Draft of the best medical treatment in patients with low-risk thyroid cancer
Authors:
Petr Vlček 1; Dagmar Nováková 1; Jan Vejvalka 1; Jaroslav Zimák 1; Martin Křenek 1; Květuše Vošmiková 1; Svatopluk Smutný 1; Petr Bavor 1; Jaromír Astl 1,3; Jindřich Lukáš 1,4
Authors‘ workplace:
Klinika nukleární medicíny a endokrinologie 2. LF UK a FN Motol Praha, přednosta prof. MUDr. Petr Vlček, CSc.
1; Chirurgická klinika 2. LF UK a FN Motol Praha, přednosta prof. MUDr. Jiří Hoch, CSc.
2; ORL klinika 3. LF UK a ÚVN Praha, přednosta prof. MUDr. Jaromír Astl, CSc.
3; Oddělení otorinolaryngologie a chirurgie hlavy a krku, Nemocnice Na Homolce Praha, primář MUDr. Petr Jirák
4
Published in:
Vnitř Lék 2015; 61(9): 769-777
Category:
Original Contributions
Overview
Introduction:
The incidence of well-differentiated low-risk thyroid cancer have increased globally over the last three decades. Thyroid cancer treatment relates to a suitable surgical procedure and the use of adjuvant radioiodine therapy in selected patients. Evaluation of prognostic factors and risk stratification are critical for determining appropriate treatment. Survival of patients with low-risk thyroid cancer is excellent. Appropriate choice of medical treatment resulted in full recovery in most patients. Relapse risk increases with the size of the primary tumor, along with the findings of the risk factors in men.
Methods and results:
Our study included a total of 1 980 patients in whom were diagnosed T1a and T1b tumors between the years 2003 to 2012. The population included 1 675 women (84.6 %) of average age of 45.22 years and 305 men (15.4 %) of average age of 50.0 years. The bulk of the file represented papillary carcinomas (1 868; 94.4 %), and smaller group of follicular carcinomas (112; 5.6 %). Patients were divided into four groups according to tumor size. Patients were evaluated according to risk factors: unifocality no other risk factors, multifocality – more bearings in thyroid tumor, metastases in regional lymph nodes, distant metastases or combination of risk factors. Group A: In the monitored set of 678 patients with papillary and follicular microcarcinoma up to 5 mm, during histological input, the findings revealed one bearing (unifocal type of cancer) in 566 patients. Multifocality was found in 112 patients, local nodal metastasis were demonstrated in 24 cases and pulmonary metastasis was discovered in 1 case. Group B: In this group there were 576 study patients with papillary and follicular microcarcinoma size of 5–10 mm. Histological findings were captured input one bearing carcinoma in 434 patients, 142 patients with multifocality, in 53 cases of local nodal metastasis, and 1 case of bone metastases. Group C: In this group there were 467 study patients with papillary and follicular microcarcinoma size 10–15 mm. The histological initial finding captured unifocal type of cancer in 344 patients, multifocality in 123 patients, in 45 cases local metastases and in 3 cases of pulmonary metastases. Group D: 259 patients were monitored in this group with breast size 16–20 mm. At the initial finding was captured one bearing cancer in 188 patients, multifocality in 71 patients, in 24 cases evidence of local metastases and 2 patients had a case of distant lung metastases. In patients in whom risk factors were found, radioiodine treatment was indicated. This included 744 patients. In this group of patients after a year or more, relapse was observed in 74 patients (9.94 %). In 1 236 patients who did not undergo radioiodine treatment, there was a relapse in 49 patients (3.96 %).
Conclusion:
Based on our analysis, it is necessary to stratify the risk of relapse according to risk factors. In case of missed radioiodine therapy in patients with low-risk cancer without confirmed risk factors, it is also necessary to have regular clinical, laboratory and ultrasound examination. It is important to distinguish patients with risk factors that may contribute to disease recurrence. Only in this way, on one hand we prevent excessive treatment of patients with low-risk thyroid cancer which leads to increased cost of health care, and on the other hand prevent reduced level of care for patients with an increase in relapses.
Key-words:
low-risk thyroid cancer – radioiodine treatment – risk stratifications
Sources
1. Baker SR, Bhatti WA. The thyroid cancer epidemic: is it the dark side of the CT revolution? Eur J Radiol 2006; 60(1): 67–69.
2. Buffet C, Golmard JL, Hoang C et al. Scoring system for predicting recurrences in patients with papillary thyroid microcarcinoma. Eur Endocrinol. 2012; 167(2): 267–275.
3. Cappelli C, Castellano M, Braga M et al. Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 2007; 95(7): 555–560.
4. Cooper DS, Doherty GM, Haugen BR et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19(11): 1167–1214. Erratum in Thyroid 2010; 20(8): 942. Hauger BR [corrected to Haugen BR] Thyroid 2010; 20(6): 674–675.
5. Cappelli C, Castellano M, Braga M. Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J Surg Oncol 2007; 95(7): 555–560.
6. Creach KM, Siegel BA, Nussenbaum B et al. Radioactive iodine therapy decreases recurrence in thyroid papillary microcarcinoma. ISRN Endocrinol 2012; 2012: 816386. Dostupné z DOI: <http://dx.doi.org/10.5402/2012/816386>.
7. Demeter S, Leslie WD, Levin DP. Radioactive iodine therapy for malignant and benign thyroid disease: a Canadian national survey of physician practice. Nucl Med Commun 2005; 26(7): 613–621.
8. Hay ID, Hutchinson ME, Gonzalez-Losada T et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 2008; 144(6): 980–987.
9. Howlader N, Noone A, Krapcho M et al. SEER Cancer Statistics Review, 1975–2010. National Cancer Institute: Bethesda (MD) 2013. Dostupné z WWW: http://seer.cancer.gov/archive/csr/1975_2010/.
10. Ito Y, Miyauchi A, Inoue H et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg 2010; 34(1): 28–35.
11. Ito Y, Miyauchi A, Kihara M et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 2014; 24(1): 27–34.
12. Lukas J, Drabek J, Lukas D et al. The epidemiology of thyroid cancer in the Czech Republic in comparison with other countries. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157(3): 266–275.
13. Macková M, Vlček P. Current trends in treatment and follow-up of patients with differentiated thyroid carcinoma – experience with the use of recombinant human thyrotropin. Vnitř Lék 2013; 59(2): 106–112.
14. Malandrino P, Scollo C, Marturano I et al. Descriptive epidemiology of human thyroid cancer: experience from a regional registry and the “volcanic factor”. Front Endocrinol (Lausanne) 2013; 4: 65. DOI: <http://dx.doi.org/10.3389/fendo.2013.00065>.
15. Malandrino P, Pellegriti G, Attard M et al. Papillary thyroid microcarcinomas: a comparative study of the characteristics and risk factors at presentation in two cancer registries. J Clin Endocrinol Metab 2013; 98(4): 1427–1434.
16. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 1994; 97(5): 418–428. Erratum in Am J Med 1995; 98(2): 215.
17. Mercante G, Frasoldati A, Pedroni C et al. Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients. Thyroid 2009; 19(7): 707–716.
18. Pacini F, Schlumberger M, Dralle H et al. European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154(6): 787- 803. Erratum in Eur J Endocrinol. 2006; 155(2): 385.
19. Pacini F. Management of papillary thyroid microcarcinoma: primum non nocere! J Clin Endocrinol Metab 2013; 98(4): 1391–1393.
20. Pellegriti G, Frasca F, Regalbuto C et al. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol 2013; 2013: 965212. Dostupné z DOI: <http://dx.doi.org/10.1155/2013/965212>.
21. Rahib L, Smith BD, Aizenberg R et al. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 2014; 74(11): 2913–2921. Erratum in Cancer Res 2014; 74(14): 400.
22. Ross DS, Litofsky D, Ain KB et al. Recurrence after treatment of micropapillary thyroid cancer. Thyroid 2009; 19(10): 1043–1048.
23. Ross DS, Tuttle RM. Observing micopapillary thyroid cancers. Thyroid 2014; 24(1): 3–6.
24. Sipos JA, Mazzaferri EL. Thyroid cancer epidemiology and prognostic variables. Clin Oncol (R Coll Radiol) 2010; 22(6): 395–404.
25. Wang TS, Goffredo P, Sosa JA et al. Papillary Thyroid Microcarcinoma: An Over-Treated Malignancy? World J Surg 2014; 38(9): 2297–2303.
26. Xu YN, Wang JD. Surgical treatment of incidental and non-incidental papillary thyroid microcarcinoma. G Chir 2010; 31(5): 205- 209.
27. Yu XM, Wan Y, Sippel RS et al. Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases. Ann Surg 2011; 254(4): 653–660.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2015 Issue 9
Most read in this issue
- Therapeutic potential of micronized purified flavonoid fraction (MPFF) of diosmin and hesperidin in treatment chronic venous disorder
- Usefulness of vena cava filters from clinicians view
- Draft of the best medical treatment in patients with low-risk thyroid cancer
- Secondary humoral immunodeficiency in patiens with systemic lupus erythematosus