlands
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Abstract
After surgery, patients with medullary thyroid carcinoma (MTC) should be assessed regarding the presence of residual disease, the localization of metastases, and the identification of progressive disease. Postoperatively, patients with MTC are staged to separate those at low risk from those at high risk of recurrence. The TNM staging system is based on tumor size, extra-thyroidal invasion, nodal metastasis, and distant spread of cancer. In addition, the number of lymph-node metastases, the number of compartments involved, and the postoperative calcitonin (CTN) and carcinoembryonic antigen (CEA) levels should be documented. The postoperative normalization of the serum CTN level is associated with a favorable outcome. When patients have basal serum CTN levels less than 150 pg/ml after a thyroidectomy, any persistent or recurrent disease is nearly always confined to lymph nodes in the neck. When the postoperative serum CTN level exceeds 150 pg/ml, patients should be evaluated with imaging procedures, including computed tomography (CT) of the neck and chest, contrast-enhanced magnetic resonance imaging (MRI) and ultrasound (US) of the liver, bone scintigraphy, MRI of the bone, and positron emission tomography (PET)/CT. One can estimate the growth rate of MTC metastases by quantifying increases in tumor size over time from sequential imaging studies analyzed with response evaluation criteria in solid tumors (RECIST), and by determining the tumor marker doubling time from sequential measures of serum CTN or CEA levels over multiple time points. One of the main challenges remains to find effective adjuvant and palliative options for patients with metastatic disease. Patients with persistent or recurrent MTC localized to the neck following thyroidectomy are candidates for neck operations, depending on the tumor extension. Once metastases appear, the clinician must decide which patients require therapy. This requires a balance between the (often) slow rate of tumor progression, which is associated with a good quality of life, and the limited efficacy and potential toxicities of local and systemic therapies. Considering that metastatic MTC is incurable, the management goals are to provide loco-regional disease control, palliate symptoms of hormonal excess, such as diarrhea, palliate symptomatic metastases, like pain or bone fracture, and control metastases that threaten life, such as bronchial obstruction or spinal cord compression. This can be achieved with palliative surgery, external beam radiation therapy (EBRT), or systemic therapy with tyrosine kinase inhibitor (TKI).
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Affiliation(s)
- Friedhelm Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endokrinologische Gemeinschaftspraxis, Brückenstr. 21, 69120, Heidelberg, Germany
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Abstract
Therapy decisions in advanced medullary thyroid carcinoma should be guided by a critical appraisal of the natural disease course (slowly progressive vs. aggressive) and benefits and side effects of therapy. Therapy goals should be distinguished between curative and palliative. Local treatments are mainly palliative and may add to quality of life. The advent of novel systemic therapies opens promising perspectives but its place in the therapeutic arsenal must be further determined.
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Affiliation(s)
- Johannes Smit
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre P,O, Box 9101, 6500 HB Nijmegen, The Netherlands.
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Schlumberger M, Bastholt L, Dralle H, Jarzab B, Pacini F, Smit J. 2012 European thyroid association guidelines for metastatic medullary thyroid cancer. Eur Thyroid J 2012; 1:5-14. [PMID: 24782992 PMCID: PMC3821456 DOI: 10.1159/000336977] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 01/31/2012] [Indexed: 02/06/2023] Open
Abstract
Distant metastases are the main cause of death in patients with medullary thyroid cancer (MTC). These 21 recommendations focus on MTC patients with distant metastases and a detailed follow-up protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials. Asymptomatic patients with low tumor burden and stable disease may benefit from local treatment modalities and can be followed up at regular intervals of time. Imaging is usually performed every 6-12 months, or at longer intervals of time depending on the doubling times of serum calcitonin and carcinoembryonic antigen levels. Patients with symptoms, large tumor burden and progression on imaging should receive systemic treatment. Indeed, major progress has recently been achieved with novel targeted therapies using kinase inhibitors directed against RET and VEGFR, but further research is needed to improve the outcome of these patients.
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Affiliation(s)
- M. Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institute Gustave-Roussy and University Paris Sud, Villejuif, France
- *Martin Schlumberger, MD, Institut Gustave-Roussy, 114 Rue Edouard Vaillant, FR–94805 Villejuif Cedex (France), Tel. +33 142 116 095, E-Mail
| | - L. Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - H. Dralle
- Department of Surgery, Martin Luther University, Halle-Wittenberg Medical Faculty, Halle/Saale, Germany
| | - B. Jarzab
- MSC Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - F. Pacini
- Department of Endocrinologia, University of Siena, Siena, Italy
| | - J.W.A. Smit
- Department of Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
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van Laarhoven S, van Baren R, Tamminga RYJ, de Jong KP. Radiofrequency ablation in the treatment of liver tumors in children. J Pediatr Surg 2012; 47:e7-e12. [PMID: 22424376 DOI: 10.1016/j.jpedsurg.2011.10.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/12/2011] [Accepted: 10/28/2011] [Indexed: 02/08/2023]
Abstract
Hepatoblastoma and liver metastasis of Wilms' tumors are rare hepatic tumors in children. Treatment of both tumors consists of a combination of chemotherapy and liver surgery. Radiofrequency ablation (RFA) is frequently used for the treatment of adult liver tumors but is rarely mentioned as a treatment option in pediatric liver tumors. We present a patient with hepatoblastoma and 1 with liver metastasis from a Wilms' tumor. Both patients were treated according to the latest protocols except that surgery included use of RFA. Both are well and recurrence free 8 and 3 years after surgery. Radiofrequency ablation may be a good addition to the existing arsenal of treatment modalities for pediatric liver tumors.
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Affiliation(s)
- Stijn van Laarhoven
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Department of Surgery, 9700 RB Groningen, The Netherlands.
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Lack of Anatomical Concordance between Preablation and Postablation CT Images: A Risk Factor Related to Ablation Site Recurrence. Int J Hepatol 2012; 2012:870306. [PMID: 23320184 PMCID: PMC3540787 DOI: 10.1155/2012/870306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022] Open
Abstract
Objective. Variation in the position of the liver between preablation and postablation CT images hampers assessment of treatment of colorectal liver metastasis (CRLM). The aim of this study was to test the hypothesis that discordant preablation and postablation imaging is associated with more ablation site recurrences (ASRs). Methods. Patients with CRLM were included. Index-tumor size, location, number, RFA approachs and ablative margins were obtained on CT scans. Preablation and postablation CT images were assigned a "Similarity of Positioning Score" (SiPS). A suitable cutoff was determined. Images were classified as identical (SiPS-id) or nonidentical (SiPS-diff). ASR was identified prospectively on follow-up imaging. Results. Forty-seven patients with 97 tumors underwent 64 RFA procedures (39 patients/63 tumors open RFA, 25 patients/34 tumours CT-targeted RFA, 12 patients underwent >1 RFA). Images of 52 (54%) ablation sites were classified as SiPS-id, 45 (46%) as SiPS-diff. Index-tumor size, tumor location and number, concomitant partial hepatectomy, and RFA approach did not influence the SiPS. ASR developed in 11/47 (23%) patients and 20/97 (21%) tumours. ASR occurred less frequently after open RFA than after CT targeted RFA (P < 0.001). ASR was associated with larger index-tumour size (18.9 versus 12.8 mm, P = 0.011). Cox proportional hazard model confirmed SiPS-diff, index-tumour size >20 mm and CT-targeted RFA as independent risk factors for ASR. Conclusion. Variation in anatomical concordance between preablation and postablation images, index-tumor size, and a CT-targeted approach are risk factors for ASR in CRLM.
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Klubo-Gwiezdzinska J, Morowitz D, Van Nostrand D, Burman KD, Vasko V, Soberman M, Wartofsky L. Metastases of well-differentiated thyroid cancer to the gastrointestinal system. Thyroid 2010; 20:381-7. [PMID: 20210670 DOI: 10.1089/thy.2009.0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The incidence of distant metastases at the time of initial presentation of well-differentiated thyroid cancer is approximately 4%. During the course of treatment and follow-up, the prevalence of distant metastases ranges from 2% in low-risk patients up to 33% in high-risk patients. When present, distant metastases occur primarily in the lungs and, to a lesser extent, in bones. Of all sites for distant metastasis, gastrointestinal metastases of thyroid cancer are very uncommon and account for 0.5-1% of all distant metastases. SUMMARY Indications of metastases to the gastrointestinal system can be overlooked with traditional total body radioisotope scans that image the abdomen, including both diagnostic and posttherapy scans, because of the confounding presence of physiologic enteric radioactivity. When suspected in high-risk patients, other imaging procedures such as computed tomography, magnetic resonance imaging, and PET-computed tomography should be considered. This communication will review thyroid cancer metastases to the gastrointestinal system in regard to occurrence rate, diagnosis, and treatment. CONCLUSIONS Because of the extreme rarity of patients with metastases of thyroid cancer to the gastrointestinal tract, long-term follow-up data as well as information on prognosis are very limited. Aggressive management may provide symptomatic relief or palliation, but cure is unlikely once widespread metastases supervene. Attempts at complete or near-complete surgical resection of the metastases invading the digestive tract, followed by 131-I treatment, offer the best opportunity for improvement but will only rarely result in cure in selected patients.
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Factors influencing local tumour progression after radiofrequency ablation of malignant liver tumours. Acta Med Litu 2009. [DOI: 10.2478/v10140-009-0005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 773] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
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