Efficacy of long-term ultrasonography in follow-up of patients with papillary thyroid carcinoma: a case of neck metastasis developed 19 years following primary treatment.

The cases of relapse in papillary thyroid cancer patients who were initially considered low-risk and for many years were without signs of the disease are extremely rare, but exist. This is supported by the clinical case of a patient who underwent a total thyroidectomy due to papillary thyroid cancer and 19 years later metastasis with extracapsular spreading in a presumed thyroid place was revealed. Due to such cases, the importance of long-term ultrasound monitoring is emphasized.

Kinase Inhibitors in the Treatment of Thyroid Cancer: Institutional Experience.

Although most patients with thyroid cancer have a favorable clinical course, some patients develop a more aggressive type of cancer and exhibit more rapid disease progression with worse prognosis. Those patients usually exhibit mutations of proteins such as tyrosine kinase enzymes that play a significant role in regulation of tumor proliferation and spreading. Development of targeted therapies is based on the inhibition of mutated kinases which are involved in the MAPK signaling pathway. The aim of this study was to present the initial results of clinical experience with kinase inhibitors in patients with metastatic differentiated thyroid cancer (DTC), poorly differentiated thyroid cancer (PDTC), and medullary thyroid cancer (MTC) who exhibited rapid disease progression. A total of 17 adult patients (11 women, mean age 53.3 years) managed for progressive, metastatic disease were included in the study. Twelve patients with DTC and PDTC were previously tested for BRAF mutations, of whom nine that had tumor tissue negative for the BRAF V600E mutation received sorafenib, while three patients with tumors harboring the BRAF V600E mutation were treated with vemurafenib. Patients with MTC were treated with sunitinib, vandetanib, and sorafenib. Two patients with tumors harboring the BRAF mutation treated with vemurafenib showed restoration of radioiodine uptake. Most of patients showed significant improvement in disease status but of limited duration until disease progression. Although there was an improvement in progression-free survival, future research has to achieve a greater and longer-lasting response, probably by utilizing combined targeted therapy.

The value of 18F-DOPA PET/CT in patients with medullary thyroid carcinoma and increased calcitonin values.

AIM: The aim of this prospective observational study was to examine the benefit of a fluorine-18-L-dihydroxyphenylalanine (F-DOPA) PET/computed tomography (CT) scan in patients with medullary thyroid carcinoma (MTC) in terms of increased calcitonin levels. PATIENTS AND METHODS: Twenty-eight MTC patients after initial total thyreoidectomy with increasing follow-up calcitonin levels suggestive for active disease after negative conventional imaging findings (neck ultrasound or thorax, abdomen, pelvis multislice computed tomography as standard imaging) were scanned using F-DOPA PET/CT from November 2012 to April 2016. The mean calcitonin level was 108.5 (range: 6.7-290) pmol/l and the mean carcinoembryonic antigen level was 15.7 (range: 1.1-221.9) µg/l. The mean follow-up period was 19.7 months. RESULTS: F-DOPA PET/CT was positive in 16 out of 28 (57%) patients, mostly because of metabolically active neck and mediastinal lymph nodes metastases. Previously unknown bone metastases were found in six patients. A positive scan was reported in four patients (25% of positive scans) with a very low calcitonin value of less than 49.9 pmol/l. PET/CT findings led to a change of management and therapy in 16 out of 28 patients, with surgical procedure performed in eight patients, radiotherapy in five patients, and chemotherapy in two patients. CONCLUSION: F-DOPA PET/CT is a clinically useful modality in MTC whenever the calcitonin level is increased. There is a clear trend toward more positive scans with the higher calcitonin values, but patients with moderately elevated calcitonin values should also be taken into consideration for molecular imaging with F-DOPA PET/CT as the tumor burden in these patients is probably low, enabling further therapy to be individualized and consequently more efficient.

Treatment of patients with anaplastic thyroid cancer during the last 20 years: whether any progress has been made?

Anaplastic thyroid cancer (ATC) is one of the most deadly cancers in humans. Searching a PubMed database, studies published during the last 20 years, 63 publications dealing with treatment of patients were identified. Cohort studies comprised 6,609 patients with the median age 68 years (range 57-77 years). The median survival was 3.9 months, and 1 year survival, 20%. The median survival of patients treated with multimodal therapy was 10.5 months. There was significant difference in median survival (7.0 vs. 3.8 months; p < 0.05) and 1 year survival (30.5 vs. 16.8 months; p < 0.05) between the patients <68 and 68 or more years old. Clinical trials, both randomized and non-randomized, comprised 205 patients. Unfortunately, considerable improvement in the understanding of the pathogenesis and genetics of the ATC has not yet resulted in the improvement of the outcome of these patients.

The most common factors influencing on quality of life of thyroid cancer patients after thyroid hormone withdrawal.

BACKGROUND: The aim of study was to evaluate which factors impact mostly on life-quality of patients with differentiated thyroid carcinoma after thyroid hormone withdrawal. SUBJECTS AND METHODS: 150 patients were enrolled in the study by using Quality of life- Thyroid version questionnaire in which they expressed their physical, psychological, social and spiritual well-being. The answers have been interpreted on a scale from 0 to 10. All patients underwent four weeks levothyroxine withdrawal in preparation for I-131 procedures and thyroglobulin testing. RESULTS: Individual statements on the physical subscale showed that patients had most difficulties with fatigue, intolerance to cold and heat, sleep changes and weight gain, but with higher average values than expected. Fatigue was one of the most common physical difficulties. Female patients had significantly more difficulties than male respondents. Five most expressed psychological difficulties have been stress caused by initial diagnosis, followed by stress caused by surgical treatment, fear of metastases, stress caused by initial radioiodine ablation treatment and fear of cancer recurrence. Generally, results revealed troubles mostly in physical symptoms relating to thyroid hormone withdrawal, as well as psychological distress caused by initial diagnosis. Respondents with higher educational level achieved a significantly higher score than less educated patients (p=0.026, Mann-Whitney U test). Illness was very distressing for their families (median value 1, range: 0 to 10) and they reported insufficient support from others (1, range: 0 to 10), but they did not feel isolated. Family and work consequences were less apparent. CONCLUSION: The results of QOL-Thyroid questionnaire help to identify high-risk areas in patients' lives that are negatively affected by hormone withdrawal. Regarding the wide definition of quality of life, a positive impact on patients' recovery could be achieved by directing attention to most expressed difficulties noted in this questionnaire.

Thyroid remnant ablation in patients with papillary cancer: a comparison of low, moderate, and high activities of radioiodine.

OBJECTIVE: The consensus about optimal activities of I-131 for thyroid remnant ablation has not yet been achieved. The aim of this study was to compare ablation rates obtained with different I-131 activities. PATIENTS AND METHODS: The study included 466 patients divided into four groups according to I-131 activities given after total thyroidectomy for papillary thyroid cancer: group A [168 patients who received 888 MBq (24 mCi)], group B [125 patients who received 1480 MBq (40 mCi)], group C [65 patients who received 1850 MBq (50 mCi)], and group D [108 patients who received 4440 MBq (120 mCi)]. Ablation outcome was assessed by whole-body scan in hypothyroid state 6-9 months after ablation and finally 18-21 months after the treatment. RESULTS: The rate of successful ablation was similar in the group of patients who received 24 and 40 mCi (75 and 71.2%, respectively). The higher rate of ablation was achieved in the groups treated with 50 and 120 mCi of radioiodine (87.69 and 90.74%, respectively). The ablation rates at the first follow-up examinations (59.5, 67.2, 73.9, 80.6%) were lower than at second control study (75.0, 71.2, 87.7, 90.7%) in all groups. Time required for thyroid remnant ablation seems to be >or=18 months. CONCLUSION: Our study indicates that activity of 50 mCi seems to be optimal to achieve a successful ablation rate (approximately 90%). Low I-131 activities are acceptable for lower risk patients because of satisfactory ablation rate (>70%), lower expense, and minimal radiation burden to patients as well as lower radiation exposure to clinical staff. The ablative use of high activities seems neither justified nor optimized.