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Heinzel A, Müller D, van Santen HM, Clement SC, Schneider AB, Verburg FA. The effect of surveillance for differentiated thyroid carcinoma in childhood cancer survivors on survival rates: a decision-tree-based analysis. Endocr Connect 2022; 11:e220092. [PMID: 36240044 PMCID: PMC9716375 DOI: 10.1530/ec-22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Abstract
Background Childhood cancer survivors (CCS) who received radiation therapy exposing the thyroid gland are at increased risk of developing differentiated thyroid cancer (DTC). Therefore, the International Guideline Harmonization Group (IGHG) on late effects of childhood cancer therefore recommends surveillance. It is unclear whether surveillance reduces mortality. Aim The aim of this study was to compare four strategies for DTC surveillance in CCS with the aim of reducing mortality: Strategy-1, no surveillance; Strategy-2, ultrasound alone; Strategy-3, ultrasound followed by fine-needle biopsy (FNB); Strategy-4, palpation followed by ultrasound and FNB. Materials and methods A decision tree was formulated with 10-year thyroid cancer-specific survival as the endpoint, based on data extracted from literature. Results It was calculated that 12.6% of CCS will develop DTC. Using Strategy-1, all CCS with DTC would erroneously not be operated upon, but no CCS would have unnecessary surgery. With Strategy-2, all CCS with and 55.6% of CCS without DTC would be operated. Using Strategy-3, 11.1% of CCS with DTC would be correctly operated upon, 11.2% without DTC would be operated upon and 1.5% with DTC would not be operated upon. With Strategy-4, these percentages would be 6.8, 3.9 and 5.8%, respectively. Median 10-year survival rates would be equal across strategies (0.997). Conclusion Different surveillance strategies for DTC in CCS all result in the same high DTC survival. Therefore, the indication for surveillance may lie in a reduction of surgery-related morbidity rather than DTC-related mortality. In accordance with the IGHG guidelines, the precise strategy should be decided upon in a process of shared decision-making.
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Affiliation(s)
- Alexander Heinzel
- RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sarah C Clement
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
- Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Amsterdam, The Netherlands
| | - Arthur B Schneider
- University of Illinois at Chicago, Department of Medicine, Chicago, IL, USA
| | - Frederik A Verburg
- Erasmus MC Rotterdam, Department of Radiology & Nuclear Medicine, Rotterdam, The Netherlands
- University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
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2
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Schmidt M, Bartenstein P, Bucerius J, Dietlein M, Drzezga A, Herrmann K, Lapa C, Lorenz K, Musholt TJ, Nagarajah J, Reiners C, Sahlmann CO, Kreissl MC. Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy - A German position paper from Surgery and Nuclear Medicine. Nuklearmedizin 2022; 61:87-96. [PMID: 35299276 DOI: 10.1055/a-1783-8154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1. This publication discusses indications for RIT on the basis of an individual risk assessment. Many of the conclusions of this consensus statement are well founded and accepted across the disciplines involved. However, especially from the perspective of nuclear medicine, as the discipline responsible for indicating and executing RIT, some of the recommendations may require further clarification with regard to their compatibility with established best practice and national standards of care. Assessment of the indications for RIT is strongly dependent on the weighing up of benefits and risks. On the basis of longstanding clinical experience in nuclear medicine, RIT represents a highly specific precision medicine procedure of proven efficacy with a favorable side-effect profile. This distinguishes RIT significantly from other adjuvant oncological therapies and has resulted in the establishment of this procedure as a usually well-tolerated, standard safety measure. With regard to its favorable risk/benefit ratio, this procedure should not be unnecessarily restricted, in the interest of offering reassurance to the patients. Both patients' interests and regional/national differences need to be taken into account. We would therefore like to comment on the recent consensus from the perspective of authors and to provide recommendations based on the respective published data.
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Affiliation(s)
- Matthias Schmidt
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Jan Bucerius
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Member of the Board, German Society of Nuclear Medicine (DGN e. V.)
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle Wittenberg, Faculty of Medicine, Halle, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - James Nagarajah
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherland.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Carsten O Sahlmann
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
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3
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[Indications and results of radioiodine treatment of differentiated thyroid cancer]. Chirurg 2020; 91:1013-1016. [PMID: 32749499 PMCID: PMC7716916 DOI: 10.1007/s00104-020-01248-x] [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] [Indexed: 11/09/2022]
Abstract
Hintergrund Bösartige Schilddrüsentumoren sind die häufigsten bösartigen endokrinen Tumoren, die ungefähr 1 % aller malignen Tumoren umfassen. In den letzten Jahren ist die Inzidenz des differenzierten Schilddrüsenkarzinoms (DTC) deutlich angestiegen, insbesondere der kleinen papillären Karzinome. Fragestellung Dargestellt werden Indikationen und Ergebnisse der Radiojodtherapie (RJT) beim DTC. Material und Methoden Es erfolgt die Durchsicht der aktuellen Literatur und Leitlinien zur RJT des DTC. Ergebnisse Die RJT stellt die wichtigste adjuvante Behandlungsoption des DTC dar und wird generell gut vertragen. Schlussfolgerungen Verglichen mit anderen Tumoren hat das DTC durch die Kombination von Operation und RJT eine sehr gute Prognose mit einer durchschnittlichen Überlebensrate von über 90 %.
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Vrachimis A, Iakovou I, Giannoula E, Giovanella L. ENDOCRINOLOGY IN THE TIME OF COVID-19: Management of thyroid nodules and cancer. Eur J Endocrinol 2020; 183:G41-G48. [PMID: 32438345 PMCID: PMC7938009 DOI: 10.1530/eje-20-0269] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Abstract
Most patients with thyroid nodules and thyroid cancer (TC) referred for diagnostic work-up and treatment are not considered at higher risk of infection from SARS-CoV-2 compared to the general population. On the other hand, healthcare resources should be spared to the maximum extent possible during a pandemic. Indeed, while thyroid nodules are very common, only a small percentage are cancerous and, in turn, most thyroid cancers are indolent in nature. Accordingly, diagnostic work-up of thyroid nodules, thyroid surgery for either benign or malignant thyroid nodules and radioiodine treatment for differentiated thyroid cancers may be safely postponed during SARS-CoV-2 pandemic. Appropriate patient counselling, however, is mandatory and red flags should be carefully identified prompting immediate evaluation and treatment as appropriate. For these selected cases diagnostic work-up (e.g. ultrasound, scintigraphy, fine-needle aspiration), surgery and radioiodine therapy may proceed despite the threat of SARS-CoV-2 infection and COVID-19, after an individual risk-benefit analysis.
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Affiliation(s)
- Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
- Correspondence should be addressed to A Vrachimis;
| | - Ioannis Iakovou
- Academic Department of Nuclear Medicine, University Hospital AHEPA, School of Medicine, Thessaloniki, Greece
- Academic Department of Nuclear Medicine, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Evanthia Giannoula
- Academic Department of Nuclear Medicine, University Hospital AHEPA, School of Medicine, Thessaloniki, Greece
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland
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Li J, Xue LB, Gong XY, Yang YF, Zhang BY, Jin J, Shi QF, Liu YH. Risk Factors of Deterioration in Quality of Life Scores in Thyroid Cancer Patients After Thyroidectomy. Cancer Manag Res 2019; 11:10593-10598. [PMID: 31908531 PMCID: PMC6927570 DOI: 10.2147/cmar.s235323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/04/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Despite the expectation of normal life expectancy for thyroid cancer, there are concerns about the decreased quality of life (QoL). The present study investigated the potential risk factors of deterioration in QoL scores in thyroid cancer patients after thyroidectomy. MATERIALS AND METHODS A total of 286 patients who were diagnosed with thyroid cancer after thyroidectomy were involved in this prospective, single-center, observational study from November 2018 to June 2019. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 was used to assess the QoL 3 months after thyroidectomy. We investigated the effects of demographics (age, gender, education, marital status, area of residence, and annual mean income), tumor characteristics (histology, clinical stage, presence of metastasis, surgery type, and radiotherapy), and neurological deficits induced by recurrent nerve or superior laryngeal injury on QoL. RESULTS The mean overall QoL in thyroid cancer survivors was 65.93 ±9.00 (on a scale of 0-100, where 100 was the best). Multivariate regression analysis confirmed that clinical stage (P < 0.010), surgery type (P < 0.001), histology (P < 0.001), neurological deficits (P < 0.001), and marital status (P < 0.001) were independent risk factors for decreased QoL 3 months after thyroidectomy. CONCLUSION Our study indicated that clinical stage, surgery type, histology, neurological deficits, and marital status were independent risk factors for decreased QoL at 3 months after thyroidectomy. Further exploration and validation of these findings in larger prospective studies are warranted.
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Affiliation(s)
- Jie Li
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Ling Bo Xue
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Xiao Yi Gong
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Yan Fang Yang
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Bu Yong Zhang
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Jian Jin
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Qing Feng Shi
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
| | - Yong Hong Liu
- Thyroid and Breast Surgery, Cangzhou Central Hospital, Cangzhou City061000, People’s Republic of China
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Verburg FA, Hänscheid H, Luster M. Radioactive iodine (RAI) therapy for metastatic differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2017; 31:279-290. [PMID: 28911724 DOI: 10.1016/j.beem.2017.04.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. It usually has a comparatively benign course. If properly executed, radioiodine therapy can provide an effective treatment of even advanced, metastatic DTC. A major problem in determining the right RAI for a patient with metastatic disease is a comparative lack of evidence. There are no reports on randomized controlled trials in this patient group which can aid us in determining which way to treat which patient. Few non-randomized prospective observational studies have been performed. Most available evidence is based on retrospective analyses which, although often informative, still are hampered by the selection bias inherent to retrospective studies on a small, preselected sample of the total DTC population. The aim of the present review is to provide an overview of the relevant literature on the issues pertinent to the execution of RAI. Radioiodine therapy of metastatic DTC in patients can be an effective treatment modality which will contribute significantly to a patients' life expectancy. However, much is unclear in the management of this malignancy, including which activity to use, how to determine this activity (empiric vs. dosimetric approach) as well as the potential long-term complications. In pediatric patients, special considerations apply with regard to weight-adaptation of activities as well the risk of pulmonary fibrosis in patients with diffuse miliary metastases.
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Affiliation(s)
- Frederik A Verburg
- University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany.
| | - Heribert Hänscheid
- University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany
| | - Markus Luster
- University Hospital Marburg, Department of Nuclear Medicine, Marburg, Germany
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Ryu CH, Park B, Ryu J, Ryu YM, Jo SA, Lee YJ, Lee EK, Hwangbo Y, Joo J, Jung YS. Development and Evaluation of a Korean Version of a Thyroid-Specific Quality-of-Life Questionnaire Scale in Thyroid Cancer Patients. Cancer Res Treat 2017; 50:405-415. [PMID: 28602058 PMCID: PMC5912148 DOI: 10.4143/crt.2017.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to develop a Korean version of the self-reported thyroid-specific quality of life (QoL) questionnaire for thyroid cancer patients (KT-QoL), and to evaluate its reliability and validity. Materials and Methods Two hundred seventy-two patients who underwent thyroidectomy from January to December 2010 were recruited in this study. The original version of the thyroid QoL was translated into Korean and evaluated for its reliability and validity. Using the developed KT-QoL, the postoperative QoL was evaluated until postoperative 1 year. Results At the preoperative baseline, the item internal consistency (IIC) ranged from ‒0.19 to 0.76, with low IIC values for items 2, 17, and 27. Item discriminant validity ranged from 86% to 97%. These values were similar at the postoperative periods. The internal consistency reliability (Cronbach’s α) was high for all dimensions, ranging from 0.90 to 0.95. The test-retest reliability (intraclass correlation coefficient) was acceptable (0.74-0.82). The external validity examined by the correlation between the item 1j (voice changes) of KT-QoL and the voice handicap index-30 ranged from 0.51 to 0.75. Patients’ QoL scores decreased after surgery, which demonstrated the sensitivity of the questionnaire. The QoL scores in patients with lobectomy showed best QoL scores postoperatively and those with receiving radioactive iodine still showed decreased QoL scores along the postoperative periods. Conclusion These results demonstrate that KT-QoL is a valid instrument for evaluating QoL of Korean patients with thyroid cancer.
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Affiliation(s)
- Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometrics Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Youn Mi Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seong Ae Jo
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - You Jin Lee
- Departement of Internal Medicine, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun-Kyung Lee
- Departement of Internal Medicine, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yul Hwangbo
- Departement of Internal Medicine, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Biometrics Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yuh-Seog Jung
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Evaluation of 131I scintigraphy and stimulated thyroglobulin levels in the follow up of patients with DTC: a retrospective analysis of 1420 patients. Eur J Nucl Med Mol Imaging 2016; 44:744-756. [DOI: 10.1007/s00259-016-3581-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/18/2016] [Indexed: 12/30/2022]
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Endogenous TSH levels at the time of 131I ablation do not influence ablation success, recurrence-free survival or differentiated thyroid cancer-related mortality. Eur J Nucl Med Mol Imaging 2015; 43:224-231. [PMID: 26493309 DOI: 10.1007/s00259-015-3223-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/07/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE Based on a single older study it is established dogma that TSH levels should be ≥30 mU/l at the time of postoperative 131I ablation in differentiated thyroid cancer (DTC) patients. We sought to determine whether endogenous TSH levels, i.e. after levothyroxine withdrawal, at the time of ablation influence ablation success rates, recurrence-free survival and DTC-related mortality. METHODS A total of 1,873 patients without distant metastases referred for postoperative adjuvant 131I therapy were retrospectively included from 1991 onwards. Successful ablation was defined as stimulated Tg <1 μg/l. RESULTS Age, gender and the presence of lymph node metastases were independent determinants of TSH levels at the time of ablation. TSH levels were not significantly related to ablation success rates (p = 0.34), recurrence-free survival (p = 0.29) or DTC -elated mortality (p = 0.82), but established risk factors such as T-stage, lymph node metastases and age were. Ablation was successful in 230 of 275 patients (83.6 %) with TSH <30 mU/l and in 1,359 of 1,598 patients (85.0 %) with TSH ≥30 mU/l. The difference was not significant (p = 0.55). Of the whole group of 1,873 patients, 21 had recurrent disease. There were no significant differences in recurrence rates between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.16). Ten of the 1,873 patients died of DTC. There were no significant differences in DTC-specific survival between patients with TSH <30 mU/l and TSH ≥30 mU/l (p = 0.53). CONCLUSION The precise endogenous TSH levels at the time of 131I ablation are not related to the ablation success rates, recurrence free survival and DTC related mortality. The established dogma that TSH levels need to be ≥30 mU/l at the time of 131I ablation can be discarded.
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Vrachimis A, Burg MC, Wenning C, Allkemper T, Weckesser M, Schäfers M, Stegger L. [18F]FDG PET/CT outperforms [18F]FDG PET/MRI in differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2015; 43:212-220. [DOI: 10.1007/s00259-015-3195-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/09/2015] [Indexed: 12/25/2022]
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