How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers

BACKGROUND

Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy.

METHODS

Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years.

RESULTS

The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months.

CONCLUSIONS

ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.

Concomitant small cell carcinoma and adenocarcinoma of the gallbladder: a case report

Gallbladder cancer is the most frequent neoplasm originating from the extrahepatic biliary tract, with characteristics of late presentation and rapid progression. We report the case of a 58 years old female patient with concomitant small cell carcinoma and adenocarcinoma of the gallbladder, incidentally reported after a cholecystectomy performed for cholelithiasis. According to the stage of the disease, we performed a second surgical procedure with laparotomy, resection of the liver parenchyma IVb and V and regional lymphadenectomy. After multidisciplinary team consultation, the patient was not administrated chemotherapy. She was well followed up at our department and she is alive 12 month after surgery.