ABSTRACT
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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Subject(s)
Humans , Male , Female , Consensus Development Conferences as Topic , Societies, Medical/organization & administration , Societies, Medical/standards , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms/radiotherapy , Radiotherapy/methods , Iodine/radiation effects , Antineoplastic Agents/therapeutic use , Thyroid Gland , Thyroid Gland/pathology , Thyroid Gland , Fluorodeoxyglucose F18/administration & dosage , Positron-Emission TomographyABSTRACT
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)
No disponible
Subject(s)
Humans , Male , Female , Thyroid Carcinoma, Anaplastic/complications , Thyroid Carcinoma, Anaplastic/epidemiology , Thyroid Carcinoma, Anaplastic/genetics , Consensus , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Thyroid Carcinoma, Anaplastic/radiotherapy , Adenocarcinoma, Papillary/complications , Adenocarcinoma, Papillary/drug therapy , Prognosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Quality of Life , Palliative CareABSTRACT
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.
Subject(s)
Thyroid Carcinoma, Anaplastic/therapy , Thyroid Neoplasms/therapy , Algorithms , Combined Modality Therapy , Consensus , Humans , SpainABSTRACT
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.
Subject(s)
Cell Differentiation/drug effects , Iodine Radioisotopes , Practice Guidelines as Topic/standards , Protein Kinase Inhibitors/therapeutic use , Radiation Tolerance/drug effects , Thyroid Neoplasms/drug therapy , Cell Differentiation/radiation effects , Consensus , Disease Management , Humans , Molecular Targeted TherapyABSTRACT
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)
No disponible
Subject(s)
Humans , Male , Female , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroid Carcinoma, Anaplastic/epidemiology , Consensus Development Conferences as Topic , Prognosis , Societies, Medical/organization & administration , Societies, Medical/standards , Molecular Biology/instrumentation , Molecular Biology/methods , Molecular Biology/trends , Biomarkers/analysis , Biomarkers, Tumor/analysisABSTRACT
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.
Subject(s)
Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/therapy , Thyroid Neoplasms/pathology , Thyroid Neoplasms/therapy , HumansABSTRACT
Therapy with anti-thyroid drugs is the initial option mostly used in our country for the treatment of hyperthyroidism due to Graves-Basedow disease. To evaluate the long term results of this kind of therapy, a total of 773 patients were studied who were diagnosed from 1975 to 1994 in three hospitals in Northern Spain (Hospital Central de Asturias, Hospital de Cruces and Hospital de Navarra) after a mean follow-up time after anti-thyroid drug withdrawal of 46 +/- 33.1 months. The results showed a likelihood of hyperthyroidism relapse of 42.9%, 59.8%, 67.9% and 78.9% at one, three, five and ten years, respectively. Goitre size was correlated very significantly with the likelihood of relapse (p < 0.0001). In contrast, only TBII positivity at the end of therapy among the remaining parameters (age, sex, goitre size, length of therapy, positivity of anti-thyroid antibodies and TBII) influenced significantly on the relapse likelihood (p < 0.05). In conclusion, after a long term follow-up after anti-thyroid therapy, a high relapse rate of hyperthyroidism in Graves-Basedow disease, which amounts up to 79% at ten years, was observed. Goitre size was the main predictive factor for this relapse.
Subject(s)
Antithyroid Agents/therapeutic use , Carbimazole/therapeutic use , Graves Disease/drug therapy , Methimazole/therapeutic use , Propylthiouracil/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Prognosis , Recurrence , SpainABSTRACT
Recidiva y factores pronósticos tras tratamiento con antitiroideos en la enfermedad de Graves-Basedow. Estudio multicéntrico en el norte de España El tratamiento con fármacos antitiroideos es la opción inicial más utilizada en nuestro país para el tratamiento del hipertiroidismo por enfermedad de Graves-Basedow. Para evaluar el resultado a largo plazo de este tipo de tratamiento hemos estudiado 773 pacientes diagnosticados entre 1975 y 1994 en tres hospitales del norte de España (Hospital Central de Asturias, Hospital de Cruces y Hospital de Navarra) después de un tiempo medio de seguimiento tras la retirada de los antitiroideos de 46 ñ 33,1 meses. Los resultados mostraron una probabilidad de recidiva del hipertiroidismo del 42,9 por ciento al año, del 59,8 por ciento a los 3 años, del 67,9 por ciento a los 5 años y del 78,9 por ciento a los 10 años. El tamaño del bocio se correlacionó muy significativamente con la probabilidad de recidiva (p < 0,0001), mientras que del resto de las variables estudiadas (edad, sexo, tamaño del bocio, duración del tratamiento, positividad de los anticuerpos antitiroideos y de los TBII) sólo la positividad de los TBII al final del tratamiento influyó de forma muy significativa (p < 0,05). En conclusión, tras un seguimiento a largo plazo después del tratamiento con antitiroideos se observa una alta tasa de recidiva del hipertiroidismo en la enfermedad de Graves-Basedow, que llega a ser del 79 por ciento a los 10 años, siendo el tamaño del bocio el factor fundamental a la hora de predecir esta recidiva (AU)
