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Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081000. [PMID: 35893115 PMCID: PMC9332790 DOI: 10.3390/medicina58081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.
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2
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Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, Saibene AM, Pipolo C, Fuccillo E, Rosso C, Felisati G, De Pasquale L. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol 2022; 12:954759. [PMID: 35875142 PMCID: PMC9300941 DOI: 10.3389/fonc.2022.954759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Eleonora Lori,
| | | | | | - Paolo Lozza
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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3
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Ieni A, Fadda G, Alario G, Pino A, Ficarra V, Dionigi G, Tuccari G. Metastatic thyroid carcinoma mimicking as a primary neoplasia of the kidney: A case report. Mol Clin Oncol 2021; 15:268. [PMID: 34790352 PMCID: PMC8591691 DOI: 10.3892/mco.2021.2430] [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: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
The unfavorable behavior of primary thyroid carcinoma (PTC) has been revealed by the hematogenous distant metastases in ~20-25% of cases with frequent localizations in lungs and bones, but infrequently in kidney. A 69-year-old male patient was admitted to Department of Human Pathology in Adulthood and Childhood 'G. Barresi', University Hospital G. Martino, (Messina, Italy) for an incidentally detected parenchymal mass involving the right kidney. A partial nephrectomy was done; at the post-surgical examination, a large nodular grayish mass was documented. Microscopically, a diffuse proliferation with solid/follicular pattern with some colloid-filled spaces was appreciable. An intense immunopositivity was revealed for thyroglobulin, thyroid transcription factor-1 (TTF-1), paired-box gene 8 (PAX-8) and cytokeratin 7, while CD10 and renal cell carcinoma marker were negative. A diagnosis of the metastatic thyroid follicular carcinoma localized in the kidney was made. At ultrasound examination, a hyperechoic mass extending from the left thyroid lobe to the isthmus, to which TIR4 diagnostic category according to the Italian reporting system for thyroid cytology was attributed. After thyroid surgical procedure, the final diagnosis of primitive differentiated follicular thyroid carcinoma with foci of poorly differentiated component was made.
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Affiliation(s)
- Antonio Ieni
- Pathology Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Guido Fadda
- Pathology Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Giuseppe Alario
- Urology Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Antonella Pino
- Endocrine and Minimally Invasive Surgery Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Vincenzo Ficarra
- Urology Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Gianlorenzo Dionigi
- Endocrine and Minimally Invasive Surgery Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
| | - Giovanni Tuccari
- Pathology Section, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University Hospital G. Martino, University of Messina, I-98125 Messina, Italy
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4
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Pradeep S, Hedne N, Vidhyadharan S, Rajiv S. Sternal metastatectomy in a case of papillary thyroid carcinoma. BMJ Case Rep 2020; 13:13/10/e235967. [PMID: 33127692 DOI: 10.1136/bcr-2020-235967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Thyroid cancer is the most common among endocrine cancers. Over 90% of all thyroid malignancies are differentiated thyroid carcinomas (DTC). However, only 2%-13% of DTC present with bone metastasis. Radioactive iodine ablation (RAI) is the treatment of choice for metastatic DTC. However, RAI therapy is not as effective in bone metastasis as it is in lung and visceral metastases. Only few cases of surgical management of bone metastasis in DTC have been reported in the literature. Here, we report a case of follicular variant of papillary thyroid carcinoma with sternal and lung metastases, for which sternal metastatectomy was performed.
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Affiliation(s)
- Sivakumar Pradeep
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Naveen Hedne
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Sivakumar Vidhyadharan
- Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Santosham Rajiv
- Cardiovascular and Thoracic Surgery, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
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5
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Tramontin MY, Faria PASD, Nascimento CMD, Barbosa CDA, Barros MDFRP, Barros ARGD, Carvalho RCD, Castro Neto AKPD, Andrade FAD, Corbo R, Vaisman F, Bulzico D. Cholestatic syndrome as initial manifestation of pancreatic metastasis of papillary thyroid carcinoma: case report and review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:179-184. [PMID: 32236313 PMCID: PMC10118944 DOI: 10.20945/2359-3997000000215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/26/2019] [Indexed: 12/29/2022]
Abstract
Most papillary thyroid carcinomas (PTC) harbor excellent prognosis. Although rare, distant metastases normally occur in lungs and/or bones. Here we describe a rare case of pancreatic metastasis presenting with rapid onset cholestatic syndrome. A literature review was also performed. A 73-year-old man with a high risk PTC was submitted to total thyroidectomy (TT) followed by radioiodine therapy. After initial therapy, he persisted with progressive rising serum thyroglobulin levels but with no evidence of structural disease. Recently, the patient presented with a rapid onset and progressive cholestatic syndrome. A 4 cm lesion in pancreas was identified, with echoendoscopy fine-needle aspiration biopsy (FNAB) confirming a pancreatic metastasis from PTC. The patient was submitted to a successful pancreaticoduodenectomy. Pancreatic metastases of PTC are rare and few long-term follow-up data are available to guide management. Fourteen cases were former reported, mean age was 65.7 years-old with mean time between PTC and pancreatic metastasis diagnosis of 7.9 years. Nine of them had another distant metastasis, nine were diagnosed by FNAB and just two received sorafenib.
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Affiliation(s)
- Mariana Yoshii Tramontin
- Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
| | | | | | - Cibele de Aquino Barbosa
- Seção de Cirurgia Abdominopélvica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | - Fernanda Accioly de Andrade
- Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
| | - Rossana Corbo
- Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
| | - Fernanda Vaisman
- Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
| | - Daniel Bulzico
- Unidade de Endocrinologia Oncológica, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, RJ, Brasil
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Han JM, Bae JC, Kim HI, Kwon S, Jeon MJ, Kim WG, Kim TY, Shong YK, Kim WB. Clinical Outcomes of Differentiated Thyroid Cancer Patients with Local Recurrence or Distant Metastasis Detected in Old Age. Endocrinol Metab (Seoul) 2018; 33:459-465. [PMID: 30513560 PMCID: PMC6279901 DOI: 10.3803/enm.2018.33.4.459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. METHODS This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. RESULTS The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. CONCLUSION The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.
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Affiliation(s)
- Ji Min Han
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Cheol Bae
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hye In Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sam Kwon
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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7
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Kato S, Murakami H, Demura S, Fujimaki Y, Yoshioka K, Yokogawa N, Tsuchiya H. The impact of complete surgical resection of spinal metastases on the survival of patients with thyroid cancer. Cancer Med 2016; 5:2343-9. [PMID: 27431619 PMCID: PMC5055174 DOI: 10.1002/cam4.823] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 02/03/2023] Open
Abstract
Spinal metastases (SMs) from thyroid cancers significantly reduce the quality of life by causing pain and neurological deficits and increase mortality. Complete surgical resection of isolated thyroid SMs is a promising treatment option; however, the postoperative outcome is unknown. This study aimed to compare the postoperative courses of patients undergoing complete resection of thyroid SMs with those of patients undergoing incomplete resection, with a minimum 4‐year follow‐up. We performed a retrospective analysis of 32 patients who underwent tumor excision surgery for thyroid SMs at our medical center during a 28‐year period. Twenty patients underwent complete excision, and 12 underwent incomplete excision. Survival was defined as the time from the first spinal surgery to death or last follow‐up. Kaplan–Meier analysis with the long‐rank test was used to compare the overall survival rates between the groups. For all patients, the overall 5‐ and 10‐year survival rates were 71% and 31%, respectively. The median overall survival time was 6.4 years. The patients undergoing complete excision survived longer than those undergoing incomplete excision (5‐year survival: 84% vs. 50%; 10‐year survival: 52% vs. 8%; P < 0.01). Only one patient undergoing complete excision experienced local tumor recurrence in the operated spine, whereas all long‐term survivors (>18 months after surgery) in the incomplete excision group experienced local tumor recurrence and a consequent deterioration in performance status. Complete surgical resection of thyroid SMs, if achievable, has the potential not only to maintain performance status, but also to prolong survival.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan.
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yoshiyasu Fujimaki
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
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8
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Adwin Z, Nur A, Suhaimi S, Rahman R. Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma. Oman Med J 2016; 31:69-72. [PMID: 26816570 DOI: 10.5001/omj.2016.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.
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Affiliation(s)
- Zainal Adwin
- Department of General Surgery, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ayub Nur
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Shahrun Suhaimi
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Ramzisham Rahman
- Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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9
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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10
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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: 8371] [Impact Index Per Article: 1046.4] [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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11
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Macherey S, Preuss SF, Doerr F, Grönke S, Heldwein M, Quaas A, Zander T, Hekmat K. [Surgical therapy of lung metastases from head and neck cancer]. HNO 2014; 62:893-901; quiz 902-3. [PMID: 25294229 DOI: 10.1007/s00106-014-2933-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary metastasectomy is an established procedure in oncological therapeutic concepts. A systematic literature search and an analysis of all studies published since 01.01.2000 should evaluate the advantage of pulmonary metastasectomy for patients with primary head and neck cancer. Lung metastases develop in 1.9-13% of head and neck cancer patients. Following metastasectomy, patients reach a median survival of 9.5-78 months and 5-year survival rates of up to 58% are achieved. Intrathoracic recurrence occurs in 18.4-81.8% of patients, selected instances of which can be successfully treated by remetastasectomy. Patients with squamous cell carcinoma have the worst prognosis, but could also become long-term survivors (≥ 60 months). Pulmonary metastasectomy is frequently the only potentially curative therapeutic approach and offers a better long-term survival than nonsurgical therapies. Lung metastasectomy is thus the treatment of choice in selected patients with pulmonary metastases from primary head and neck cancer.
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Affiliation(s)
- S Macherey
- Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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12
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Cho SW, Choi HS, Yeom GJ, Lim JA, Moon JH, Park DJ, Chung JK, Cho BY, Yi KH, Park YJ. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid 2014; 24:277-86. [PMID: 23758653 PMCID: PMC3926138 DOI: 10.1089/thy.2012.0654] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Distant metastasis, generally to lung and bone, is rare in differentiated thyroid carcinoma (DTC) and the prognosis is still elusive. We investigated long-term outcomes of lung metastasis in DTC patients and its prognostic factors. METHODS A retrospective review was performed of 4572 patients who underwent surgery for DTC from 1962 to 2009 at Seoul National University Hospital. Among them, 164 patients were identified with lung metastasis and 152 patients were enrolled in the final analysis. Poor prognosis was defined as progressive disease or death. RESULTS Of these 152 patients, 10- and 20-year survival rates were 85.0% and 71.0%, respectively. No evidence of disease, stable disease, progressive disease, and death was identified in 22.4%, 28.3%, 35.5%, and 13.8%, respectively, after 11 years of median follow-up (range 2-41 years). Older age at diagnosis (≥45 years), primary tumor size ≥2 cm, follicular thyroid cancer, metastasis diagnosed after initial evaluation or (131)I remnant ablation (late metastasis), multiple metastases other than lung, (131)I nonavidity, and the presence of macronodules (≥1 cm) were more frequent in poor prognoses. Cox proportional hazard ratio for progression-free survival showed that (131)I nonavidity was the only independent predictive factor for poor prognosis. CONCLUSIONS The prognosis of lung metastasis from DTC in Korea within this study was favorable. (131)I nonavidity, observed more frequently in late metastasis, was the only independent factor predicting poor prognosis.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Gye Jeong Yeom
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Bundang Hospital, Seoul National University, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Bo Youn Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Boramae Medical Center; Seoul National University, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
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Cheung FH. The practicing orthopedic surgeon's guide to managing long bone metastases. Orthop Clin North Am 2014; 45:109-19. [PMID: 24267212 DOI: 10.1016/j.ocl.2013.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Long bone skeletal metastases are common in the United States, with more than 280,000 new cases every year. Most of these will be managed by the on-call orthopedic surgeon. A practical primer is offered for the evaluation and surgical management for the practicing orthopedist, including questions to ask during the history, pertinent physical examination findings, appropriate imaging requests, proper laboratory work, and biopsy options. Finally, 7 scenarios are presented to encompass most situations a practicing orthopedic surgeon will encounter, and guidelines for treatment and referral are offered.
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Affiliation(s)
- Felix H Cheung
- Department of Orthopaedic Surgery, Joan C Edwards School of Medicine, Marshall University, 1600 Medical Center Dr, Ste G500, Huntington, WV 25701, USA.
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14
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Bagan P, Mordant P, Pricopi C, Le Pimpec Barthes F, Riquet M. [Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:363-367. [PMID: 24210159 DOI: 10.1016/j.pneumo.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Affiliation(s)
- P Bagan
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France.
| | - P Mordant
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique et transplantation pulmonaire, hôpital européen Georges-Pompidou, hôpitaux universitaires Paris-Ouest, 20, rue Leblanc, 75015 Paris, France
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Two cases of sternectomy for bone metastasis due to aggressive variants of thyroid papillary carcinoma. Int J Surg Case Rep 2013; 4:156-9. [PMID: 23276755 DOI: 10.1016/j.ijscr.2012.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/22/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There are only few cases reported about the role of surgery in the presence of single or multiple bulky bone metastases. The literature about treatment for bulky sternal metastases is scarce. PRESENTATION OF CASE We present two patients treated surgically for metastatic thyroid lesions. Case 1 is a female with tumor of the thyroid right lobe, mediastinal extension and multiple pulmonary metastases. Bony infiltration was observed in the sternum and ribs. Case 2 is a female with a lesion in the cervical region of the thyroid left lobe and increase in volume on the upper sternal manubrium. DISCUSSION Patients with well-differentiated thyroid cancer may present with extracervical metastasis in 5-10% of cases at diagnosis. Bone metastases occur in 0.4% of cases of papillary carcinoma. Management remains controversial. There are only isolated cases reported in the literature of the role surgery plays in the presence of single or multiple bulky bone metastases. The basis for initial surgical approach is keeping in mind that the surgical procedure is palliative in order to achieve optimal hypothetical ablation as a result of reduced tumor volume. CONCLUSION Surgery is the elective treatment and can be performed safely and with adequate results, allowing proper optimization of the dose of (131)I for ablative therapy.
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Riquet M, Bagan P, Fabre-Guillevin E, Scotté F, Cazes A, Le Pimpec-Barthes F. [Isolated malignant mediastinal lymphadenopathy]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:36-40. [PMID: 20207295 DOI: 10.1016/j.pneumo.2009.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal adenopathies without pulmonary disease may be benign, lymphomatous or the metastases from intra- or extrathoracic malignancy or more rarely metastases with unknown primary site. We observed 507 patients with isolated mediastinal adenopathies: benign, lymphomatous and metastatic disease represented 41.4% (210/507), 26.8% (136/507), 31.8% (161/507) of them, respectively. Management of the latter was the most challenging. Surgery was generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes in 84% of patients (135/161). However, radical surgery consisting in lymphadenectomy proved effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed long-term good results in such cases, which also was demonstrated by case reports in the literature. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients.
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Affiliation(s)
- M Riquet
- Service de Chirurgie Thoracique et Service d'Oncologie Médicale, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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17
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Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-214. [PMID: 19860577 DOI: 10.1089/thy.2009.0110] [Citation(s) in RCA: 4622] [Impact Index Per Article: 308.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. METHODS Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. 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, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. CONCLUSIONS We created evidence-based recommendations in response to our appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Porterfield JR, Cassivi SD, Wigle DA, Shen KR, Nichols FC, Grant CS, Allen MS, Deschamps C. Thoracic metastasectomy for thyroid malignancies. Eur J Cardiothorac Surg 2009; 36:155-8. [PMID: 19539179 DOI: 10.1016/j.ejcts.2008.12.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 12/14/2008] [Accepted: 12/19/2008] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To better define early and long-term outcomes of patients undergoing thoracic metastasectomy for thyroid cancer. METHODS We identified, reviewed, and analyzed the medical records of all patients who underwent thoracic metastasectomy for thyroid cancer in our institution from 1971 to 2006. RESULTS There were 48 patients (25 men, 23 women). A complete resection (R0) of all known disease was performed in 33 (69%) patients, while 15 (31%) underwent incomplete resection (R1 or R2). By histology, the majority were papillary 31 (65%), follicular 8 (17%), medullary 5 (10%), and Hürthle cell 4 (8%). Ninety percent were confined to a single side of the chest, with 10% presenting with bilateral metastases. Thoracotomy was performed in 28 (58%), sternotomy in 12 (25%), and thoracoscopy was used in 8 (17%). Operative mortality was zero and postoperative complications occurred in 8 patients (17%). There are currently 18 surviving patients from the cohort (37%) with a median follow-up of 10 years (range, 1 month to 17 years). The overall 5-year survival after thoracic metastasectomy was 60%. Based on histology, 5-year survival for papillary cancer was 64% compared to 37% for follicular and Hürthle cell neoplasms (p=0.03). All five medullary thyroid cancer patients were alive at 5 years. Five-year survival was also improved for patients less than 45 years old at the time of diagnosis of their initial thyroid malignancy (94% vs 49%; p=0.03). Disease-free interval of >3 years between initial thyroid malignancy diagnosis and thoracic metastasectomy demonstrated improved 5-year survival (67% vs 52%; p=0.01). CONCLUSION Pulmonary resection for thyroid metastasis is safe with low morbidity and mortality. Retrospective analysis demonstrates improved long-term survival in patients with papillary histology, longer disease-free interval (>3 years) and younger age at diagnosis of initial thyroid malignancy. Excellent long-term survival was also achievable in selected patients with medullary thyroid metastasis.
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Abstract
The role of surgical resection in patients with metastatic thyroid cancer is not clearly defined. Reported is a case of concurrent thyroid metastases to the lungs and sternum treated with total sternectomy followed by radioiodine therapy. A comprehensive review of the literature was also performed to evaluate the characteristics of reported cases of sternal thyroid cancer metastases treated with surgical resection. Overall, we demonstrate that radical resection of sternal metastases can be performed safely even in patients with poor prognosis to achieve palliation and potentiation of radioiodine therapy for concurrent metastases.
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Intrathoracic lymph node metastases from extrathoracic carcinoma: the place for surgery. Ann Thorac Surg 2009; 88:200-5. [PMID: 19559225 DOI: 10.1016/j.athoracsur.2009.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/31/2009] [Accepted: 04/01/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management. METHODS Among 565 patients with mediastinal lymph node enlargement, 37 had a history of extrathoracic carcinoma. The enlargement consisted in HMLNMs in 26 (15 men, 11 women), with a mean age of 57.6 (range 19-78) years. Surgical procedures were reviewed. RESULTS Diagnostic procedures, comprising mediastinoscopy in 9, anterior mediastinotomy in 2, and video-assisted thoracic surgery (VATS) in 4, were performed mainly because of unresectability due to diffuse and bilateral HMLNMs. Cancer location was breast in 6, kidney or prostate in 2 each, and bladder, rectum, testis, melanoma, and larynx in 1 each. Median survival was 21 months. Resection was performed in 11 patients, comprising posterolateral thoracotomy in 6, muscle sparing thoracotomy in 2, and VATS in 3. Seventeen involved LN stations were removed; of these, primary were kidney in 3, testis or thyroid in 2 each, and larynx, nasopharynx, and intestinum in 1 each. Five-year survival was 41.6% (median, 45 months). CONCLUSIONS HMLNMs of extrathoracic carcinoma may be isolated, probably in the context of a particular lymphatic mode of spread. Our experience demonstrates that operation is mainly diagnostic but resection may safely achieve local control of the disease and deserves being advocated in patients with isolated and resectable HMLNMs.
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21
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Ríos A, Manuel Rodríguez J, Balsalobre MD, Febrero B, Tébar J, Parrilla P. [Distant metastases as the initial manifestation of follicular thyroid carcinoma]. ACTA ACUST UNITED AC 2009; 56:213-4. [PMID: 19627740 DOI: 10.1016/s1575-0922(09)70988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Efficacy of computer-aided detection system and thin-slab maximum intensity projection technique in the detection of pulmonary nodules in patients with resected metastases. Invest Radiol 2009; 44:105-13. [PMID: 19034026 DOI: 10.1097/rli.0b013e318190fcfc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the efficacy of the computer-aided detection (CAD) system and thin-slab maximum intensity projection (MIP) technique in the detection of pulmonary nodules at multidetector computed tomography (CT) in patients who underwent metastatectomy. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and patients' informed consent was waived. Forty-nine consecutive patients who underwent pulmonary metastatectomy were enrolled. Four chest radiologists analyzed preoperative 1-mm section CT images and recorded the locus of each nodule candidate. Afterward, they reevaluated the images once using CAD software and once with thin-slab MIP given the results of 1-mm section CT alone. The reference standard for nodule presence was established by a consensus panel and pathologic records for malignant nodules. RESULTS A total of 514 nodules were identified by a consensus panel. Of 212 nodules surgically removed, 121 nodules were malignant. The sensitivity of each observer in detecting malignant nodules with thin-section CT scans alone was 91%, 88%, 87%, and 86% for observers A- to D, respectively. With CAD, sensitivity increased significantly to 95%, 95%, 94%, and 95% (P< 0.05 for observer B-D), and using MIP increased to 94%, 96%, 91%, and 92% (P < 0.05 for observer B-D), respectively. There were no significant differences in sensitivity between CAD and MIP for the detection of malignant nodules. The average number of false-positive findings per patient was 0.8 with thin-section CT alone, 1.1 with CAD, and 1.4 with MIP. CONCLUSIONS In candidates for metastatectomy, reading with the aid of either CAD or MIP significantly improved the detection of malignant nodules compared with using thin-section CT alone.
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Persistent Disease in Patients with Papillary Thyroid Carcinoma and Lymph Node Metastases After Surgery and Iodine-131 Ablation. World J Surg 2007; 31:2309-14. [DOI: 10.1007/s00268-007-9257-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maia AL, Ward LS, Carvalho GA, Graf H, Maciel RMB, Maciel LMZ, Rosário PW, Vaisman M. Nódulos de tireóide e câncer diferenciado de tireóide: consenso brasileiro. ACTA ACUST UNITED AC 2007; 51:867-93. [PMID: 17891253 DOI: 10.1590/s0004-27302007000500027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 03/19/2007] [Indexed: 11/21/2022]
Abstract
Os nódulos tireoidianos constituem a principal manifestação clínica de uma série de doenças da tireóide com uma prevalência de aproximadamente 10% na população adulta. O maior desafio é excluir o câncer da tireóide, que ocorre em 5 a 10% dos casos. Os carcinomas diferenciados respondem por 90% dos casos de todas as neoplasias malignas da tireóide. A maioria dos pacientes com carcinoma diferenciado apresenta, geralmente, um bom prognóstico quando tratada adequadamente, com índices de mortalidade similares à população geral. No entanto, alguns indivíduos apresentam doença agressiva, desafiando o conhecimento atual e ilustrando a complexidade do manejo dessa neoplasia. No presente trabalho, reunimos 8 membros do Departamento de Tireóide da Sociedade Brasileira de Endocrinologia & Metabologia, para elaborarmos, por consenso, as diretrizes brasileiras no manejo dos nódulos tireoidianos e do câncer diferenciado da tireóide. Os membros participantes representam diferentes Centros Universitários do Brasil, refletindo diferentes abordagens diagnósticas e terapêuticas. Inicialmente, cada participante ficou responsável pela redação de determinado tema a ser enviado ao Coordenador, que, após revisão editorial e elaboração da primeira versão do manuscrito, enviou ao grupo para sugestões e aperfeiçoamentos. Quando concluído, o manuscrito foi novamente enviado e revisado por todos. A elaboração dessas diretrizes foi baseada na experiência dos participantes e revisão pertinente da literatura.
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Affiliation(s)
- Ana Luiza Maia
- Departamento de Tireóide, Sociedade Brasileira de Endocrinologia e Metabologia, Serviço de Endocrinologia, Hospital de Clínicas de Porto Alegre, Universidad Federal do Rio Grande do Sul, RS, Brazil.
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Freschi G, Landi L, Castagnoli A, Taddei A, Bechi P, Bucciarelli G. Advanced thyroid carcinoma: An experience of 385 cases. Eur J Surg Oncol 2006; 32:577-82. [PMID: 16644177 DOI: 10.1016/j.ejso.2006.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Revised: 01/16/2006] [Accepted: 01/27/2006] [Indexed: 11/19/2022] Open
Abstract
AIMS To report clinical outcomes of a large series of cases with advanced thyroid cancer. STUDY DESIGN Three hundred and eighty-five patients at the UICC stages III and IV were selected for the study with thyroid cancer. RESULTS Papillary carcinoma and sclerosing carcinoma have better survival than the Hürthle cell and insular types. Lymphatic metastasis does not appear to worsen the prognosis. All the tumour forms offer the chance of long survival. CONCLUSIONS Surgical treatment is the primary treatment of thyroid carcinoma. The combined treatments of surgery, metabolic beam therapy, suppressive hormone therapy, radiotherapy and chemotherapy cure a high percentage of patients with the tumour at an advanced stage.
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Affiliation(s)
- G Freschi
- Department of Surgical Pathology, University of Florence, Italy.
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Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16:109-42. [PMID: 16420177 DOI: 10.1089/thy.2006.16.109] [Citation(s) in RCA: 1288] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- David S Cooper
- Sinai Hospital of Baltimore and Johns Hopkins University School of Medicine, MD, USA
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27
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Abstract
This article reviews the recent changes affecting the care of patients with well-differentiated thyroid carcinoma. The impacts of positron emission tomographic imaging, recombinant human thyroid stimulating hormone,and current surgical management standards are discussed.
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Affiliation(s)
- Richard O Wein
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, USA.
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Abstract
Limited clinical information is specified in the presentations, results of treatment and prognostic factors of follicular thyroid carcinoma with lung metastases. In order to better characterize the information, we retrospectively analyzed the data of 2,003 thyroid cancer patients who received treatment and follow-up at the Chang Gung Memorial Hospital during the period from January 1979 to December 2002. There were 1,516 cases of papillary and 272 cases of follicular thyroid carcinomas. In the study, lung metastases of the follicular thyroid carcinomas were defined as post-operative or follow-up chest X-ray, diagnostic or therapeutic (131)I scan with positive finding of lung metastases. Serum thyroglobulin (Tg) levels under thyroxine treatment of patients with lung metastases had to be over 1.5 ng/mL. Of the follicular thyroid carcinomas, there were 70 (25.7%) with lung metastases including 50 females (mean age 54.1 +/- 12.6 years old) and 20 males (mean age 59.4 +/- 12.0 years old). Of the 70 patients, there were 53 patients (75.7%) who presented with lung metastases at the time of diagnosis. Of the 70 patients of follicular thyroid carcinoma with lung metastases, 30 patients (42.9%) died at the end of the follow-up, and only 4 patients improved to disease free status. The 5, 10, 15, and 20 year survival rates in these patients were 68.5%, 54.0%, 41.6%, 27.7%, respectively. Age, post-operative Tg level and tumor size are important prognostic factors which are demonstrated to be significantly different statistically between lung metastases group and the group of the patients without distant metastasis. Otherwise, only the tumor size and accumulative dose of (131)I therapy demonstrate a significant difference between survival and mortality groups. Seventeen of the 70 patients developed lung metastases during the follow-up period. Mean period between diagnosis and recurrence of these patients was 3.6 +/- 0.9 years. Over 75% of follicular thyroid carcinoma with lung metastases was diagnosed at the time of presentation. Forty percent (28/70 cases) of the follicular thyroid carcinoma with lung metastases had history of thyroid surgery in this study. If lung metastases are diagnosed in follicular thyroid carcinoma, it will be followed by a poor prognosis. Older patients, higher postoperative Tg, and larger tumor size in follicular thyroid carcinoma need aggressive postoperative treatment.
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Affiliation(s)
- Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan, ROC
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Chang HS. Treatment of Locally Advanced Thyroid Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.12.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hang-Seok Chang
- Department of Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Korea.
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30
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Abstract
Although most patients with differentiated thyroid cancer (DTC) of follicular cell origin enjoy a relatively good prognosis, some patients unfortunately present with or develop locally advanced DTC which leads to significant local morbidity and mortality. DTC accounts for 54-94% of all locally advanced thyroid cancers. DTC invasion of the recurrent laryngeal nerve, strap muscles and trachea are the most common followed by invasion of the esophagus, internal jugular vein and carotid artery. Surgical resection is the primary treatment for locally advanced DTC. Although the optimal surgical approach (ranging from conservative shave excision to aggressive en bloc resection of tumor and vital structures) in patients with locally advanced DTC is controversial, a curative resection should be the goal unless complete tumor resection results in unwanted perioperative morbidity and mortality or widely metastatic disease is present. Postoperative radioiodine ablation with TSH suppression is imperative after surgical resection of locally advanced DTC. Patients with microscopic or small gross residual disease, after surgical resection, may benefit from postoperative external radiotherapy for local control of disease.
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Affiliation(s)
- Electron Kebebew
- Department of Surgery, University of California, San Francisco, UCSF/Mount Zion Medical Center, 513 Parnassus, S-343, San Francisco, CA 94143-1674, USA.
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