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Naous E, Younes N, Achkar A, Osseis M, Atallah C. Transient facial nerve paralysis following low dose radioactive iodine in a patient with Graves' disease. Minerva Endocrinol (Torino) 2023; 48:364-366. [PMID: 36625795 DOI: 10.23736/s2724-6507.22.03876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Elie Naous
- Saint Joseph University, Beirut, Lebanon -
- Division of Endocrinology, Department of Internal Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon -
| | | | - Angela Achkar
- Saint Joseph University, Beirut, Lebanon
- Division of Endocrinology, Department of Internal Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Michael Osseis
- Saint Joseph University, Beirut, Lebanon
- Division of General Surgery, Department of Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Chawki Atallah
- Saint Joseph University, Beirut, Lebanon
- Division of Endocrinology, Department of Internal Medicine, Hotel Dieu de France Hospital, Beirut, Lebanon
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2
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Li F, Li W, Gray KD, Zarnegar R, Wang D, Fahey TJ. Ablation therapy using a low dose of radioiodine may be sufficient in low- to intermediate-risk patients with follicular variant papillary thyroid carcinoma. J Int Med Res 2021; 48:300060520966491. [PMID: 33213252 PMCID: PMC7683922 DOI: 10.1177/0300060520966491] [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: 11/16/2022] Open
Abstract
OBJECTIVES Follicular variant papillary thyroid carcinoma (FVPTC) is treated similarly to classical variant papillary thyroid carcinoma (cPTC). However, FVPTC has unique tumour features and behaviours. We investigated whether a low dose of radioiodine was as effective as a high dose for remnant ablation in patients with FVPTC and evaluated the recurrence of low-intermediate risk FVPTC. METHODS Data from cPTC and FVPTC patients treated with I-131 from 2004 to 2014 were reviewed. Demographics, tumour behaviour, lymph node metastasis, and local recurrence data were compared between FVPTC and cPTC patients. Then, low-intermediate risk FVPTC patients were divided into low, intermediate, and high I-131 dose groups, and postoperative I-131 activities were analysed to evaluate the effectiveness of I-131 therapy for thyroid remnant ablation. RESULTS In total, 799 cases of FVPTC (n = 168) and cPTC (n = 631) treated with I-131 were identified. Patients with FVPTC had a larger primary nodule size than cPTC, but lymph node metastases and local recurrence were more prevalent in cPTC than in FVPTC. For the low-, intermediate-, and high-dose groups, success rates of ablation did not differ (82.0%, 80%, and 81.3%, respectively). CONCLUSION FVPTC differs from cPTC in behaviour. Low-dose ablation may be sufficient in FVPTC patients with low-intermediate disease risk.
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Affiliation(s)
- Fuxin Li
- Department of Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Katherine D Gray
- New York Presbyterian Hospital-Weill Cornell Medicine Department of Surgery, New York, USA
| | - Rasa Zarnegar
- New York Presbyterian Hospital-Weill Cornell Medicine Department of Surgery, New York, USA
| | - Dan Wang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin, China
| | - Thomas J Fahey
- New York Presbyterian Hospital-Weill Cornell Medicine Department of Surgery, New York, USA
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3
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Le Roux MK, Graillon N, Guyot L, Taieb D, Galli P, Godio-Raboutet Y, Chossegros C, Foletti JM. Salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma: Long-term study. Head Neck 2020; 42:3133-3140. [PMID: 32652742 DOI: 10.1002/hed.26359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/05/2020] [Accepted: 06/15/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although many studies focus on short-term side effects of radioiodine therapy, almost none studied long-term side effects. We assessed radioiodine long-term salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma and compared it to short-term morbidity within the same population. METHODS A standardized self-administrated questionnaire was submitted in 2019 by patients treated with radioiodine between January 2011 and December 2012. These patients had already answered the same questionnaire 6 years before. RESULTS Our study showed a significant reduction for salivary side effects: discomfort in submandibular or parotid area, swelling, pain, a bad or salty taste in the mouth, allowing to get back to a "normal" diet. CONCLUSIONS Our study suggests that a significant rate of patients will recover from I131 therapy salivary side effects. As almost 30% of these remissions happened during our late stage follow-up, we highlight the necessity of a long-term follow-up in these patients.
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Affiliation(s)
- Marc-Kevin Le Roux
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France.,Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
| | - Nicolas Graillon
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - Laurent Guyot
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - David Taieb
- Aix Marseille Univ, IFSTTAR, Marseille, France.,Department of Nuclear Medecine, APHM, CHU Timone, Marseille, France
| | - Philippe Galli
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | | | - Cyrille Chossegros
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France
| | - Jean-Marc Foletti
- Department of Maxillofacial Surgery and Stomatology of Pr Chossegros, APHM, CHU Conception, Marseille, France.,Aix Marseille Univ, IFSTTAR, Marseille, France.,Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
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Tribulova N, Kurahara LH, Hlivak P, Hirano K, Szeiffova Bacova B. Pro-Arrhythmic Signaling of Thyroid Hormones and Its Relevance in Subclinical Hyperthyroidism. Int J Mol Sci 2020; 21:ijms21082844. [PMID: 32325836 PMCID: PMC7215427 DOI: 10.3390/ijms21082844] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
A perennial task is to prevent the occurrence and/or recurrence of most frequent or life-threatening cardiac arrhythmias such as atrial fibrillation (AF) and ventricular fibrillation (VF). VF may be lethal in cases without an implantable cardioverter defibrillator or with failure of this device. Incidences of AF, even the asymptomatic ones, jeopardize the patient's life due to its complication, notably the high risk of embolic stroke. Therefore, there has been a growing interest in subclinical AF screening and searching for novel electrophysiological and molecular markers. Considering the worldwide increase in cases of thyroid dysfunction and diseases, including thyroid carcinoma, we aimed to explore the implication of thyroid hormones in pro-arrhythmic signaling in the pathophysiological setting. The present review provides updated information about the impact of altered thyroid status on both the occurrence and recurrence of cardiac arrhythmias, predominantly AF. Moreover, it emphasizes the importance of both thyroid status monitoring and AF screening in the general population, as well as in patients with thyroid dysfunction and malignancies. Real-world data on early AF identification in relation to thyroid function are scarce. Even though symptomatic AF is rare in patients with thyroid malignancies, who are under thyroid suppressive therapy, clinicians should be aware of potential interaction with asymptomatic AF. It may prevent adverse consequences and improve the quality of life. This issue may be challenging for an updated registry of AF in clinical practice. Thyroid hormones should be considered a biomarker for cardiac arrhythmias screening and their tailored management because of their multifaceted cellular actions.
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Affiliation(s)
- Narcis Tribulova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia
- Correspondence: (N.T.); (B.S.B.); Tel.: +421-2-32295-423 (B.S.B.)
| | - Lin Hai Kurahara
- Department of Cardiovascular Physiology, Faculty of Medicine, Kagawa University, Kagawa 76 0793, Japan; (L.H.K.); (K.H.)
| | - Peter Hlivak
- Department of Arrhythmias and Pacing, National Institute of Cardiovascular Diseases, Pod Krásnou Hôrkou 1, 83348 Bratislava, Slovakia;
| | - Katsuya Hirano
- Department of Cardiovascular Physiology, Faculty of Medicine, Kagawa University, Kagawa 76 0793, Japan; (L.H.K.); (K.H.)
| | - Barbara Szeiffova Bacova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia
- Correspondence: (N.T.); (B.S.B.); Tel.: +421-2-32295-423 (B.S.B.)
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5
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Wang S, Liu Y, Feng Y, Zhang J, Swinnen J, Li Y, Ni Y. A Review on Curability of Cancers: More Efforts for Novel Therapeutic Options Are Needed. Cancers (Basel) 2019; 11:E1782. [PMID: 31766180 PMCID: PMC6896199 DOI: 10.3390/cancers11111782] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer remains a major cause of death globally. Given its relapsing and fatal features, curing cancer seems to be something hardly possible for the majority of patients. In view of the development in cancer therapies, this article summarizes currently available cancer therapeutics and cure potential by cancer type and stage at diagnosis, based on literature and database reviews. Currently common cancer therapeutics include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. However, treatment with curative intent by these methods are mainly eligible for patients with localized disease or treatment-sensitive cancers and therefore their contributions to cancer curability are relatively limited. The prognosis for cancer patients varies among different cancer types with a five-year relative survival rate (RSR) of more than 80% in thyroid cancer, melanoma, breast cancer, and Hodgkin's lymphoma. The most dismal prognosis is observed in patients with small-cell lung cancer, pancreatic cancer, hepatocellular carcinoma, oesophagal cancer, acute myeloid leukemia, non-small cell lung cancer, and gastric cancer with a five-year RSR ranging between 7% and 28%. The current review is intended to provide a general view about how much we have achieved in curing cancer as regards to different therapies and cancer types. Finally, we propose a small molecule dual-targeting broad-spectrum anticancer strategy called OncoCiDia, in combination with emerging highly sensitive liquid biopsy, with theoretical curative potential for the management of solid malignancies, especially at the micro-cancer stage.
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Affiliation(s)
- Shuncong Wang
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yewei Liu
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yuanbo Feng
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Jian Zhang
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China;
| | - Johan Swinnen
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
| | - Yue Li
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China
| | - Yicheng Ni
- KU Leuven, Campus Gasthuisberg, Faculty of Medicine, 3000 Leuven, Belgium; (S.W.); (Y.L.); (Y.F.); (J.S.)
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6
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Zavala LF, Barra MI, Olmos R, Tuttle M, González H, Droppelmann N, Mosso L, Domínguez JM. In properly selected patients with differentiated thyroid cancer, antithyroglobulin antibodies decline after thyroidectomy and their sole presence should not be an indication for radioiodine ablation. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:293-299. [PMID: 31038590 PMCID: PMC10522203 DOI: 10.20945/2359-3997000000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/17/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our objective was to evaluate the trend of antithyroglobulin antibodies (TgAb) during follow-up of patients with differentiated thyroid cancer (DTC) treated without RAI, as well as their role in the risk of recurrence. SUBJECTS AND METHODS This was a prospective, descriptive study. A total of 152 consecutive patients with DTC treated in a single institution undergoing total thyroidectomy without RAI and followed for a median of 2.3 years (0.5-10.3) were divided in two groups: TgAb(-) (n = 111) and TgAb(+) (n = 41). Patients were classified according to AJCC 7th and 8th editions, as well as to their risk of recurrence and response to treatment categories. RESULTS Both groups, TgAb(-) and TgAb(+), were similar regarding patient and tumor characteristics. At the end of follow-up, 90 (59.2%), 57 (37.5%), 3 (2%) and 2 (1.3%) patients achieved excellent, indeterminate, biochemically incomplete and structurally incomplete response, respectively. The risk of structural recurrence was similar in both groups (TgAb[-] 0.9% vs. TgAb[+] 2.4%, p = 0.46). In the TgAb(+) group, TgAb became negative in 10 (24.4%), decreased ≥ 50% without negativization in 25 (60.9%), decreased < 50% in 4 (9.8%) and remained stable or increased in 2 (4.9%) cases. The only incomplete structural response had increasing TgAb during follow-up. CONCLUSIONS In properly selected patients with DTC, TgAb concentration immediately after total thyroidectomy should not mandate RAI ablation, and their trend during follow-up may impact the risk of recurrence.
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Affiliation(s)
- Luis Felipe Zavala
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Inés Barra
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Olmos
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael Tuttle
- Department of Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New YorkUnited States
| | - Hernán González
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Head and Neck Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena Mosso
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Domínguez
- Departments of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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7
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Liu T, Zhang W, Xiao S, Xu L, Wen Q, Bai L, Ma Q, Ji B. Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial. Cancer Manag Res 2019; 11:467-474. [PMID: 30655698 PMCID: PMC6324610 DOI: 10.2147/cmar.s183299] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the efficacy of mindfulness-based stress reduction (MBSR) on health-related quality of life (QoL), depression, and anxiety in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine therapy (RIT). Patients and methods A randomized controlled trial of MBSR with 120 DTC patients was performed. They were randomly assigned into the MBSR intervention group and usual care (UC) group. An 8-week MBSR program was administered to the MBSR group starting 8 weeks before RIT. Health-related QoL, depression, and anxiety were measured immediately before the start of MBSR (T1), immediately after RIT hospitalization was concluded (1 week after concluding the last MBSR session, T2), and 3 months after RIT hospitalization (T3), using the QoL Questionnaire Core 30 Items (QLQ-C30), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS). Results Fifty-three patients in the UC group and 49 patients in the MBSR group completed the study and were analyzed. Both the UC and MBSR groups reported low QoL and high SDS and SAS scores immediately after RIT hospitalization. Patients randomly assigned to the MBSR group showed significantly greater improvements in emotional function (P=0.012, d=-0.03 for T2 and d=1.17 for T3), fatigue (P=0.037, d=1.00 for T2 and d=-0.69 for T3), global QoL (P=0.015, d=1.61 for T2 and d=1.56 for T3), depression (P=0.027, d=-1.19 for T2 and d=-0.83 for T3), and anxiety (P=0.043, d=-1.00 for T2 and d=-0.86 for T3). Conclusion An 8-week MBSR program significantly improved a wide range of scales in health-related QoL and mitigated depression and anxiety among DTC patients receiving RIT.
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Affiliation(s)
- Tianji Liu
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
| | - Wenqi Zhang
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
| | - Shuai Xiao
- Department of Nursing, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lei Xu
- Department of Psychology and Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Qiang Wen
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
| | - Lin Bai
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
| | - Qingjie Ma
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, ;
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Ullmann TM, Gray KD, Moore MD, Zarnegar R, Fahey TJ. Current controversies and future directions in the diagnosis and management of differentiated thyroid cancers. Gland Surg 2018; 7:473-486. [PMID: 30505769 DOI: 10.21037/gs.2017.09.08] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the development of novel diagnostic, surgical, and chemotherapeutic approaches to differentiated thyroid cancers (DTCs), the diagnosis and management of these tumors remains controversial. The most recent American Thyroid Association (ATA) guidelines, released in 2015, reflect a recent shift towards less aggressive management for patients with DTCs. However, many clinicians have expressed concern that more conservative management will put patients at risk for disease recurrence and metastasis. In particular, the management of indeterminate nodules on fine needle aspiration (with special attention to genetic and epigenetic markers of malignancy), the extent of surgery for known differentiated cancers, the role of adjuvant radioactive iodine (RAI) therapy, and novel targeted treatments with tyrosine kinase inhibitors (TKIs) represent current areas of uncertainty and opportunities for future research. In this review, we examine the current state of the art in these areas, and address some of the questions that remain.
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Affiliation(s)
- Timothy M Ullmann
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Maureen D Moore
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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9
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Ronsley R, Rassekh SR, Shen Y, Lee AF, Jantzen C, Halparin J, Albert C, Hawkins DS, Amed S, Rothstein R, Mungall AJ, Dix D, Blair G, Nadel H, Jones SJM, Laskin J, Marra MA, J Deyell R. Application of genomics to identify therapeutic targets in recurrent pediatric papillary thyroid carcinoma. Cold Spring Harb Mol Case Stud 2018; 4:mcs.a002568. [PMID: 29610391 PMCID: PMC5880264 DOI: 10.1101/mcs.a002568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/03/2018] [Indexed: 01/24/2023] Open
Abstract
Children with papillary thyroid carcinoma (PTC) may relapse despite response to radioactive iodine (RAI). Two children with multiply relapsed PTC underwent whole-genome and transcriptome sequencing. A TPM3-NTRK1 fusion was identified in one tumor, with outlier NTRK1 expression compared to the TCGA thyroid cancer compendium and to Illumina BodyMap normal thyroid. This patient demonstrated resolution of multiple pulmonary nodules without toxicity on oral TRK inhibitor therapy. A RET fusion was identified in the second tumor, another potentially actionable finding. Identification of oncogenic drivers in recurrent pediatric PTC may facilitate targeted therapy while avoiding repeated RAI.
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Affiliation(s)
- Rebecca Ronsley
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - S Rod Rassekh
- BC Children's Hospital Research Institute, Vancouver, British Columbia V5Z 4H4, Canada.,Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Yaoqing Shen
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Colleen Jantzen
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Jessica Halparin
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Catherine Albert
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington 98105, USA
| | - Shazhan Amed
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Ralph Rothstein
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - David Dix
- Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Geoffrey Blair
- Department of Surgery, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Helen Nadel
- Department of Radiology, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Janessa Laskin
- British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia V5Z 4S6, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Rebecca J Deyell
- BC Children's Hospital Research Institute, Vancouver, British Columbia V5Z 4H4, Canada.,Division of Oncology and Hematology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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10
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Mainthia R, Wachtel H, Chen Y, Mort E, Parangi S, Sadow PM, Lubitz CC. Evaluating the projected surgical impact of reclassifying noninvasive encapsulated follicular variant of papillary thyroid cancer as noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Surgery 2017; 163:60-65. [PMID: 29146229 DOI: 10.1016/j.surg.2017.04.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/14/2017] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer to noninvasive follicular thyroid neoplasm with papillary-like nuclear features will reduce nonefficacious and potentially harmful care. Reclassification is estimated in 18.6% of patients with papillary thyroid carcinoma; we aimed to quantify the implications of this change. METHODS Pathology reports from April 2006 to April 2016 were reviewed to isolate cases that would have been designated as neoplasm with papillary-like nuclear features. Of the 1,335 cases of papillary thyroid carcinomas, 194 cases (14.5%) met criteria. Cases in which neoplasm with papillary-like nuclear features was found in combination with other thyroid malignancies (n = 25) and cases of prior thyroid lobectomy (n = 5) were excluded. Demographic, pathologic, treatment, and follow-up data were assessed for the remaining 164 potential neoplasm with papillary-like nuclear features cases. Logistic regression analysis was performed to evaluate association between fine-needle aspiration result and index procedure. RESULTS Of the 164 patients with tumors who met neoplasm with papillary-like nuclear features criteria, fine-needle aspiration results were nondiagnostic (2%), benign (18%), atypia/follicular lesion of undetermined significance (26%), follicular neoplasm or suspicious for follicular neoplasm (20%), suspicious for malignancy (19%), malignant (6%), and not obtained (9%). Eighty-five (52%) patients underwent total thyroidectomy. A "suspicious for malignancy" fine-needle aspiration result was associated with undergoing total thyroidectomy versus thyroid lobectomy (P = .006). Thyroid lobectomy was the index procedure for 79 patients (48%); of these patients, 54% (n = 43, 3.2% of all patients with papillary thyroid carcinomas) underwent subsequent total thyroidectomy, and 24% received postoperative radioactive iodine treatment. There were no recurrences among the 125 patients with >3 months of follow-up. CONCLUSION The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer as neoplasm with papillary-like nuclear features will decrease nonefficacious treatment and reduce costs. However, the impact of this change with regard to extent of surgery was limited to 3.2% of patients with papillary thyroid carcinomas compared with the projected potential impact on 18.6%.
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Affiliation(s)
- Rajshri Mainthia
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Heather Wachtel
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yufei Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Elizabeth Mort
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sareh Parangi
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carrie C Lubitz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Institute for Technology Assessment, Boston, MA.
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