Consensus on the management of advanced radioactive iodine-refractory differentiated thyroid cancer on behalf of the Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and Spanish Rare Cancer Working Group (GETHI)

Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC (AU)

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Spanish consensus for the management of patients with anaplastic cell thyroid carcinoma

Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years (AU)

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Consensus on management of advanced medullary thyroid carcinoma on behalf of the Working Group of Thyroid Cancer of the Spanish Society of Endocrinology (SEEN) and the Spanish Task Force Group for Orphan and Infrequent Tumors (GETHI)

Background: Of all thyroid cancers,< 5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. Methods: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. Results: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. Conclusions: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression (AU)

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Comments to SEOM clinical guidelines for the treatment of thyroid cancer

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Hipofosfatemia en nutrición parenteral: prevención y factores de riesgo asociados / Hypophosphatemia in parenteral nutrition: prevention and associated risks factors

Objetivo: Determinar la incidencia de hipofosfatemia en pacientes con nutrición parenteral, la cantidad de fosfato necesaria para prevenir esta complicación y los factores de riesgo asociados. Ámbito: Estudio observacional no controlado en un hospital de nivel III. Pacientes: pacientes ingresados con nutrición parenteral a los que se les ha realizado como mínimo una analitica completa. Intervención: Se registran durante un año, los días de nutrición parenteral, el fosfato administrado y los niveles plasmáticos de calcio ionizado, -glutamiltranspeptidasa, glucosa, fosfato, prealbúmina, urea y leucocitos. Para el análisis se aplica una regresión múltiple stepwise y una regresión logistica. Resultados: Se incluyeron en el estudio 827 determinaciones correspondientes a 401 pacientes. Las variables significativas (p < 0,05) fueron: fosfato administrado y los niveles séricos de calcio ionizado, glucosa, prealbúmina y urea; los coeficientes de regresión fueron 0,004 (95 por ciento IC: 0,002-0,006), -0,156 (95 por ciento IC: -0,270-0,037), 0,014 (95 por ciento IC: -0,022-0,009), 0,005 (95 por ciento CI: 0,0020,009) y 0,019 (95 por ciento IC: 0,016-0,022) respectivamente; la constante fue 1,0735 (95 por ciento IC: 0,939-1,2079). El riesgo de desarrollar hipofosfatemia disminuyó de 0,65 (95 por ciento IC: 0,33-1,26) a 0,16 (95 por ciento IC: 0,078-0.35) cuando el fosfato administrado variaba deL rango 7,5-17,5 mmol a valores superiores a 27,5 mmol. Conclusiones: es necesario suplementar rutinariamente las nutriciones con fosfato debido a que su contenido en las emulsiones lipídicas comercializadas no es suficiente para evitar la hipofosfatemia en la mayoría de pacientes con nutrición parenteral. El aporte de fosfato debe ser suficiente para restaurar el déficit de fosfato intracelular y compensar la caída de fosfato plasmático, con especial cuidado para los pacientes desnutridos, hiperglucémicos o con insuficiencia renal. Aportes de fosfato entre 27-37 mmol, disminuyen drásticamente la incidencia de hipofosfatemia en los pacientes estudiados, no registrándose ningún caso de hipofosfatemia severa (AU)

Aim: To determine the incidence of hypophosphatemia in parenterally fed patients, the phosphate amount necessary to prevent this complication and associated risks factors. Setting: Observational study, not controlled, in a third level hospital. Patients: In-patients with parenteral nutrition with at least a complete laboratory work-up. Intervention: For a complete year, days on parenteral nutrition, administered phosphate and plasmatic ionised calcium levels, γ-glutamiltranspeptidase, glucose, phosphate, pre-albumin, urea, and leukocytes were recorded. A multiple stepwise regression analysis and logistic regression are used for data analysis. Results: Eight hundred and twenty seven determinations, corresponding to 401 patients, were included. Significant variables (p < 0.05) were: administered phosphate and ionised calcium serum levels, glucose, pre-albumin, and urea; regression coefficients were 0.004 (95%CI: 0.002 to 0.006), -0.156 (95%CI: -0.270 to 0.037), -0.014 (95%IC: -0.022 to 0.009), 0.005 (95%CI: 0.002 to 0.009) and 0.019 (95%CI: 0.016 to 0.022), respectively; the constant was 1.0735 (95%CI: 0.939 to 1.2079). The risk for developing hypophosphatemia decreased from 0.65 (95%CI: 0.33 to 1.26) to 0.16 (95%CI: 0.078 to 0.35) when administered phosphate varied from the span 7.5-17.5 mmol to values higher than 27.5 mmol. Conclusions: It is necessary to routinely supplement nutrition with phosphate since its content in commercially available lipidic emulsions is not sufficient to prevent hypophosphatemia in the majority of patients with parenteral nutrition. Phosphate intake must be sufficient to restore the intracellular phosphate deficit and to compensate for the plasmatic phosphate fall, with special attention to poorly nourished, hyperglycaemic or with renal failure patients. Phosphate intakes around 27-37 mmol dramatically decrease the incidence of hypophosphatemia in studied patients, with no recorded cases of severe hypophosphatemia (AU)