Recurrences of Thyroid Cancer After Radical Surgery and Complementary Treatment: Are Macroscopic, Microscopic, Scintigraphic, and Biochemical Criteria Sufficient in the Evaluation of Radicality of Primary Treatment?

6069 Background: Surgery is the primary treatment for locally advanced thyroid cancer (TC). For some locally advanced TC, R0/R1 resection could not be achieved at initial diagnosis and neoadjuvant treatment would be an option. However, there is still little evidence regarding neoadjuvant treatment in locally advanced TC. Methods: This single-arm, phase 2 study investigated the efficacy and safety of Anlotinib (12mg orally daily, for two weeks on/on week off) for 2-6 cycles in patients with locally advanced TC in the neoadjuvant setting. Operable patients received surgery after neoadjuvant treatment. The primary endpoint was objective response rate (ORR). Results: A total of 13 patients were included and received an average of 3.5 cycles (range: 3-6 cycles) of Anlotinib treatment. 12 cases were papillary thyroid cancer, and 1 was follicular thyroid cancer. The ORR of Anlotinib was 76.9% with 10 partial response (PR), 2 stable disease (SD), and 1 progressive disease (PD). 8 PR and 1 SD patients received surgery after neoadjuvant treatment, of whom 8 had R0/1 resections and 1 had R2 resection. 2 PR patients refused to have surgery and the rest 2 patients were not operable. The R0/1 resection rate for intent to treat population was 61.5% and for per-protocol population was 72.7%. The maximum reduction in sum of tumor diameter was an average of 34.8% (range: 30.9%-45.5%) for PR patients. Most adverse events were grade 1 or 2. Common adverse events of all grade were hypertension (76.9%), hypertriglyceridemia (69.2%), proteinuria (53.8%), TSH increase (53.8%), cholesterol elevation (53.8%) and hand-foot syndrome (38.5%). The majority of adverse events discontinued after the neoadjuvant treatment stopped. Conclusions: Anlotinib demonstrated antitumor activity in the neoadjuvant treatment in locally advanced TC and the majority of patients achieved R0/1 resection. Adverse events were consistent with the known Anlotinib adverse event profile. These results suggest that Anlotinib neoadjuvant treatment represents a new option for locally advanced TC. Clinical trial information: NCT04309136.

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Radiotherapy of Soft Tissue Sarcomas

Tumori Journal ◽

10.1177/030089167005600505 ◽

1970 ◽

Vol 56 (5) ◽

pp. 297-310

Author(s):

Giovanni Crema ◽

Bruno Damascelli ◽

Renato Musumeci ◽

Carlo Uslenghi

Keyword(s):

Soft Tissue ◽

Patient Survival ◽

Radical Surgery ◽

Postoperative Radiotherapy ◽

Soft Tissue Sarcomas ◽

Lower Limbs ◽

Histologic Type ◽

Complementary Treatment ◽

Histologic Types ◽

First Time

This review series comprises 245 patients with soft tissue sarcomas of various sites and histologic types observed at this Institute between 1928 and 1966. 132 patients were men (54.2%) and 113 women (45.8%). Fibrosarcomas accounted for the largest number of cases (161 cases - 65.5%), followed by undifferentiated sarcomas (36 cases). Other histologic types accounted for a smaller number of cases. As to the site of the primary tumor, the lower limbs accounted for 32.2% and the abdomen for 26.5% of the cases. 152 of the 245 patients attended for the first time and 93 presented recurrences of the tumor sometime after receiving surgical treatment and/or radiotherapy elsewhere. 159/245 cases were subjected at this Institute to designedly radical surgery followed by postoperative radiotherapy by various techniques. In the remaining 86 cases, in which surgery was either not indicated or not possible because of the patients’ local or general condition, radiotherapy only was given, where possible curative. Radium was used in 97 cases almost always as complementary treatment in superficial tumors that had developed mainly towards the surface and been removed surgically either radically or as radically as conditions allowed. The therapeutic techniques and results are discussed in relation to patient survival by histologic type and to failures and recurrences.

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Controversies in the follow-up and management of well-differentiated thyroid cancer.

Endocrine Related Cancer ◽

10.1677/erc.0.0110097 ◽

2004 ◽

Vol 11 (1) ◽

pp. 97-116 ◽

Cited By ~ 46

Author(s):

M D Ringel ◽

P W Ladenson

Keyword(s):

Thyroid Cancer ◽

Residual Disease ◽

Wide Spectrum ◽

Preoperative Assessment ◽

Staging System ◽

Primary Treatment ◽

Long Term Monitoring ◽

Well Differentiated ◽

Term Monitoring

Thyroid cancer is a common malignancy with an apparent increasing incidence and a wide spectrum of clinical behavior and therapeutic responsiveness. Recent advances in diagnosis, primary treatment, and long-term monitoring have led to enhanced detection of primary and recurrent disease and improvements in therapy. Controversy still surrounds several issues: the most accurate predictive staging system and histological subclassification scheme, optimal preoperative assessment and surgical extent, appropriate use of radioiodine for remnant ablation, goal for thyrotropin-suppressive thyroid hormone therapy, best practices in immediate postoperative and long-term monitoring, and approach to the patient with thyroglobulin evidence of residual disease. In this paper, recent data related to these controversial issues are critically reviewed.

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Primary treatment of well-differentiated thyroid cancer

Journal of Surgical Oncology ◽

10.1002/jso.2930160313 ◽

1981 ◽

Vol 16 (3) ◽

pp. 279-288 ◽

Cited By ~ 7

Author(s):

Melvin A. Block

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Primary Treatment ◽

Well Differentiated

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Thyroid Cancer Incidentally Found in Radical Surgery for Laryngeal/Hypopharyngeal Cancer

Otolaryngology ◽

10.1016/j.otohns.2009.05.008 ◽

2009 ◽

Vol 141 (3) ◽

pp. 343-346 ◽

Cited By ~ 4

Author(s):

Chien Shih ◽

Cheng-Ping Wang ◽

Pei-Jen Lou ◽

Ya-Ling Hu ◽

Tsung-Lin Yang ◽

...

Keyword(s):

Thyroid Cancer ◽

Laryngeal Cancer ◽

Radical Surgery ◽

Thyroid Tissue ◽

Case Series ◽

Distant Metastases ◽

Hypopharyngeal Cancer ◽

Conservative Approach ◽

Retrospective Case ◽

One Year

OBJECTIVES: To report on four patients with thyroid cancer found in their specimen of laryngectomy for laryngeal/hypopharyngeal cancer. STUDY DESIGN: Retrospective case series. SETTING: Patients with laryngeal cancer and hypopharyngeal cancers treated at our institution between 1991 and 2005 were enrolled. SUBJECTS AND METHODS: There were 463 patients with laryngeal cancer and 219 patients with hypopharyngeal cancers under retrospective review. RESULTS: There were 254 patients with laryngeal caner and 130 patients with hypopharyngeal cancer receiving surgery. Thyroid cancer was observed in the resected thyroid gland in two cases of laryngeal cancer and in two cases of hypopharyngeal cancer. They received treatment only for their laryngeal/hypopharyngeal cancers. Two patients died of distant metastases from larynx/hypopharynx cancer within one year. The other two patients are currently alive without disease from either of the two types of cancer. CONCLUSIONS: It is rare to discover an unexpected simultaneous thyroid cancer confirmed postoperatively from thyroid tissue partially removed in laryngectomy. A conservative approach is suggested for such patients.

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Surgical removal still the primary treatment for thyroid cancer

Drugs & Therapy Perspectives ◽

10.2165/00042310-199913050-00002 ◽

1999 ◽

Vol 13 (5) ◽

pp. 7-10

Author(s):

&NA;

Keyword(s):

Thyroid Cancer ◽

Primary Treatment ◽

Surgical Removal

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Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

International Journal of Endocrinology ◽

10.1155/2018/4735436 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Krzysztof Kaliszewski ◽

Beata Wojtczak ◽

Jędrzej Grzegrzółka ◽

Jacob Bronowicki ◽

Sawsan Saeid ◽

...

Keyword(s):

Thyroid Cancer ◽

Retrospective Study ◽

Radical Surgery ◽

Postoperative Bleeding ◽

Recurrent Laryngeal Nerve Paralysis ◽

Multinodular Goitre ◽

Early Complications ◽

Nerve Paralysis ◽

Laryngeal Nerve Paralysis ◽

Observation Period

Objectives. A discussion with regard to the most optimal surgical procedure in nontoxic multinodular goitre (NTMNG). We assessed and compared three main types of operations in 2032 patients with NTMNG. Methods. This is a retrospective study of 2032 patients operated on in one center due to NTMNG. The observation period was 48 to 120 months (mean and SD: 87 ± 20). Results. The early complications included uni- and bilateral recurrent laryngeal nerve paralysis (URLNP, BRLNP), overt tetany (OT), and postoperative bleeding (POB). We observed after TT, STT, and DO URLNP: 15 (1.73%), 3 (0.64%), and 2 (0.28%), respectively (p<0.05); BRLNP: 3 (0.34%), 2 (0.43%), and 0 (0.0%), respectively (p=0.25); OT: 42 (4.84%), 6 (1.29%), and 9 (1.28%), respectively (p<0.0001); and POB: 11 (1.26%), 4 (0.86%), and 3 (0.42%), respectively (p=0.209). Persistent complications we observed after TT, STT, and DO are the following: URLNP: 9 (1.03%), 3 (0.64%), and 1 (0.14%), respectively (p=0.086); BRLNP: 1 (0.11%), 1 (0.21%), and 0 (0.0%), respectively (p=0.51); and OT: 11 (1.26%), 2 (0.43%), and 2 (0.28%), respectively (p=0.052). Incidental thyroid cancer (ITC) was recognized after TT, STT, and DO in 18 (2.07%), 21 (4.52%), and 11 (1.56%), respectively (p=0.039). Recurrent goitre (RG) was observed in 1 (0.11%) after TT, 3 (0.64%) after STT, and 2 (0.28%) after DO (p=0.234). Conclusions. Performing less radical surgery in NTMNG is associated with a significantly lower risk of early and late URLNP and OT. In the case of BRLNP (early and persistent) and POB, no statistically significant differences are seen. The occurrence of ITC is higher following more radical surgeries. Less radical surgery is connected with a higher risk of RG.

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