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Tumor recurrence after thyroid surgery and thyroid hormone therapy with and without 131 I therapy. Total thyroidectomy includes subtotal thyroidectomy (ipsilateral lobectomy, isthmusectomy, and near-total contralateral lobectomy); subtotal thyroidectomy is lobectomy with or without isthmusectomy. Patients undergoing total thyroidectomy had more advanced tumor stage than those undergoing subtotal thyroidectomy (ANOVA, P 0.001). (Mazzaferri, E. L., unpublished data.)
Contexts in source publication
Context 1
... lobectomy alone may result in a 5-10% recur- rence rate in the opposite thyroid lobe (27,28), a high tumor recurrence rate (Fig. 2), and a high (11%) incidence of subse- quent pulmonary metastases (29). High recurrence rates in pa- tients with cervical lymph node metastases and multicentric tumors (3) also justify bilateral thyroidectomy and 131 I ablation. If lobectomy is performed, microscopic metastases in the con- tralateral lobe or found by 131 I imaging may ...
Context 2
... treatment with 131 I also obscures the thera-peutic influence of surgery (8). Patients in our study treated with total or near-total thyroidectomy plus 131 I ablation and l-thyroxine had significantly fewer recurrences and distant recurrences than those treated with any other combination, including total thyroidectomy and l-thyroxine (Fig. 2). Sur- gery and 131 I therapy had independent effects on recurrence and cancer mortality ( Table 2). After a median follow-up of 16.6 yr, surgery more extensive than lobectomy was an in- dependent variable that reduced the likelihood of cancer death by 50% ( Table ...
Similar publications
A diagnostic iodine-131 (131I) total body scan (TBS) is usually recommended 6 to 12 months after thyroid ablation for differentiated thyroid carcinoma. Its usefulness was evaluated in 256 consecutive patients treated and followed up at the Institut Gustave Roussy for papillary (n = 200), well differentiated (n = 27), or poorly differentiated (n = 2...
Citations
... Although most DTC carry with indolent clinical course and show good prognosis, metastatic DTC could be fatal, with 10% of patients developing distant metastasis (9,10). Lung is the most common site for distant metastases in DTC, and lung metastases (LMs) has been reported accounting for 4% in adult DTC (11), with a higher risk in children and young adults, with an incidence rate up to 23% -25% (12,13). ...
Objectives
The growing incidence of differentiated thyroid cancer (DTC) have been linked to insulin resistance and metabolic syndrome. The imperative need for developing effective diagnostic imaging tools to predict the non-iodine-avid status of lung metastasis (LMs) in differentiated thyroid cancer (DTC) patients is underscored to prevent unnecessary radioactive iodine treatment (RAI).
Methods
Primary cohort consisted 1962 pretreated LMs of 496 consecutive DTC patients with pretreated initially diagnosed LMs who underwent chest CT and subsequent post-treatment radioiodine SPECT. After automatic lesion segmentation by SE V-Net, SE Net deep learning was trained to predict non-iodine-avid status of LMs. External validation cohort contained 123 pretreated LMs of 24 consecutive patients from other two hospitals. Stepwise validation was further performed according to the nodule’s largest diameter.
Results
The SE-Net deep learning network yielded area under the receiver operating characteristic curve (AUC) values of 0.879 (95% confidence interval: 0.852–0.906) and 0.713 (95% confidence interval: 0.613–0.813) for internal and external validation. With the LM diameter decreasing from ≥10mm to ≤4mm, the AUCs remained relatively stable, for smallest nodules (≤4mm), the model yielded an AUC of 0.783. Decision curve analysis showed that most patients benefited using deep learning to decide radioactive I¹³¹ treatment.
Conclusion
This study presents a noninvasive, less radioactive and fully automatic approach that can facilitate suitable DTC patient selection for RAI therapy of LMs. Further prospective multicenter studies with larger study cohorts and related metabolic factors should address the possibility of comprehensive clinical transformation.
... Differentiated thyroid cancer (DTC) is the most common thyroid cancer and comprises more than 90% of cases. Although patients with DTC have excellent disease-specific survival, approximately 30% of patients experience recurrence during long-term follow-up, and two-thirds of these patients have local recurrence [2,3]. The mainstay treatment for locally recurrent tumors is salvage surgical resection. ...
Purpose
The treatment of recurrent thyroid cancer with critical organ invasion is challenging. The combination of radiofrequency ablation (RFA) and external beam radiation therapy (EBRT) has been proposed as an effective option. This study evaluates outcomes for inoperable residual/recurrent differentiated thyroid cancer (rDTC) patients treated with RFA followed by EBRT.
Materials and Methods
Patients with rDTC treated with RFA followed by EBRT were retrospectively studied. RFA was performed using a free‐hand, ‘moving‐shot’ technique under US or CT guidance. For lesions invading critical structures intolerant to ‘en bloc’ high-temperature RFA, limited-field EBRT using 6‐ or 10‐MV photons was used for adjuvant treatment at a dose of 66 Gy in 33 daily fractions. Toxicities and outcomes were reviewed.
Results
Between April 2020 and January 2022, 11 patients with 14 rDTC lesions underwent RFA followed by EBRT. Five patients had metastatic lesions at rDTC diagnosis. With a median follow-up period of 33.7 months, all patients maintained locoregional control, while achieving a 2-year survival rate of 90.9%. This combined treatment achieved a volume reduction ratio of 92.1% ± 5.1%. The mean nadir thyroglobulin level in patients without initial distant metastases after treatment was 1.40 ± 0.81 ng/ml. Regarding treatment-related complications, one patient (9%) experienced temporary hoarseness after RFA, grade 2 radiation dermatitis occurred in 3 patients (27.2%), and grade 2 dysphagia was noted in 4 patients (36.4%). No grade 3 or greater toxicities occurred.
Conclusions
Salvage RFA followed by EBRT is feasible, effective and safe for patients with rDTC.
... Life 2024, 14, 22 2 of 25 curable cancers, with excellent long-term prognosis, but up to 20% of patients develop local or regional recurrences, and up to 10% develop distant metastases [4]. With longer follow ups, up to 35% of patients with DTC can recur after 40 years, with 20% failing to concentrate iodine, resulting in overall close to 10% of patients dying of their disease [5][6][7]. A study looking at the SEER database showed that independent predictive factors for distant metastasis are tumor size, age at diagnosis, thyroidectomy, node positive disease, T3-T4 age, and histopathology for female DTC patients [8]. ...
... In this study the MEK inhibitor Selumetinib was used in a cohort of 24 patients with RAIR DTC, treated at a dose of 75 mg twice a day. Selumetinib increased the iodine-124 uptake on PET-CT in all patients with N-RAS mutations (5) and in four out of the nine patients with BRAF mutation. Eight patients received RAI therapy, five patients had a partial response (one patient with BRAFV600E mutation), and three had stable disease. ...
Patients with differentiated thyroid cancer usually present with early-stage disease and undergo surgery followed by adjuvant radioactive iodine ablation, resulting in excellent clinical outcomes and prognosis. However, a minority of patients relapse with metastatic disease, and eventually develop radioactive iodine refractory disease (RAIR). In the past there were limited and ineffective options for systemic therapy for RAIR, but over the last ten to fifteen years the emergence of tyrosine kinase inhibitors (TKIs) has provided important new avenues of treatment for these patients, that are the focus of this review. Currently, Lenvatinib and Sorafenib, multitargeted TKIs, represent the standard first-line systemic treatment options for RAIR thyroid carcinoma, while Cabozantinib is the standard second-line treatment option. Furthermore, targeted therapies for patients with specific targetable molecular abnormalities include Latrectinib or Entrectinib for patients with NTRK gene fusions and Selpercatinib or Pralsetinib for patients with RET gene fusions. Dabrafenib plus Trametinib currently only have tumor agnostic approval in the USA for patients with BRAF V600E mutations, including thyroid cancer. Redifferentiation therapy is an area of active research, with promising initial results, while immunotherapy studies with checkpoint inhibitors in combination with tyrosine kinase inhibitors are underway.
... Как правило, течение ДРЩЖ вялотекущее; специфическая выживаемость через 5, 10 и 15 лет составляет 98,6; 94,7 и 87,4 % соответственно [4]. Частота развития отдаленных метастазов при ДРЩЖ -менее 5 %, частота рецидивов -около 15 % [5][6][7]. При рефрактерности к радиоактивному йоду показатели 10-летней выживаемости снижаются до 10-29 % [8]. ...
... PTCs are associated with good prognoses and a low mortality rate. However, the high recurrence rate remains a major concern, and it has been reported to be as high as 35% [1,4]. However, most patients required reoperation for recurrent tumors diagnosed within 24 months after their kjronline.org ...
Objective
We investigated the impacts of computed tomography (CT) added to ultrasound (US) for preoperative evaluation of patients with papillary thyroid carcinoma (PTC) on staging, surgical extent, and postsurgical survival.
Materials and Methods
Consecutive patients who underwent surgery for PTC between January 2015 and December 2015 were retrospectively identified. Of them, 584 had undergone preoperative additional thyroid CT imaging (CT + US group), and 859 had not (US group). Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to adjust for 14 variables and balance the two groups. Changes in nodal staging and surgical extent caused by CT were recorded. The recurrence-free survival and distant metastasis-free survival after surgery were compared between the two groups.
Results
In the CT + US group, discordant nodal staging results between CT and US were observed in 94 of 584 patients (16.1%). Of them, CT accurately diagnosed nodal staging in 54 patients (57.4%), while the US provided incorrect nodal staging. Ten patients (1.7%) had a change in the extent of surgery based on CT findings. Postsurgical recurrence developed in 3.6% (31 of 859) of the CT + US group and 2.9% (17 of 584) of the US group during the median follow-up of 59 months. After adjustment using IPTW (580 vs. 861 patients), the CT + US group showed significantly higher recurrence-free survival rates than the US group (hazard ratio [HR], 0.52 [95% confidence interval {CI}, 0.29–0.96]; P = 0.037). PSM analysis (535 patients in each group) showed similar HR without statistical significance (HR, 0.60 [95% CI, 0.31–1.17]; P = 0.134). For distant metastasis-free survival, HRs after IPTW and PSM were 0.75 (95% CI, 0.17–3.36; P = 0.71) and 0.87 (95% CI, 0.20–3.80; P = 0.851), respectively.
Conclusion
The addition of CT imaging for preoperative evaluation changed nodal staging and surgical extent and might improve recurrence-free survival in patients with PTC.
... However, most staging systems that use age to stratify risk tend to be inaccurate in predicting recurrence-free survival, since younger patients have higher recurrence rates. Additionally, these staging systems have been derived from multivariate analyses that do not consider recurrence or the effect of therapy [16]. ...
... Recently, endocrine surgeons have been performing more thyroid lobectomies on low-risk differentiated thyroid cancers and less common completion thyroidectomies since the introduction of the 2015 ATA guidelines [17][18][19]. Disease-free status and survival cannot be assured at the low stage in most systems, thus, providing imperfect guidance in selecting the therapy [16,20]. Furthermore, the literature on oncologic outcomes, such as recurrence or prognosis, after RET is very limited. ...
Simple Summary
The biology of papillary thyroid carcinoma (PTC) in young patients is poorly understood, and there are conflicting data regarding recurrence for younger patients compared to older patients. We retrospectively analyzed 2348 clinically node-negative (cN0) PTC patients who underwent a thyroid lobectomy between 2008 and 2017. The clinicopathological characteristics and oncologic outcomes of young patients were compared to older patients. In the young age group, there was a significantly larger proportion of females, endoscopic/robotic thyroid lobectomy, large tumor sizes, and stage N1a. Post-lobectomy recurrences were higher in the young age group. In the Cox analysis, young age, large tumors, and stage N1a were significant risk factors. The multivariate analyses reveals that young age and stage N1a are significant risk factors. Conversely, minimally invasive and endoscopic/robotic thyroidectomies were not risk factors for post-lobectomy recurrence. Further studies are needed to elucidate the relationship between young age and the risk of post-lobectomy recurrence.
Abstract
The biology of papillary thyroid carcinoma (PTC) in young patients is poorly understood, and there are conflicting data regarding the recurrence for younger patients compared to older patients. We retrospectively analyzed 2348 clinically node-negative (cN0) PTC patients who underwent a thyroid lobectomy between 2008 and 2017. Young age was defined as less than 35 years old. The clinicopathological characteristics and oncologic outcomes of the young age group were compared to those of the older age group. The number of young age cN0 PTC patients accounted for 20.7% of the enrolled patients, and 24.2% were upstaged into pathologic N1a. The young age group had a significantly larger proportion of females, endoscopic/robotic thyroid lobectomies, stage N1a, and larger tumor sizes. Post-lobectomy recurrences were significantly higher in the young age group. In the Cox analysis, young age, large tumor size, and stage N1a were significant risk factors. The multivariate analysis reveals that young age and stage N1a are significant risk factors. Conversely, minimally invasive or robot-endoscopic thyroidectomies were not risk factors for post-lobectomy recurrence compared to conventional thyroidectomies. While young patients with a stage N1a had a significant risk factor for post-lobectomy recurrence, endoscopic/robotic thyroidectomy was as feasible and safe as conventional thyroidectomies in the median seven-year oncologic follow-up. Further high-quality studies are needed to elucidate the relationship between age and the risk of post-lobectomy recurrence.
... In metastatic DTCs, high-dose I 131 can be associated with complete responses, albeit rarely (16). Most tumor responses following RAI therapy are transient, mixed and/or completely refractory (17)(18)(19). Mechanistically, this is due in part to the genomic alterations which induce thyroid oncogenesis as well as inhibit thyroid cancer differentiation leading to impaired expression of the sodium iodine symporter (NIS), decreased follicular iodine uptake, and poor response to I-131 therapy (13,(20)(21) Redifferentiation therapy (RDT) is a potential salvage therapeutic strategy for patients with advanced DTCs, but with limited efficacy data to date. Currently, much of RDT is off label with outcome data that is limited to small cohorts with marked differences in patient selection and treatment protocols as well as a lack of comparison in clinical outcomes between patients with and without restored RAI avidity following RDT (24). ...
Objective: Redifferentiation therapy (RDT) can restore radioactive iodine (RAI) uptake in differentiated thyroid cancer (DTC) cells to enable salvage 131I therapy for previously RAI refractory (RAIR) disease. This study evaluated the clinical outcomes of patients who underwent RDT and identified clinicopathologic characteristics predictive of RAI restoration following RDT. Methods: This is a retrospective case series of 33 patients with response evaluation criteria in solid tumors (RECIST)-progressive metastatic RAIR-DTC who underwent RDT between 2017 and 2022 at the Mayo Clinic (Rochester, MN). All patients underwent genomic profiling and received MEK, RET or ALK inhibitors alone, or combination BRAF-MEK inhibitors for 4 weeks. At week 3, those with increased RAI avidity in metastatic foci received high-dose 131I therapy. Baseline and clinicopathologic outcomes were comprehensively reviewed. Results: Of the 33 patients, 57.6% had restored RAI uptake following RDT (Redifferentiated subgroup). 42.1% (8/19) with papillary thyroid cancers (PTC), 100% (4/4) with invasive encapsulated follicular variant PTCs (IEFV-PTCs), and 100% (7/7) with follicular thyroid cancers (FTC) redifferentiated. All (11/11) RAS mutant tumors redifferentiated compared with 38.9% (7/18) with BRAF mutant disease (6 PTC and 1 IEFV-PTC). 76.5% (13/17) of redifferentiated and 66.7% (8/12) of non-redifferentiated patients achieved a best overall RECIST response of stable disease (SD) or non-complete response/non-progressive disease. Both subgroups had a median 12% tumor shrinkage at 3 weeks on drug(s) alone. The redifferentiated subgroup, following high-dose 131I therapy, achieved an additional median 20% tumor reduction at 6 months after RDT. There were no statistically significant differences between both groups in progression free survival (PFS), time to initiation of systemic therapy, and time to any additional therapy. Of the entire cohort, 6.1% (2/33) experienced histologic transformation to anaplastic thyroid cancer, 15.1% (5/33) died, and all had redifferentiated following RDT and received 131I therapy. Conclusion: RDT has the potential to restore RAI avidity and induce RECIST responses following 131I therapy in select patients with RAIR-DTC, particularly those with RAS-driven "follicular" phenotypes. In patients with PTC, none of the evaluated clinical outcomes differed statistically between the redifferentiated and non-redifferentiated subgroups. Further studies are needed to better characterize the long-term survival and/or safety outcomes of high-dose RAI following RDT, particularly whether it could be associated with histologic anaplastic transformation.
... As mentioned previously, WDTCs are generally indolent tumors characterized by an excellent prognosis, although some authors observe a high rate of WDTC recurrence worldwide [16,17]. A completely different situation occurs in the case of PDTC and ATC. ...
Simple Summary
The incidence of thyroid cancer (TC) has increased greatly since the 1970s, mostly because of higher detection of the small forms of papillary thyroid cancer (PTC). Despite this main and popular opinion, an increase in the occurrence of the larger forms of TC has also been observed. Due to some noticed trends concerning TC incidence and behavior, the management of these neoplasms has also changed in recent years. “Cancer screening activity”, which is the most popular of the aforementioned events, might have increased the PTC number during the analyzed period. However, the observed increase in the occurrence of TC continued to a point in time where there was a slowdown and even a reversal. This phenomenon is still debated and worthy of further investigation.
Abstract
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as “cancer screening activity”, introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management, and, finally, COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the remaining types of TC in terms of incidence, clinical and pathological characteristics, and treatment. We analyzed patients treated in a single surgical center in eastern Europe (Poland). The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015, and then significantly decreased to 1.33% in 2022 when the COVID-19 pandemic lasted (p < 0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p < 0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, and pTNM between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p < 0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine, and the COVID-19 pandemic, may have influenced the general statistics of TC.
... Differentiated thyroid cancer (DTC) accounts for more than 95% of thyroid cancers and is the most common endocrine tumor. Surgery, selective radioiodine therapy (RAIT) after total thyroidectomy (TT), and thyroid-stimulating hormone (TSH) suppressive therapy are the standard treatments for DTC (1). As a specific tumor marker for long-term follow-up after RAIT in DTC, serum thyroglobulin (Tg) can predict DTC persistence, distant metastasis, or recurrence (2)(3)(4). ...
Objective
We aimed to explore the predictive value of stimulated thyroglobulin (sTg) and pre-ablation antithyroglobulin (pa-TgAb) products for the effect of radioiodine therapy (RAIT) on TgAb-positive differentiated thyroid cancer (DTC) patients.
Methods
In this study, we enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT). Based on the last follow-up result, the patients were divided into two groups: the excellent response (ER) group and the non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT.
Results
The ER group consisted of 197 patients. The NER group consisted of 68 patients. For the univariate analysis, we found that the maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, multifocality, preoperative TgAb (preop-TgAb), pa-TgAb, sTg × pa-TgAb, initial RAIT dose, N stage, and surgical extent (modified radical neck dissection or not), showed significant differences between the ER group and NER group (all p -values <0.05). The receiver operating characteristic (ROC) curves showed that the cutoff value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, pa-TgAb, and sTg × pa-TgAb, respectively. The multivariate logistic regression analysis results indicated that pa-TgAb, sTg × pa-TgAb, initial RAIT dose, and N stage were independent risk factors for NER (all p -values <0.05). For the Kaplan–Meier analysis of disease-free survival (DFS), the median DFS of the patients with sTg × pa-TgAb < 59.73 and initial RAIT dose ≤ 100 mCi was significantly longer than that of the patients with sTg × pa-TgAb ≥ 59.73 (50.27 months vs. 48.59 months, p = 0.041) and initial RAIT dose >100 mCi (50.50 months vs. 38.00 months, p = 0.030).
Conclusion
We found the sTg and pa-TgAb conducts is a good predictor of the efficacy of RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis, and reducing the burden of patients.
... As mentioned previously, WDTCs are generally indolent tumors characterized by an excellent prognosis, although some authors observe a high rate of WDTC recurrence worldwide [16,17]. A completely different situation occurs in the case of PDTC and ATC. ...
Because of ambiguous and widely debated observations concerning incidence trend and management of TC, we performed this analysis. We drew attention to some events, such as “cancer screening activity,” introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management and finally COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the rest of types of TC in terms of incidence, clinical and pathological characteristics and treatment. The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015 and then significantly decreased to 1.33% in 2022 when the pandemic lasted (p<0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p<0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, pTNM, between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p<0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine and the COVID-19 pandemic, may have influenced the general statistics of TC.
