Medullary Thyroid Carcinoma: Management of Lymph Node Metastases

2010 ◽  
Vol 8 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Jeffrey F. Moley
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Tumor Burden ◽  
Surgical Removal ◽  
Primary Tumors ◽  
Medullary Thyroid ◽  
Central Lymph Node Dissection ◽  
Hormonal Manipulation ◽  
Thyroid C Cells

Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells. Metastatic spread commonly occurs to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation. Surgery is currently the only therapy that can reliably lead to cure, reduction in tumor burden, or effective palliation. In patients with hereditary MTC, central lymph node dissection should be considered in preventative operations if the calcitonin level is elevated. Systematic surgical removal of at-risk or involved lymph node basins (compartmental dissection) should be performed in all patients with palpable primary tumors and recurrent disease. A “berry-picking” approach is discouraged. Although data are limited, standard chemotherapy and radiation therapy have not been shown to be effective in the treatment of MTC. Newer targeted drug therapies are promising and are being examined in therapeutic clinical trials.

scholarly journals Complications after medullary thyroid carcinoma surgery: multicentre study of the SQRTPA and EUROCRINE® databases

2021 ◽  
Vol 108 (6) ◽  
pp. 691-701
Author(s):  
D -J van Beek ◽  
M Almquist ◽  
A O Bergenfelz ◽  
T J Musholt ◽  
E Nordenström ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Lateral Lymph Node ◽  
Medullary Thyroid ◽  
Curative Therapy ◽  
Central Lymph Node Dissection

Abstract Background Surgery is the curative therapy for patients with medullary thyroid carcinoma (MTC). In determining the extent of surgery, the risk of complications should be considered. The aim of this study was to assess procedure-specific outcomes and risk factors for complications after surgery for MTC. Methods Patients who underwent thyroid surgery for MTC were identified in two European prospective quality databases. Hypoparathyroidism was defined by treatment with calcium/active vitamin D. Recurrent laryngeal nerve (RLN) palsy was diagnosed on laryngoscopy. Complications were considered at least transient if present at last follow-up. Risk factors for at-least transient hypoparathyroidism and RLN palsy were identified by logistic regression analysis. Results A total of 650 patients underwent surgery in 69 centres at a median age of 56 years. Hypoparathyroidism, RLN palsy and bleeding requiring reoperation occurred in 170 (26·2 per cent), 62 (13·7 per cent) and 17 (2·6 per cent) respectively. Factors associated with hypoparathyroidism were central lymph node dissection (CLND) (odds ratio (OR) 2·20, 95 per cent c.i. 1·04 to 4·67), CLND plus unilateral lateral lymph node dissection (LLND) (OR 2·78, 1·20 to 6·43), CLND plus bilateral LLND (OR 2·83, 1·13 to 7·05) and four or more parathyroid glands observed (OR 4·18, 1·46 to 12·00). RLN palsy was associated with CLND plus LLND (OR 4·04, 1·12 to 14·58) and T4 tumours (OR 12·16, 4·46 to 33·18). After compartment-oriented lymph node dissection, N0 status was achieved in 248 of 537 patients (46·2 per cent). Conclusion Complications after surgery for MTC are procedure-specific and may relate to the unavoidable consequences of radical dissection needed in some patients.

scholarly journals Comprehensive Assessment of Copy Number Alterations Uncovers Recurrent AIFM3 and DLK1 Copy Gain in Medullary Thyroid Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 218
Author(s):  
Aline Neves Araujo ◽  
Cléber Pinto Camacho ◽  
Thais Biude Mendes ◽  
Susan Chow Lindsey ◽  
Lais Moraes ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Copy Number ◽  
Snp Array ◽  
In Silico Analysis ◽  
Pcr Analysis ◽  
Copy Number Alterations ◽  
Medullary Thyroid ◽  
Thyroid C Cells ◽  
Ajcc Staging

Medullary thyroid carcinoma (MTC) is a malignant tumor originating from thyroid C-cells that can occur either in sporadic (70–80%) or hereditary (20–30%) form. In this study we aimed to identify recurrent copy number alterations (CNA) that might be related to the pathogenesis or progression of MTC. We used Affymetrix SNP array 6.0 on MTC and paired-blood samples to identify CNA using PennCNV and Genotyping Console software. The algorithms identified recurrent copy number gains in chromosomes 15q, 10q, 14q and 22q in MTC, whereas 4q cumulated losses. Coding genes were identified within CNA regions. The quantitative PCR analysis performed in an independent series of MTCs (n = 51) confirmed focal recurrent copy number gains encompassing the DLK1 (14q32.2) and AIFM3 (22q11.21) genes. Immunohistochemistry confirmed AIFM3 and DLK1 expression in MTC cases, while no expression was found in normal thyroid tissues and few MTC samples were found with normal copy numbers. The functional relevance of CNA was also assessed by in silico analysis. CNA status correlated with protein expression (DLK1, p = 0.01), tumor size (DLK1, p = 0.04) and AJCC staging (AIFM3p = 0.01 and DLK1p = 0.05). These data provide a novel insight into MTC biology, and suggest a common CNA landscape, regardless of if it is sporadic or hereditary MTC.

scholarly journals Medullary thyroid carcinoma beyond surgery: advances, challenges, and perspectives

2019 ◽  
Vol 26 (9) ◽  
pp. R499-R518 ◽  
Author(s):  
Lucieli Ceolin ◽  
Marta Amaro da Silveira Duval ◽  
Antônio Felippe Benini ◽  
Carla Vaz Ferreira ◽  
Ana Luiza Maia
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Intracellular Signaling ◽  
Progression Free Survival ◽  
Thyroid Neoplasms ◽  
Rare Type ◽  
Medullary Thyroid ◽  
Men 2 ◽  
Thyroid C Cells ◽  
Molecular Therapies

Medullary thyroid carcinoma (MTC) is a rare type of tumor that originates from thyroid C cells and accounts for 2–4% of all malignant thyroid neoplasms. MTC may occur sporadically or be inherited, as part of the MEN 2 syndrome. Germline mutations of the RET (REarranged during Transfection) proto-oncogene cause hereditary cancer, whereas somatic RET mutations and, less frequently, RAS mutations have been described in sporadic MTC samples. Since early surgery with complete resection of tumor mostly determines the likelihood of attaining cure for MTC, the broader use of RET genetic screening has dramatically changed the prognostic of gene carriers in hereditary MTC. Nevertheless, despite recent advances, the management of advanced, progressive MTC remains challenging. The multikinase inhibitors (MKI), vandetanib and cabozantinib, were approved for the treatment of progressive or symptomatic MTC, and several other compounds have exhibited variable efficacy. Although these drugs have been shown to improve progression-free survival, no MKI has been shown to increase the overall survival. As these drugs are nonselective, significant off-target toxicities may occur, limiting achievement of the required TK-specific inhibition. Recently, next-generation small-molecule TKI has been developed. These TKI are specifically designed for highly potent and selective targeting of oncogenic RET alterations, making them promising drugs for the treatment of advanced MTC. Here, we summarize the current understanding of the intracellular signaling pathways involved in MTC pathogenesis as well as the therapeutic approaches and challenges for the management of advanced MTC, focusing on targeted molecular therapies.

scholarly journals Progression of medullary thyroid carcinoma: assessment with calcitonin and carcinoembryonic antigen doubling times

2008 ◽  
Vol 158 (2) ◽  
pp. 239-246 ◽  
Author(s):  
Anne Laure Giraudet ◽  
Abir Al Ghulzan ◽  
Anne Aupérin ◽  
Sophie Leboulleux ◽  
Ahmed Chehboun ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Carcinoembryonic Antigen ◽  
Disease Progression ◽  
Medullary Thyroid Carcinoma ◽  
Stable Disease ◽  
Progressive Disease ◽  
Tumor Burden ◽  
Ki 67 ◽  
Medullary Thyroid ◽  
Doubling Times

ObjectiveThe progression of medullary thyroid cancer is difficult to assess with imaging modalities; we studied the interest of calcitonin and carcinoembryonic antigen (CEA) doubling times and of Ki-67 labeling and mitotic index (MI).Patients and methodsFifty-five consecutive medullary thyroid carcinoma (MTC) patients with elevated calcitonin levels underwent repeated imaging studies in order to assess tumor burden and progression status. We looked for relationships between tumor burden and levels of calcitonin and CEA and between progression status according to the response evaluation criteria in solid tumors (RECIST) and calcitonin and CEA doubling times, and Ki-67 labeling and MI.ResultsThe calcitonin and CEA levels were correlated with tumor burden. Ten patients with calcitonin levels below 816 pg/ml had no imaged tumor foci. Among the 45 patients with imaged tumor foci, 19 had stable disease and 26 had progressive disease, according to the RECIST. The calcitonin and CEA doubling times were strongly related to disease progression, with very few overlaps: 94% of patients with doubling times shorter than 25 months had progressive disease and 86% of patients with doubling times longer than 24 months had stable disease. Ki-67 labeling and MI were not significantly associated with disease progression.ConclusionFor MTC patients, the doubling times of both calcitonin and CEA are efficient tools for assessing tumor progression.

scholarly journals Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

2020 ◽  
Vol 19 ◽  
pp. 153303382096208
Author(s):  
Xin Wu ◽  
Binglu Li ◽  
Chaoji Zheng ◽  
Wei Liu ◽  
Tao Hong ◽  
...  
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Lymph Node Metastases ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Lateral Lymph Node ◽  
Sporadic Medullary Thyroid Carcinoma ◽  
Medullary Thyroid ◽  
Node Metastases

Purpose: Medullary thyroid carcinoma is a rare endocrine malignancy; 75% of patients with this disease have sporadic medullary thyroid carcinoma. While surgery is the only curative treatment, the benefit of prophylactic lateral neck dissection is unclear. This study aimed to analyze the clinicopathological risk factors associated with lateral lymph node metastases and determine the indication for prophylactic lateral neck dissection in patients with sporadic medullary thyroid carcinoma. Methods: The medical records of patients with medullary thyroid carcinoma who were treated at our hospital between January 2002 and January 2020 were retrospectively reviewed; a database of their demographic characteristics, test results, and pathological information was constructed. The relationship between lateral lymph node metastases and clinicopathologic sporadic medullary thyroid carcinoma features were analyzed using univariate and multivariate analyses. Results: Overall, 125 patients with sporadic medullary thyroid carcinoma were included; 47.2% and 39.2% had confirmed central and lateral lymph node metastases, respectively. Univariate and multivariate analyses identified 2 independent factors associated with lateral lymph node metastases: positive central lymph node metastases (odds ratio = 9.764, 95% confidence interval: 2.610–36.523; p = 0.001) and positive lateral lymph nodes on ultrasonography (odds ratio = 101.747, 95% confidence interval: 14.666–705.869; p < 0.001). Conclusion: Medullary thyroid carcinoma is a rare endocrine malignancy. Lymph node metastases are common in patients with sporadic medullary thyroid carcinoma. Prophylactic lateral neck dissection is recommended for patients who exhibit positive central lymph node metastases and/or positive lateral lymph nodes on ultrasonography.

scholarly journals Prognostic value of numbers of metastatic lymph node in medullary thyroid carcinoma

Medicine ◽  
2019 ◽  
Vol 98 (1) ◽  
pp. e13884 ◽  
Author(s):  
Kexin Meng ◽  
Hua Luo ◽  
Hailong Chen ◽  
Haiwei Guo ◽  
Wenjie Xia
Keyword(s):  
Lymph Node ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Prognostic Value ◽  
Metastatic Lymph Node ◽  
Medullary Thyroid ◽  
Metastatic Lymph
Sign in / Sign up

Export Citation Format

Share Document