Papillary thyroid carcinoma (PTC) is the most common

Size: px
Start display at page:

Download "Papillary thyroid carcinoma (PTC) is the most common"

Transcription

1 ORIGINAL Endocrine ARTICLE Care Does Postoperative Thyrotropin Suppression Therapy Truly Decrease Recurrence in Papillary Thyroid Carcinoma? A Randomized Controlled Trial Iwao Sugitani and Yoshihide Fujimoto Division of Head and Neck, Cancer Institute Hospital, Tokyo , Japan Context: TSH suppression therapy has been used to decrease thyroid cancer recurrence. However, validation of effects through studies providing a high level of evidence has been lacking. Objective: This single-center, open-label, randomized controlled trial tested the hypothesis that disease-free survival (DFS) for papillary thyroid carcinoma (PTC) in patients without TSH suppression is not inferior to that in patients with TSH suppression. Design: Participants were randomly assigned to receive postoperative TSH suppression therapy (group A) or not (group B). Before assignment, patients were stratified into groups with low- and high-risk PTC according to the AMES (age, metastasis, extension, size) risk-group classification. Interventions and Outcome Measures: For patients assigned to group A, L-T 4 was administered to keep serum TSH levels below 0.01 U/ml. TSH levels were adjusted to within normal ranges for patients assigned to group B. Recurrence was evaluated by neck ultrasonography and chest computed tomography. Results: Eligible participants were recruited from , with 218 patients assigned to group A and 215 patients to group B. Analysis was performed on an intention-to-treat basis. DFS did not differ significantly between groups. The 95% confidence interval of the hazard ratio for recurrence was according to Cox proportional hazard modeling, within the margin of 2.12 required to declare 10% noninferiority. Conclusions: DFS for patients without TSH suppression was not inferior by more than 10% to DFS for patients with TSH suppression. Thyroid-conserving surgery without TSH suppression should be considered for patients with low-risk PTC to avoid potential adverse effects of TSH suppression. (J Clin Endocrinol Metab 95: , 2010) Papillary thyroid carcinoma (PTC) is the most common variety of thyroid cancer in iodine intake-sufficient countries like Japan and the United States. Although most patients with PTC show excellent survival, considerable debate remains regarding the optimal initial management of PTC. According to recent guidelines from Western countries (1, 2), the standard therapeutic strategy for PTC consists of total or near-total thyroidectomy followed by radioactive iodine (RAI) ablation and TSH suppression therapy by administration of thyroid hormone. However, some investigators opt for lobectomy or subtotal thyroidectomy without ISSN Print X ISSN Online Printed in U.S.A. Copyright 2010 by The Endocrine Society doi: /jc Received January 21, Accepted June 10, First Published Online July 21, 2010 any adjuvant therapy, particularly for patients with low-risk PTC. Surgeons in Japan frequently perform preoperative ultrasonography, and many have traditionally selected thyroid-conserving surgery as long as the PTC lesions are unilateral and distant metastases are not present (3, 4). One reason for this policy is the strict legal regulation on the use of RAI in Japan. This strategy offers considerable advantages in minimizing potential treatment-related complications including palsy of the recurrent laryngeal nerves and hypoparathyroidism and in preserving thyroid function in patients who usually enjoy a normal life expectancy. Abbreviations: AMES, Age, metastasis, extension, size; BMD, bone mineral density; CI, confidence interval; DFS, disease-free survival; HR, hazard ratio; PTC, papillary thyroid carcinoma; RAI, radioactive iodine; RCT, randomized controlled trial; WDTC, well-differentiated thyroid carcinoma jcem.endojournals.org J Clin Endocrinol Metab, October 2010, 95(10):

2 J Clin Endocrinol Metab, October 2010, 95(10): jcem.endojournals.org 4577 Well-differentiated thyroid carcinoma (WDTC) expresses TSH receptors on the cell membrane (5) and responds to TSH stimulation by increasing the expression of several thyroid-specific proteins, including thyroglobulin, and by increasing rates of cell growth. Long-term suppression of TSH using supraphysiological doses of L-T 4 has been used in an attempt to decrease the risk of thyroid cancer recurrence and even cancer-related mortality. The first description of the use of thyroid hormone in the management of thyroid cancer was reported by Dunhill in 1937 (6). In 1977, Mazzaferri et al. (7) collected multiinstitutional retrospective data and reported that 5-yr accumulated recurrence rates after initial surgery for PTC were significantly lower for patients with TSH suppression therapy than for patients with no adjuvant therapy (approximately 10 vs. 20%, respectively). Thereafter, long-term TSH suppression therapy has been considered a standard treatment in the management of WDTC, and numerous case reports, case series, and clinical cohort studies have reported the efficacy of TSH suppression therapy (8 18). However, formal validation of the effects of this therapy through studies guaranteeing a high level of evidence remains lacking. In addition, long-term administration of supraphysiological doses of L-T 4 could cause some serious side effects, including thyrotoxicosis, osteoporosis, angina, and arrhythmia. We investigated the efficacy of TSH suppression therapy on disease-free survival (DFS) after surgery for patients with PTC in a single-center, open-label, randomized controlled trial (RCT). This RCT was designed as a noninferiority study to test the hypothesis that DFS in patients without TSH suppression therapy would not be inferior to that in patients with TSH suppression therapy. Subjects and Methods Eligibility criteria for participants All patients who were diagnosed with PTC by fine-needle aspiration cytology and underwent initial surgery at the Cancer Institute Hospital, a tertiary oncology referral center in Japan, were considered as candidates for inclusion in the study. All patients were from Japan, a world-representative iodine intakesufficient area. Patients were not admitted to the study if any of the following criteria were met: 1) maximum diameter of primary tumor as measured by preoperative ultrasonography 1 cm or smaller (microcarcinoma), 2) age 80 yr or older, 3) distant metastasis, 4) Graves disease, 5) ischemic heart disease or arrhythmia, or 6) severe osteoporosis from the result of bone mineral density (BMD) testing. BMD was measured at the lumbar spine (L2 L4) using dual-energy x-ray absorptiometry. T-score was defined as the number of SD between measured values and the mean for a control group from the general populations matched for gender at yr old, with values more than 3.0 SD below this mean regarded as indicating severe osteoporosis. Patients who showed a final pathological diagnosis other than PTC were also excluded after assignment. The ethics committee of the hospital approved all study protocols in December Randomization and intervention Patients who had provided written informed consent were randomly assigned to receive postoperative TSH suppression therapy (group A) or not (group B). Before assignment, patients were categorized as showing low- or high-risk PTC according to the age, metastasis, extension, size (AMES) risk-group classification (19) to minimize any imbalance between groups. A permuted-block randomization method with a block size of six (AAABBB, AABABB, AABBAB, AABBBA, ABAABB, AB- ABAB, ABABBA, ABBAAB, ABBABA, ABBBAA, BAAABB, BAABAB, BAABBA, BABAAB, BABABA, BABBAA, BBAAAB, BBAABA, BBABAA, and BBBAAA) was used, and participants displayed an equal probability of assignment to each group. Sequential numbers were assigned to 600 sealed, opaque envelopes: 480 for low-risk PTC and 120 for high-risk PTC. These envelopes contained the assigned treatment group for each patient, according to the permuted-block randomization table. Envelopes were opened by the investigator right after surgery in sequential order for each qualifying patient. Both investigators and patients were aware of the assignments. For patients assigned to group A, L-T 4 was administered from postoperative d 1. Oral L-T 4 was given at an initial dose of 100 g/d (taken in a single dose in the morning) for patients with body weight under 50 kg, 150 g/d for patients weighing kg, and 200 g/d for patients weighing 70 kg or more. Blood tests were subsequently conducted every 4 wk, with doses individually adjusted to control serum TSH levels to less than 0.01 U/ml. Serum levels of free T 4 and free T 3 were maintained within the normal range as well as possible. In contrast, TSH level was adjusted to within the normal range ( U/ml) for patients assigned to group B. After adjusting the initial dose of L-T 4, blood tests for serum TSH, free T 4, and free T 3 were repeated every 6 months to confirm that hormonal balance was controlled as intended. During the study period, 61% of all thyroid surgeries were performed by a single surgeon (I.S.), and all other surgeries were assisted by the same surgeon. Our basic standard for primary surgery for patients with PTC is complete resection of the tumor based on findings from ultrasonography. All patients were routinely assessed using preoperative ultrasonography by the same expert radiologist to estimate the extent of intrathyroidal spread of cancer and lymph node metastasis. When the tumor was limited to a single lobe and no clinically evident lymph node metastasis was present, lobectomy of the affected side was performed with nodal dissection of the central zone. In patients with clinical involvement of lateral cervical lymph nodes, modified radical lateral neck dissection was performed. When patients displayed primary tumor invading surrounding organs such as the trachea or esophagus, resection and reconstruction of the involved organs were conducted. Total or near-total thyroidectomy was performed only when the cancer extended to the contralateral lobe or when nodal metastasis was evident bilaterally in the neck. No patients underwent RAI ablation. Outcome measures and follow-up The primary endpoint in this study was DFS. Patients were evaluated for tumor recurrence at lymph nodes, thyroid bed, remnant thyroid tissue, and distant sites every 6 months by phys-

3 4578 Sugitani and Fujimoto TSH Suppression and Recurrence of Thyroid CancerJ Clin Endocrinol Metab, October 2010, 95(10): ical examination, chest radiography, or lung computed tomography in addition to neck ultrasonography performed by the single expert radiologist specializing in thyroid ultrasonography. The radiologist suspected lymph nodes as metastatic based on the following criteria: 1) diameter 1 cm or larger, 2) clear hypoechoic or inhomogeneous pattern, 3) irregular cystic appearance, 4) presence of internal microcalcification, and 5) rounded shape with increased anteroposterior diameter. Confirmation of recurrence required cytological or pathological evaluation for cervical lesions but not for hematogenous metastasis. TSH-stimulated serum thyroglobulin measurement and RAI whole-body scan were not used. TSH suppression therapy was suspended for patients in group A showing symptoms of thyrotoxicosis, cardiovascular disease (angina or atrial fibrillation), or progressive osteoporosis (T-score 3.0 SD below mean for controls). Sample size and statistical analysis We assumed that 5-yr DFS for patients with TSH suppression therapy was 90%, and the noninferiority margin was set as 10%. Analysis was intention to treat, comparing DFS in group B with that in group A. Based on 80% power to declare noninferiority, 204 patients were required for each group according to Freedman s formula. Using Shoenfeld s formula, the power to declare noninferiority is 80% for 372 patients, 83% for 400 patients, and 86% for 432 patients. Hazard ratio (HR) for recurrence would be 2.12 if DFS for group B was 10% worse than that for group A. Group B would thus be noninferior to group A in terms of DFS if the upper limit of the 95% confidence interval (CI) for the HR was less than 2.12 according to Cox proportional hazard model. For statistical analysis, SAS/STAT software (SAS Institute, Cary, NC) was used. Survival curves were determined using the Kaplan-Meier method. The Cox proportional hazard model and log-rank test were used to compare time-to-event distributions. To analyze the significance of intergroup differences, the 2 test for categorical data and the t test for unpaired variables were used. Values of P 0.05 were considered statistically significant. Results Eligible participants were recruited from January 1996 to February A total of 441 patients diagnosed with PTC on the basis of preoperative fine-needle aspiration cytology were randomly assigned to group A (n 221) or group B (n 220). Postoperative pathological examination revealed that eight patients did not have PTC and were thus ineligible for the study, leaving 433 patients for final analysis: 218 patients assigned to group A underwent TSH suppression therapy, and 215 patients assigned to group B were followed without TSH suppression. As of February 2009, mean duration of follow-up was yr (range, yr). Five-year follow-up has been completed in 325 patients (74%). Thirty-three patients (8%) were lost to follow-up, but these patients were included in the analysis censoring at the point of last follow-up. Another 33 patients (8%) had discontinued the allocated intervention based on the decision of the patient or side FIG. 1. Flow diagram of participants in the trial [CONSORT (the Consolidated Standards of Reporting Trials) diagram]. effects of TSH suppression therapy. In group A, TSH suppression therapy was suspended for 12 patients with thyrotoxicosis, five patients with angina or atrial fibrillation, and six patients with progressive osteoporosis. A flow diagram for participants is shown in Fig. 1. Clinical characteristics of patients in each group are summarized in Table 1. Baseline demographic characteristics including age, sex, extent of thyroidectomy and lymph node dissection, risk group distribution, and status of lymph node metastasis did not differ significantly between groups. TSH was well suppressed in group A and was controlled within the normal range in group B. Primary analysis was intention to treat, involving all 433 patients. Forty-nine patients (11%) have shown recurrence, and nine (2%) have died of PTC. Disease-free 5-yr survival, disease-specific 5-yr survival, overall recurrence rates, and sites of recurrence were not significantly different between groups A and B (Table 2). DFS curves for patients without TSH suppression therapy did not differ significantly from those for patients with the therapy (Fig. 2A). The 95% CI of HR for recurrence ranged from according to Cox proportional hazard model. This was within the margin of 2.12 required to declare 10% noninferiority for DFS in patients without TSH suppres-

4 J Clin Endocrinol Metab, October 2010, 95(10): jcem.endojournals.org 4579 TABLE 1. Clinical characteristics of each trial group Characteristic Group A (with TSH suppression therapy), n 218 Group B (without TSH suppression therapy), n 215 P Age at randomization (yr) (range, 17 79) (range, 16 78) 0.55 a Sex (male/female) 44/174 54/ b Thyroidectomy (total or neartotal/less 35/183 31/ b than total) Lymph node dissection 147/71 148/ b (central zone only/central and lateral neck) AMES risk group classification 194/24 189/ b (low-risk/high-risk) Clinical N stage (0/1) 130/88 136/ b Pathological N (0/1) 70/148 67/ b L-T 4 administration ( g/d) (range, ) (range, 0 200) a Free T 4 (ng/dl) (range, ) (range, ) a Free T 3 (pg/ml) (range, ) (range, ) a TSH ( U/ml) (range, ) (range, ) a Number of TSH measurements after initial control a The laboratory data shown are the mean values for the study period. a Unpaired t test. b 2 test. sion therapy compared with patients with the therapy and was even less than 1.54, representing the criteria for 5% inferiority. DFS was similar for these groups in subset analysis that divided patients into low- and high-risk groups according to AMES risk-group classification (Fig. 2, B and C). Discussion A recent metaanalysis studying the effect of TSH suppression therapy was performed by McGriff et al. (20). Among 4174 patients with WDTC, 2880 (69%) were reported as being on TSH suppression therapy, and patients who received the therapy showed decreased risk of major adverse clinical events, including disease progression, recurrence, and death (risk ratio, 0.73; 95% CI, ; P 0.05). However, only 10 (36%) of 28 longitudinal, observational cohort studies published between 1934 and 2001 were amenable to metaanalysis. Unfortunately, all of the large cohort studies have been limited by a lack of randomization and a lack of appropriate controls. McGriff et al. (20) concluded that the causal link between TSH suppression and reduction of major adverse clinical events was a probable association, and future research will better define the effects of TSH suppression therapy on clinical outcomes for WDTC. TABLE 2. Outcomes for patients with and without TSH suppression therapy Outcome Group A (with TSH suppression), n 218 Group B (without TSH suppression), n 215 Follow-up (yr) a Number of exams to detect recurrence a Overall recurrence 22 (10%) 27 (13%) 0.42 b 5-yr DFS 91% 89% 0.39 c Site of recurrence Remnant thyroid 0 (0%) 1 (0.5%) 0.31 b Cervical lymph node 21 (10%) 25 (12%) 0.50 b Distant site 9 (4%) 12 (6%) 0.48 b Death from the disease 3 (1%) 6 (3%) 0.30 b 5-yr disease-specific survival 99% 98% 0.31 c Death from other diseases 10 (5%) 13 (6%) 0.50 b a Unpaired t test. b 2 test. c Log-rank test. P

5 4580 Sugitani and Fujimoto TSH Suppression and Recurrence of Thyroid CancerJ Clin Endocrinol Metab, October 2010, 95(10): FIG. 2. DFS curves for patients with TSH suppression therapy (group A) and without TSH suppression therapy (group B). A, All patients; B, AMES low-risk group; C, AMES high-risk group. In Japan, we have mainly performed thyroid-conserving surgery on patients with PTC and have achieved rather favorable outcomes, particularly for low-risk patients. According to our retrospective institutional data, 10-yr disease-specific survival for 604 patients treated between 1976 and 1998 was 94% at a mean of 10.7 yr follow-up after initial surgery (21). Younger patients (age 50 yr) with distant metastasis and older patients (age 50 yr) with any of the three factors including distant metastasis, extrathyroidal invasion, and large nodal metastasis of 3 cm or larger were defined as high risk, whereas all other patients were defined as low risk. For 498 low-risk group patients, 10-yr disease-specific and disease-free survival rates were over 99 and 91%, respectively. Among these, 451 patients (91%) received less-than-total thyroidectomy (lobectomy or subtotal thyroidectomy) and 47 (9%) underwent total or near-total thyroidectomy. Disease-specific and disease-free survival rates did not differ significantly between those groups. If patients with PTC were safely treated with less-than-total thyroidectomy, the majority of patients could enjoy a normal lifespan without medication. RCTs are necessary to acquire the high level of evidence needed to sway the unresolved debate regarding the treatment of choice for WDTC. Although the revised American Thyroid Association guidelines recently have recommended a risk-adapted titration of TSH suppression (1), total thyroidectomy combined with RAI ablation and TSH suppression is the most prevailing practice pattern for patients with WDTC in the United States. Conducting an RCT comparing those therapies with conservative methods lacking any part of those treatments would thus be difficult. In 1996, we started this noninferiority trial to demonstrate equivalency for not conducting TSH suppression to keep TSH within the normal range after surgery, compared with performing TSH suppression therapy to suppress TSH to under 0.01 U/ml. We registered a total of 433 patients with a mean follow-up of 6.9 yr. This sample size was comparable to the assumptions reported by Udelsman et al. (22), who reported that an RCT investigating the operation of choice for PTC would require a sample size of and a follow-up of 6 10 yr if the endpoint was defined as recurrence. Although potential bias due to use of a single-center, nonblinded protocol should be considered and the size and duration of this trial were limited, this appears to represent the first RCT investigating the efficacy of TSH suppression therapy. As a result, DFS for patients without TSH sup-

6 J Clin Endocrinol Metab, October 2010, 95(10): jcem.endojournals.org 4581 pression therapy has been established as not more than 10% inferior to DFS for patients with TSH suppression. In addition, as exploratory analysis, the difference between groups was shown to be within 5%. Moreover, although not powered to make a statement of significance, conclusions were the same when participants were divided into low- and high-risk groups according to the AMES riskgroup classification. The fact that TSH suppression therapy has suppressive effects on growth of cancer cells has been demonstrated by several basic research studies (23, 24). Recent studies have identified serum TSH as an independent predictor of malignancy in thyroid nodules, and higher serum TSH is associated with advanced stage of differentiated thyroid cancer (25 27). However, the efficacy of TSH suppression on DFS in patients with PTC was not shown to be significant at a practical level when comparing patients with TSH suppressed to less than 0.01 U/ml and patients with TSH maintained within the normal range. In the present study, the tests used to detect recurrence were mainly neck ultrasonography and chest computed tomography. TSH-stimulated serum thyroglobulin measurement and RAI whole-body scan were not used, because the majority of patients underwent thyroidconserving surgery. In Japan, ultrasonography has long been used for pre- and postoperative diagnosis of lymph node status in the neck, and the effectiveness of this approach is well established, particularly when the procedure is performed by an expert (28, 29). Although serum thyroglobulin measurement and RAI whole-body scan are said to offer greater sensitivity in identifying residual disease, the results of these exams are known to sometimes be inconsistent. One report showed that 2% of patients with completely undetectable thyroglobulin after stimulation showed recurrence over the next 3 5 yr (30). Another report showed that persistent tumor could be identified on imaging studies in only one third of a stimulated thyroglobulin-positive group (31). Furthermore, serum thyroglobulin measurements are less sensitive in patients with small cervical metastases or less-differentiated tumor. Follow-up strategies with neck ultrasonography have been recognized as effective in identifying patients with recurrent PTC in the United States (32). The risk of false-negative results for our methods in detecting recurrent or persistent disease demands continued longer follow-up, but the prognosis for each patient might primarily be determined by the biological malignancy of each individual cancer. Among the 184 patients in group B who underwent thyroid-conserving surgery, 142 patients (77%) did not need L-T 4 supplementation to maintain TSH within the normal range. Conversely, TSH in group A patients was strictly suppressed to less than 0.01 U/ml. The daily dose of L-T 4 capable of inducing TSH suppression was defined as higher than 1.6 g/kg d (33). In the present study, we adopted a higher dose of L-T 4 administration according to a Japanese report (34) to clearly discriminate between groups. Serum levels of free T 4 and free T 3 were significantly higher in group A than in group B, although most were within the normal range. Consequently, therapy had to be suspended for 23 patients because of various side effects, whereas nine patients showed noncompliance, electing to discontinue medication. However, the rate of loss to follow-up was significantly lower in group A than in group B (P 0.017). L-T 4 supplementation might provide a good motivation for periodic surveillance after treatment. The fact that a total of 66 among 433 patients (15%) were lost to follow-up or discontinued therapy might slightly undermine the validity of the study. However, the simulated sample size required for 80% power to declare noninferiority was 456 under this circumstance, and power was still maintained at nearly 80%. Even among patients who were lost to follow-up, cases of early dropout were rare, and mean duration of follow-up was 4.4 yr. Overall, the total duration of follow-up did not differ significantly between groups. We therefore considered that the potential bias due to loss to follow-up was limited when those patients were treated as censored at the time of last follow-up. For group A patients who discontinued TSH suppression, the reason for suspension seemed unrelated to cancer recurrence, and no recurrences were identified after the suspension of TSH suppression therapy. Study conclusions were unchanged when analysis was performed on a per-protocol basis (HR, 1.25; 95% CI, ). In Western countries, the optimal TSH level to be achieved in patients who have undergone total thyroidectomy for PTC remains contentious (1, 18, 35). Excessive TSH suppression carries a risk of thyrotoxicosis, cardiovascular disease, and osteoporosis (36 38). Pujol et al. (15) found that constant suppression of TSH to under 0.05 U/ml is associated with longer relapse-free survival compared with serum TSH levels always 1 U/ml or higher, and the degree of TSH suppression was an independent predictor of recurrence in multivariate analysis. On the other hand, Cooper et al. (16) conducted a multicenter, prospective study using the database of the National Thyroid Cancer Cooperative Registry, analyzing 617 patients with PTC followed for a median of 4.5 yr. They mentioned TSH score category as an independent predictor of disease progression in high-risk patients, but the data did not support the concept that a greater degree of TSH suppression was required to prevent disease progression in low-risk patients. Jonklaas et al. (39) also reported that superior

7 4582 Sugitani and Fujimoto TSH Suppression and Recurrence of Thyroid CancerJ Clin Endocrinol Metab, October 2010, 95(10): outcomes were associated with aggressive TSH suppression in high-risk patients but were achieved with only modest suppression in stage II patients. They were unable to show any impact, positive or negative, of specific therapies in stage I patients. According to the major guidelines from Western countries, the appropriate dose of thyroid hormone for low-risk patients is the dose that will decrease serum TSH concentrations to just below the lower limit of the normal range. A greater degree of TSH suppression is generally recommended for high-risk patients (1). However, considering that high-risk PTC becomes increasingly prevalent with age, strict suppression of TSH would increase the possibility of critical side effects such as cardiovascular disease and osteoporosis and still seems unlikely to decrease recurrence rates as much as has been expected. The present study demonstrated the equivalency of not performing TSH suppression therapy compared with performing the therapy. However, we did not show any superiority of not performing TSH suppression therapy over performing the therapy. Based on our own risk-group definition (21) and retrospective outcomes for patients with PTC, since 2005 we have been recommending total thyroidectomy, RAI ablation, and TSH suppression therapy in addition to locally aggressive surgery for every patient with high-risk PTC. Accumulation of these prospective outcomes and comparison with historical controls are an area of high priority. Conversely, for low-risk PTC where cancer-specific death is seen in less than 1% of patients, we agree with Cady s remark (40) that punishment has to fit the crime and caution against overtreatment for patients with low-risk PTC. We currently recommend TSH suppression therapy only for patients who will inevitably receive L-T 4 supplementation due to postoperative hypothyroidism or who desire to receive TSH suppression, paying special attention to the risk of cardiovascular disease and osteoporosis. Future studies may show whether our results in patients treated according to Japanese practice patterns can be generalized to the differently treated populations in other geographic areas. Acknowledgments We thank Dr. Keiko Yamada (Department of Ultrasonography, Cancer Institute Hospital) for performing ultrasonographic surveillance of patients. We are also grateful to Mr. Masato Suzuki (Biostatistics and Research Decision Sciences, BANYU Pharmaceutical) for statistical support. Address all correspondence and requests for reprints to: Iwao Sugitani, M.D., Ph.D., Division of Head and Neck, Cancer Institute Hospital, , Ariake, Koto-ku, Tokyo , Japan. isugitani@jfcr.or.jp. This work was supported by the Foundation for Promotion of Cancer Research in Japan. Disclosure Summary: The authors have nothing to disclose. References 1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM 2009 Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19: AACE/AME Task Force on Thyroid Nodules 2006 American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 12: Shigematsu N, Takami H, Kubo A 2006 Unique treatment policy for well-differentiated thyroid cancer in Japan: results of a questionnaire distributed to members of the Japanese Society of Thyroid Surgery and the International Association of Endocrine Surgeons. Endocr J 53: Sugitani I, Fujimoto Y 2010 Management of low-risk papillary thyroid carcinoma: unique conventional policy in Japan and our efforts to improve the level of evidence. Surg Today 40: Ichikawa Y, Saito E, Abe Y, Homma M, Muraki T, Ito K Presence of TSH receptor in thyroid neoplasms. J Clin Endocrinol Metab 42: Dunhill TP 1937 The surgery of the thyroid gland: the Lettsomian lectures. Trans Med Soc Lond 60: Mazzaferri EL, Young RL, Oertel JE, Kemmerer WT, Page CP 1977 Papillary thyroid carcinoma: the impact of therapy in 576 patients. Medicine 56: Crile Jr G 1971 Changing end results in patients with papillary carcinoma of the thyroid. Surg Gynecol Obstet 132: Young RL, Mazzaferri EL, Rahe AJ, Dorfman SG 1980 Pure follicular thyroid carcinoma: impact of therapy in 214 patients. J Nucl Med 21: Wanebo HJ, Andrews W, Kaiser DL 1981 Thyroid cancer: some basic considerations. Am J Surg 142: Cady B, Cohn K, Rossi RL, Sedgwick CE, Meissner WA, Werber J, Gelman RS 1983 The effect of thyroid hormone administration upon survival in patients with differentiated thyroid carcinoma. Surgery 94: Rossi RL, Cady B, Silverman ML, Wool MS, ReMine SG, Hodge MB, Salzman FA 1988 Surgically incurable well-differentiated thyroid carcinoma. Prognostic factors and results of therapy. Arch Surg 123: Mazzaferri EL, Jhiang SM 1994 Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97: Sanders LE, Rossi RL 1995 Occult well differentiated thyroid carcinoma presenting as cervical node disease. World J Surg 19: Pujol P, Daures JP, Nsakala N, Baldet L, Bringer J, Jaffiol C 1996 Degree of thyrotropin suppression as a prognostic determinant in differentiated thyroid cancer. J Clin Endocrinol Metab 81: Cooper DS, Specker B, Ho M, Sperling M, Ladenson PW, Ross DS, Ain KB, Bigos ST, Brierley JD, Haugen BR, Klein I, Robbins J, Sherman SI, Taylor T, Maxon 3rd HR 1998 Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid 8: Hovens GC, Stokkel MP, Kievit J, Corssmit EP, Pereira AM, Romijn JA, Smit JW 2007 Association of serum thyrotropin concentration with recurrence and death in differentiated thyroid cancer. J Clin Endocrinol Metab 92: Kamel N, Güllü S, Daðci Ilgin S, Corapçioðlu D, Tonyukuk Cesur

8 J Clin Endocrinol Metab, October 2010, 95(10): jcem.endojournals.org 4583 V, Uysal AR, Baþkal N, Erdoðan G 1999 Degree of thyrotropin suppression in differentiated thyroid cancer without recurrence or metastases. Thyroid 9: Cady B, Rossi R 1988 An expanded view of risk group definition in differentiated thyroid carcinoma. Surgery 104: McGriff NJ, Csako G, Gourgiotis L, Lori C G, Pucino F, Sarlis NJ 2002 Effects of thyroid hormone suppression therapy on adverse clinical outcomes in thyroid cancer. Ann Med 34: Sugitani I, Kasai N, Fujimoto Y, Yanagisawa A 2004 A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period. Surgery 135: Udelsman R, Lakatos E, Ladenson P 1996 Optimal surgery for papillary thyroid carcinoma. World J Surg 20: Carayon P, Thomas-Morvan C, Castanas E, Tubiana M 1980 Human thyroid cancer: membrane thyrotropin binding and adenylate cyclate activity. J Clin Endocrinol Metab 51: Bruno R, Ferretti E, Tosi E, Arturi F, Giannasio P, Mattei T, Scipioni A, Presta I, Morisi R, Gulino A, Filetti S, Russo D 2005 Modulation of thyroid-specific gene expression in normal and nodular human thyroid tissues from adults: an in vivo effect of thyrotropin. J Clin Endocrinol Metab 90: Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA 2006 Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab 91: Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, Chen H 2008 Higher serum TSH level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab 93: Fiore E, Rago T, Provenzale MA, Scutari M, Ugolini C, Basolo F, Di Coscio G, Berti P, Grasso L, Elisei R, Pinchera A, Vitti P 2009 Lower levels of TSH are associated with a lower risk of papillary thyroid cancer in patients with thyroid nodular disease: thyroid autonomy may play a predictive role. Endocr Relat Cancer 16: Furukawa MK, Furukawa M 2010 Diagnosis of lymph node metastasis of head and neck cancer and evaluation of effects of chemoradiotherapy using ultrasonography. Int J Clin Oncol 15: Sugitani I, Fujimoto Y, Yamada K, Yamamoto N 2008 Prospective outcomes of selective lymph node dissection for papillary thyroid carcinoma based on preoperative ultrasonography. World J Surg 32: Kloos RT, Mazzaferri EL 2005 A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five years later. J Clin Endocrinol Metab 90: Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, Haugen BR, Sherman SI, Cooper DS, Braunstein GD, Lee S, Davies TF, Arafah BM, Ladenson PW, Pinchera A 2003 Author s response: a consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 88: Mittendorf EA, Wang X, Perrier ND, Francis AM, Edeiken BS, Shapiro SE, Lee JE, Evans DB 2007 Followup of patients with papillary thyroid cancer: in search of the optimal algorithm. J Am Coll Surg 205: Fish LH, Schwartz HL, Cavanaugh J, Steffes MW, Bantle JP, Oppenheimer JH 1987 Replacement dose, metabolism, and bioavailability of levothyroxine in the treatment of hypothyroidism. Role of triiodothyronine in pituitary feedback in humans. N Engl J Med 316: Oda M 1979 [Hormone therapy in postoperative cases of differentiated thyroid cancer]. Nippon Geka Gakkai Zassi 80:32 41 (Japanese) 35. Biondi B, Filetti S, Schlumberger M 2005 Thyroid-hormone therapy and thyroid cancer: a reassessment. Nat Clin Pract Endocrinol Metab 1: Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D Agostino RB 1994 Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 331: Cobin RH 1995 Thyroid hormone excess and bone: a clinical review. Endocr Pract 1: Burman KD 1995 How serious are the risks of thyroid hormone over-replacement? Thyroid Today 18: Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, Cooper DS, Haugen BR, Ladenson PW, Magner J, Robbins J, Ross DS, Skarulis M, Maxon HR, Sherman SI 2006 Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid 16: Cady B 1998 Presidential address: beyond risk groups: a new look at differentiated thyroid cancer. Surgery 124:

Update on thyroid cancer surveillance and management of recurrent disease. Minimally invasive thyroid surgery

Update on thyroid cancer surveillance and management of recurrent disease. Minimally invasive thyroid surgery Update on thyroid cancer surveillance and management of recurrent disease Minimally invasive thyroid surgery July 2006 Michael W. Yeh, MD Program Director, Endocrine Surgery Assistant Professor, David

More information

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH

9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH 9. Discuss guidelines for follow-up post-thyroidectomy for cancer (labs/tests) HH Differentiated thyroid cancer expresses the TSH receptor on the cell membrane and responds to TSH stimulation by increasing

More information

Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科

Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科 Surgical Management of Papillary Microcarcinoma 趙 子 傑 長 庚 紀 念 醫 院 林 口 總 院 一 般 外 科 Papillary microcarcinoma of thyroid Definition latent aberrant thyroid occult thyroid carcinoma latent papillary carcinoma)

More information

SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD

SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD SUNY DOWNSTATE MEDICAL CENTER SURGERY GRAND ROUNDS February 28, 2013 VERENA LIU, MD ROSEANNA LEE, MD Case Presentation 35 year old male referred from PMD with an asymptomatic palpable right neck mass PMH/PSH:

More information

Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence. Cord Sturgeon, MD

Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence. Cord Sturgeon, MD Thyroid Cancer: Resection, Dissection, Surveillance and Recurrence Cord Sturgeon, MD Associate Professor of Surgery Northwestern University Feinberg School of Medicine Director of Endocrine Surgery Chicago,

More information

Followup of Patients with Papillary Thyroid Cancer: In Search of the Optimal Algorithm

Followup of Patients with Papillary Thyroid Cancer: In Search of the Optimal Algorithm Followup of Patients with Papillary Thyroid Cancer: In Search of the Optimal Algorithm Elizabeth A Mittendorf, MD, Xuemei Wang, MS, Nancy D Perrier, MD, Ashleigh M Francis, BSPH, Beth S Edeiken, MD, Suzanne

More information

Locoregional recurrence or persistence of papillary carcinoma: radioiodine treatment

Locoregional recurrence or persistence of papillary carcinoma: radioiodine treatment Locoregional recurrence or persistence of papillary carcinoma: radioiodine treatment Michele Klain, Marco Salvatore Department of Functional and Biomorphological Science University of Naples "Federico

More information

THYROID CANCER. I. Introduction

THYROID CANCER. I. Introduction THYROID CANCER I. Introduction There are over 11,000 new cases of thyroid cancer each year in the US. Females are more likely to have thyroid cancer than men by a ratio of 3:1, and it is more common in

More information

Latest Oncologic Strategies for Well-Differentiated Thyroid Carcinoma

Latest Oncologic Strategies for Well-Differentiated Thyroid Carcinoma Latest Oncologic Strategies for Well-Differentiated Thyroid Carcinoma April 2008 Michael W. Yeh, MD Program Director, Endocrine Surgery Assistant Professor of Surgery and Medicine David Geffen School of

More information

Thyroid Differentiated Cancer: Does Size Really Count? (New ways to evaluate thyroid nodules)

Thyroid Differentiated Cancer: Does Size Really Count? (New ways to evaluate thyroid nodules) Thyroid Differentiated Cancer: Does Size Really Count? (New ways to evaluate thyroid nodules) Jeffrey S. Freeman, D.O., F.A.C.O.I. Chairman, Division of Endocrinology and Metabolism Philadelphia College

More information

Preventable reoperations for persistent and recurrent papillary thyroid carcinoma

Preventable reoperations for persistent and recurrent papillary thyroid carcinoma Preventable reoperations for persistent and recurrent papillary thyroid carcinoma Maria A. Kouvaraki, MD, PhD, Jeffrey E. Lee, MD, Suzanne E. Shapiro, MS, Steven I. Sherman, MD, and Douglas B. Evans, MD,

More information

Management of Differentiated Thyroid Carcinoma American Thyroid Association Guidelines and Data from Kaohsiung Chang Gung Memorial Hospital

Management of Differentiated Thyroid Carcinoma American Thyroid Association Guidelines and Data from Kaohsiung Chang Gung Memorial Hospital Review Management of Differentiated Thyroid Carcinoma American Thyroid Association Guidelines and Data from Kaohsiung Chang Gung Memorial Hospital Pei-Wen Wang Abstract Background. Most thyroid cancers

More information

Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated? An Analysis of 18,445 Cases

Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated? An Analysis of 18,445 Cases PAPERS OF THE 131ST ASA ANNUAL MEETING Should All Papillary Thyroid Microcarcinomas Be Aggressively Treated? An Analysis of 18,445 Cases Xiao-Min Yu, MD, PhD, Yin Wan, MS, Rebecca S. Sippel, MD, FACS,

More information

Thyroid Cancer Diagnosis and Management. Jerome Hershman, M.D. Internal Medicine Grand Rounds University of Missouri, Columbia October 21, 2010

Thyroid Cancer Diagnosis and Management. Jerome Hershman, M.D. Internal Medicine Grand Rounds University of Missouri, Columbia October 21, 2010 Thyroid Cancer Diagnosis and Management Jerome Hershman, M.D. Internal Medicine Grand Rounds University of Missouri, Columbia October 21, 2010 DISCLOSURE NOTHING TO DISCLOSE in regard to financial conflict

More information

RECOMMENDATIONS. INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline April 2014

RECOMMENDATIONS. INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline April 2014 INVESTIGATION AND MANAGEMENT OF PRIMARY THYROID DYSFUNCTION Clinical Practice Guideline April 2014 OBJECTIVE Alberta clinicians optimize laboratory testing for the investigation and management of primary

More information

Outcomes of Patients with Differentiated Thyroid Carcinoma Following Initial Therapy*

Outcomes of Patients with Differentiated Thyroid Carcinoma Following Initial Therapy* THYROID Volume 16, Number 12, 2006 ª Mary Ann Liebert, Inc. Outcomes of Patients with Differentiated Thyroid Carcinoma Following Initial Therapy* Jacqueline Jonklaas, 1 Nicholas J. Sarlis, 2{ Danielle

More information

Historical Basis for Concern

Historical Basis for Concern Androgens After : Are We Ready? Mohit Khera, MD, MBA Assistant Professor of Urology Division of Male Reproductive Medicine and Surgery Scott Department of Urology Baylor College of Medicine Historical

More information

Recurrent & Persistent Papillary Thyroid Cancer Central Nodal Dissection vs. Node-Picking Patterns of Nodal Metastases Recurrent Laryngeal Nerve,

Recurrent & Persistent Papillary Thyroid Cancer Central Nodal Dissection vs. Node-Picking Patterns of Nodal Metastases Recurrent Laryngeal Nerve, Recurrent & Persistent Papillary Thyroid Cancer Central Nodal Dissection vs. Node-Picking Patterns of Nodal Metastases Recurrent Laryngeal Nerve, Larynx, Trachea, & Esophageal Management Robert C. Wang,

More information

Sonographic Findings in the Surgical Bed After Thyroidectomy

Sonographic Findings in the Surgical Bed After Thyroidectomy Article Sonographic Findings in the Surgical Bed After Thyroidectomy Comparison of Recurrent Tumors and Nonrecurrent Lesions Jung Hee Shin, MD, Boo-Kyung Han, MD, Eun Young Ko, MD, Seok Seon Kang, MD Objective.

More information

Advances in Differentiated Thyroid Cancer

Advances in Differentiated Thyroid Cancer Advances in Differentiated Thyroid Cancer Steven A. De Jong, M.D., FACS, FACE Professor and Vice Chair Clinical Affairs Department of Surgery Loyola University Medical Center Thyroid Cancer classification

More information

0021-972X/97/$03.00/0 Vol. 82, No. 11 Journal of Clinical Endocrinology and Metabolism Copyright 1997 by The Endocrine Society

0021-972X/97/$03.00/0 Vol. 82, No. 11 Journal of Clinical Endocrinology and Metabolism Copyright 1997 by The Endocrine Society 0021-972X/97/$03.00/0 Vol. 82, No. 11 Journal of Clinical Endocrinology and Metabolism Printed in U.S.A. Copyright 1997 by The Endocrine Society Pathological Tumor-Node-Metastasis (ptnm) Staging for Papillary

More information

Il percorso diagnostico del nodulo tiroideo: il ruolo dell analisi molecolare

Il percorso diagnostico del nodulo tiroideo: il ruolo dell analisi molecolare Il percorso diagnostico del nodulo tiroideo: il ruolo dell analisi molecolare Maria Chiara Zatelli Sezione di Endocrinologia Direttore: Prof. Ettore degli Uberti Dipartimento di Scienze Mediche Università

More information

Graves disease in childhood Antithyroid drug therapy

Graves disease in childhood Antithyroid drug therapy 83rd Annual Meeting of the ATA October 620, 203 Duration of antithyroid drugs treatment Disclosure Nothing to disclose Pr Juliane Léger Paediatric Endocrinology Department Paris Diderot University Hôpital

More information

Current Treatment of Papillary Thyroid Microcarcinoma

Current Treatment of Papillary Thyroid Microcarcinoma Advances in Surgery 46 (2012) 191 203 ADVANCES IN SURGERY Current Treatment of Papillary Thyroid Microcarcinoma Xiao-Min Yu, MD, PhD a, Ricardo Lloyd, MD, PhD b, Herbert Chen, MD c, * a Department of Surgery,

More information

7. Prostate cancer in PSA relapse

7. Prostate cancer in PSA relapse 7. Prostate cancer in PSA relapse A patient with prostate cancer in PSA relapse is one who, having received a primary treatment with intent to cure, has a raised PSA (prostate-specific antigen) level defined

More information

Papillary Thyroid Cancer with Chest Metastases Only Detected Using Radioactive Iodine

Papillary Thyroid Cancer with Chest Metastases Only Detected Using Radioactive Iodine Original Article 663 Papillary Thyroid Cancer with Chest Metastases Only Detected Using Radioactive Iodine Sheng-Fong Kuo, MD; Szu-Tah Chen, MD, PhD; Pan-Fu Kao 1, MD; Yu-Chen Chang 1, MD; Shuo-Chi Chou,

More information

Guidance for Preconception Care of Women with Thyroid Disease

Guidance for Preconception Care of Women with Thyroid Disease Before, Between & Beyond Pregnancy The National Preconception Curriculum and Resources Guide for Clinicians Guidance for Preconception Care of Women with Thyroid Disease Avi Alkalay, MD Department of Obstetrics

More information

Papillary thyroid cancer accounts for approximately 90% Lymph Node Dissection in Papillary Thyroid Carcinoma

Papillary thyroid cancer accounts for approximately 90% Lymph Node Dissection in Papillary Thyroid Carcinoma Lymph Node Dissection in Papillary Thyroid Carcinoma Tracy-Ann S. Moo, MD, and Thomas J. Fahey III, MD The management of papillary thyroid carcinoma continues to evolve. Although the debate over the extent

More information

I Radiotherapy of Pediatric Thyroid Cancer

I Radiotherapy of Pediatric Thyroid Cancer 131 I Radiotherapy of Pediatric Thyroid Cancer Steven Waguespack, MD Associate Professor Dept of Endocrine Neoplasia and Hormonal Disorders Department of Pediatrics Patient Care University of Texas M.D.

More information

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj.

PSA Testing 101. Stanley H. Weiss, MD. Professor, UMDNJ-New Jersey Medical School. Director & PI, Essex County Cancer Coalition. weiss@umdnj. PSA Testing 101 Stanley H. Weiss, MD Professor, UMDNJ-New Jersey Medical School Director & PI, Essex County Cancer Coalition weiss@umdnj.edu September 23, 2010 Screening: 3 tests for PCa A good screening

More information

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group

Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Komorbide brystkræftpatienter kan de tåle behandling? Et registerstudie baseret på Danish Breast Cancer Cooperative Group Lotte Holm Land MD, ph.d. Onkologisk Afd. R. OUH Kræft og komorbiditet - alle skal

More information

Corporate Medical Policy Molecular Markers in Fine Needle Aspirates of the Thyroid

Corporate Medical Policy Molecular Markers in Fine Needle Aspirates of the Thyroid Corporate Medical Policy Molecular Markers in Fine Needle Aspirates of the Thyroid File Name: Origination: Last CAP Review: Next CAP Review: Last Review: molecular_markers_in_fine_needle_aspirates_of_the_thyroid

More information

If several different trials are mentioned in one publication, the data of each should be extracted in a separate data extraction form.

If several different trials are mentioned in one publication, the data of each should be extracted in a separate data extraction form. General Remarks This template of a data extraction form is intended to help you to start developing your own data extraction form, it certainly has to be adapted to your specific question. Delete unnecessary

More information

Adjuvant Radioactive Iodine Use Among Differentiated Thyroid Cancer Patients in the Military Health System

Adjuvant Radioactive Iodine Use Among Differentiated Thyroid Cancer Patients in the Military Health System MILITARY MEDICINE, 179, 9:1043, 2014 Adjuvant Radioactive Iodine Use Among Differentiated Thyroid Cancer Patients in the Military Health System Abegail A. Gill, MPH*; Lindsey Enewold, PhD*; Shelia H. Zahm,

More information

A new score predicting the survival of patients with spinal cord compression from myeloma

A new score predicting the survival of patients with spinal cord compression from myeloma A new score predicting the survival of patients with spinal cord compression from myeloma (1) Sarah Douglas, Department of Radiation Oncology, University of Lubeck, Germany; sarah_douglas@gmx.de (2) Steven

More information

Conflict of Interest. Overdiagnosis. Beyond Bethesda: Challenges with Indeterminate Thyroid Aspirates 4/17/2015. Jeffrey F.

Conflict of Interest. Overdiagnosis. Beyond Bethesda: Challenges with Indeterminate Thyroid Aspirates 4/17/2015. Jeffrey F. Beyond Bethesda: Challenges with Indeterminate Thyroid Aspirates Jeffrey F. Krane, MD PhD Associate Professor of Pathology Harvard Medical School Chief, Head and Neck Pathology Service Associate Director,

More information

Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma

Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma 1412 Hemithyroidectomy increases the risk of disease recurrence in patients with ipsilateral multifocal papillary thyroid carcinoma XIAOLONG LI 1*, CUI ZHAO 1*, DANDAN HU 1, YANG YU 1, JIN GAO 2, WENCHUAN

More information

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms

Table of Contents. Data Supplement 1: Summary of ASTRO Guideline Statements. Data Supplement 2: Definition of Terms Definitive and Adjuvant Radiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation

More information

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin E L Mazzaferri 1 and N Massoll 2 1 Adjunct Professor of Medicine, University of

More information

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data

Analysis of Prostate Cancer at Easter Connecticut Health Network Using Cancer Registry Data The 2014 Cancer Program Annual Public Reporting of Outcomes/Annual Site Analysis Statistical Data from 2013 More than 70 percent of all newly diagnosed cancer patients are treated in the more than 1,500

More information

RESEARCH COMMUNICATION

RESEARCH COMMUNICATION DOI:http://dx.doi.org/10.7314/APJCP.2012.13.4.1267 BRAF Mutation is Predictive of Occult Contralateral Carcinoma in Papillary Thyroid Microcarcinoma Cases RESEARCH COMMUNICATION Preoperative BRAF Mutation

More information

KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA

KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA KIDNEY FUNCTION RELATION TO SIZE OF THE TUMOR IN RENAL CELL CANCINOMA O.E. Stakhvoskyi, E.O. Stakhovsky, Y.V. Vitruk, O.A. Voylenko, P.S. Vukalovich, V.A. Kotov, O.M. Gavriluk National Canсer Institute,

More information

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer THYROID Volume 16, Number 2, 2006 American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer The American Thyroid Association Guidelines Taskforce*

More information

AACE/AAES MEDICAL/SURGICAL GUIDELINES FOR CLINICAL PRACTICE: MANAGEMENT OF THYROID CARCINOMA

AACE/AAES MEDICAL/SURGICAL GUIDELINES FOR CLINICAL PRACTICE: MANAGEMENT OF THYROID CARCINOMA AACE/AAES MEDICAL/SURGICAL GUIDELINES FOR CLINICAL PRACTICE: MANAGEMENT OF THYROID CARCINOMA Thyroid Carcinoma Task Force Co-Chairpersons Rhoda H. Cobin, MD, FACE Hossein Gharib, MD, FACP, FACE Committee

More information

Thyroglobulin. versie 071120 J. Billen LAG-UZ-KULeuven 1

Thyroglobulin. versie 071120 J. Billen LAG-UZ-KULeuven 1 Thyroglobulin Large glycoprotein Two identical polypeptide chains 660 kda Prohormone in the intra-thyroid T4 and T3 synthesis Produced only by normal thyrocytes or well-differentiated thyroid cancer (DTC)

More information

MANAGEMENT OF WELL DIFFERENTIATED THYROID CARCINOMA

MANAGEMENT OF WELL DIFFERENTIATED THYROID CARCINOMA MANAGEMENT OF WELL DIFFERENTIATED THYROID CARCINOMA These guidelines are intended to optimize the day-to-day care of patients with welldifferentiated thyroid cancer of follicular origin. They are not a

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

BRAF as a prognostic marker in papillary thyroid cancer

BRAF as a prognostic marker in papillary thyroid cancer 12 Congresso Nazionale AME Molecular markers in thyroid cancer: current role in clinical practice BRAF as a prognostic marker in papillary thyroid cancer Dott. ssa Cristina Romei Sezione di Endocrinologia

More information

Well-differentiated Thyroid Carcinoma: Factors Predicting Recurrence and Survival

Well-differentiated Thyroid Carcinoma: Factors Predicting Recurrence and Survival Singapore Med J 2002 Vol 43(9) : 457-462 O r i g i n a l A r t i c l e Well-differentiated Thyroid Carcinoma: Factors Predicting Recurrence and Survival L H Y Lim, K C Soo, Y K Chong, F Gao, G S Hong,

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information

Influence of Initial Treatment on the Survival and Recurrence in Patients With Differentiated Thyroid Microcarcinoma

Influence of Initial Treatment on the Survival and Recurrence in Patients With Differentiated Thyroid Microcarcinoma ORIGINAL ARTICLE Influence of Initial Treatment on the Survival and Recurrence in Patients With Differentiated Thyroid Microcarcinoma Jasna Mihailovic, MD, PhD,*Þ Ljubomir Stefanovic, MD, PhD,* and Ranka

More information

Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonographyguided

Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonographyguided Eur Radiol (2008) 18: 835 842 DOI 10.1007/s00330-007-0809-5 HEAD AND NECK Byung Moon Kim Min Jung Kim Eun-Kyung Kim Sung Il Park Cheong Soo Park Woong Youn Chung Controlling recurrent papillary thyroid

More information

MEDICAL POLICY SUBJECT: MOLECULAR MARKERS IN FINE NEEDLE ASPIRATES OF THE THYROID EFFECTIVE DATE: 11/19/15

MEDICAL POLICY SUBJECT: MOLECULAR MARKERS IN FINE NEEDLE ASPIRATES OF THE THYROID EFFECTIVE DATE: 11/19/15 MEDICAL POLICY SUBJECT: MOLECULAR MARKERS IN FINE NEEDLE PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases,

More information

The incidence of thyroid cancer has increased exponentially over

The incidence of thyroid cancer has increased exponentially over FEATURE THYROID Papillary thyroid cancer: the most common endocrine malignancy JAMES C. LEE FRACS STANLEY B. SIDHU FRACS, PhD Papillary thyroid cancer has an excellent prognosis and over 90% of affected

More information

PET/CT in Lung Cancer

PET/CT in Lung Cancer PET/CT in Lung Cancer Rodolfo Núñez Miller, M.D. Nuclear Medicine and Diagnostic Imaging Section Division of Human Health International Atomic Energy Agency Vienna, Austria GLOBOCAN 2012 #1 #3 FDG-PET/CT

More information

Thyroid Cancer Treatment in 2010

Thyroid Cancer Treatment in 2010 Rising U.S. Incidence of Thyroid Cancer ATA Guidelines Paul W. Ladenson, M.D. Brussels May 28, 2010 Davies & Welch. JAMA. 2006;295:2164-21672167 Rising U.S. Incidence of Thyroid Cancer LR: 38 y.o. computer

More information

The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality. Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006

The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality. Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006 The Whipple Operation for Pancreatic Cancer: Optimism vs. Reality Franklin Wright UCHSC Department of Surgery Grand Rounds September 11, 2006 Overview Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy

More information

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer

L Lang-Lazdunski, A Bille, S Marshall, R Lal, D Landau, J Spicer Pleurectomy/decortication, hyperthermic pleural lavage with povidone-iodine and systemic chemotherapy in malignant pleural mesothelioma. A 10-year experience. L Lang-Lazdunski, A Bille, S Marshall, R Lal,

More information

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer

Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer Copyright E 2007 Journal of Insurance Medicine J Insur Med 2007;39:242 250 MORTALITY Secondary Cancer and Relapse Rates Following Radical Prostatectomy for Prostate-Confined Cancer David Wesley, MD; Hugh

More information

European Journal of Endocrinology (2003) 148 19 24 ISSN 0804-4643

European Journal of Endocrinology (2003) 148 19 24 ISSN 0804-4643 European Journal of Endocrinology (2003) 148 19 24 ISSN 0804-4643 CLINICAL STUDY Serum thyroglobulin and 131 I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients

More information

Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy

Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy Pathologic Assessment Of The Breast And Axilla After Preoperative Therapy W. Fraser Symmans, M.D. Associate Professor of Pathology UT M.D. Anderson Cancer Center Pathologic Complete Response (pcr) Proof

More information

Image. 3.11.3 SW Review the anatomy of the EAC and how this plays a role in the spread of tumors.

Image. 3.11.3 SW Review the anatomy of the EAC and how this plays a role in the spread of tumors. Neoplasms of the Ear and Lateral Skull Base Image 3.11.1 SW What are the three most common neoplasms of the auricle? 3.11.2 SW What are the four most common neoplasms of the external auditory canal (EAC)

More information

Current Status and Perspectives of Radiation Therapy for Breast Cancer

Current Status and Perspectives of Radiation Therapy for Breast Cancer Breast Cancer Current Status and Perspectives of Radiation Therapy for Breast Cancer JMAJ 45(10): 434 439, 2002 Masahiro HIRAOKA, Masaki KOKUBO, Chikako YAMAMOTO and Michihide MITSUMORI Department of Therapeutic

More information

Management of Well Differentiated Thyroid Cancers: Where We Have Been and Where We are Headed

Management of Well Differentiated Thyroid Cancers: Where We Have Been and Where We are Headed Management of Well Differentiated Thyroid Cancers: Where We Have Been and Where We are Headed Medical Grand Rounds December 10,2015 Christine Signore, MD ECNU Learning Objectives Discuss the epidemiology

More information

Intensity Modulated Radiation Therapy (IMRT) for Thyroid Cancer

Intensity Modulated Radiation Therapy (IMRT) for Thyroid Cancer Thyroid Science 5(1):CLS1-8, 2010 www.thyroidscience.com Clinical and Laboratory Studies Intensity Modulated Radiation Therapy (IMRT) for Thyroid Cancer 1 2 5 Aruna Turaka, MD, Tianyu Li, MS, Jian Q. Yu,

More information

Original Investigation

Original Investigation Research Original Investigation Lack of Association of BRAF Mutation With Negative Prognostic Indicators in Papillary Thyroid Carcinoma The University of California, San Francisco, Experience Christopher

More information

The Role of Genetic Testing in the Evaluation of Thyroid Nodules. Thyroid Cancer and FNA. Thyroid Cancer. Pure Follicular Cancers.

The Role of Genetic Testing in the Evaluation of Thyroid Nodules. Thyroid Cancer and FNA. Thyroid Cancer. Pure Follicular Cancers. Where does Molecular Analysis of FNA Specimens fit into the evaluation of thyroid nodules? The Role of Genetic Testing in the Evaluation of Thyroid Nodules Ultrasound TSH Risk factors Jill E. Langer, MD

More information

Athyroid nodule is a palpable

Athyroid nodule is a palpable PRACTICAL THERAPEUTICS Thyroid Nodules MARY JO WELKER, M.D., and DIANE ORLOV, M.S., C.N.P. Ohio State University College of Medicine and Public Health, Columbus, Ohio Palpable thyroid nodules occur in

More information

A new score predicting the survival of patients with spinal cord compression from myeloma

A new score predicting the survival of patients with spinal cord compression from myeloma A new score predicting the survival of patients with spinal cord compression from myeloma (1) Sarah Douglas, Department of Radiation Oncology, University of Lubeck, Germany; sarah_douglas@gmx.de (2) Steven

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT

More information

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka

Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Adiuwantowe i neoadiuwantowe leczenie chorych na zaawansowanego raka żołądka Neoadiuvant and adiuvant therapy for advanced gastric cancer Franco Roviello, IT Neoadjuvant and adjuvant therapy for advanced

More information

Does my patient need more therapy after prostate cancer surgery?

Does my patient need more therapy after prostate cancer surgery? Does my patient need more therapy after prostate cancer surgery? Contact the GenomeDx Patient Care Team at: 1.888.792.1601 (toll-free) or e-mail: client.service@genomedx.com Prostate Cancer Classifier

More information

Treating Thyroid Cancer using I-131 Maximum Tolerable Dose Method

Treating Thyroid Cancer using I-131 Maximum Tolerable Dose Method Treating Thyroid Cancer using I-131 Maximum Tolerable Dose Method Christopher Martel, M.Sc., CHP Lisa Thornhill,, NRRPT, RT(NM) Boston University Medical Center Thyroid Carcinoma New cases and deaths in

More information

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer

Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Protein kinase C alpha expression and resistance to neo-adjuvant gemcitabine-containing chemotherapy in non-small cell lung cancer Dan Vogl Lay Abstract Early stage non-small cell lung cancer can be cured

More information

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Liver Transplantation for Hepatocellular Carcinoma John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Hepatocellular Carcinoma HCC is the 5th most common

More information

Writing Group for the AACE Thyroid Scientific Committee. Bernet V, Hupart KH, Parangi S and Woeber KA

Writing Group for the AACE Thyroid Scientific Committee. Bernet V, Hupart KH, Parangi S and Woeber KA Molecular Diagnostic Testing of Thyroid Nodules with Indeterminate Cytopathology Summary Highlights Writing Group for the AACE Thyroid Scientific Committee Bernet V, Hupart KH, Parangi S and Woeber KA

More information

Clinicopathological features of recurrent papillary thyroid cancer

Clinicopathological features of recurrent papillary thyroid cancer Zhu et al. Diagnostic Pathology (2015) 10:96 DOI 10.1186/s13000-015-0346-5 RESEARCH Open Access Clinicopathological features of recurrent papillary thyroid cancer Jian Zhu 1, Xinli Wang 2, Xiaoxuan Zhang

More information

Thyroid Cancer A Multidisciplinary Approach

Thyroid Cancer A Multidisciplinary Approach Thyroid Cancer A Multidisciplinary Approach Shuvendu Sen, MD, MS, FACP Associate Program Director, Internal Medicine Residency Program Director, Medical Education Raritan Bay Medical Center, Rutgers University

More information

Background. t 1/2 of 3.7 4.7 days allows once-daily dosing (1.5 mg) with consistent serum concentration 2,3 No interaction with CYP3A4 inhibitors 4

Background. t 1/2 of 3.7 4.7 days allows once-daily dosing (1.5 mg) with consistent serum concentration 2,3 No interaction with CYP3A4 inhibitors 4 Abstract No. 4501 Tivozanib versus sorafenib as initial targeted therapy for patients with advanced renal cell carcinoma: Results from a Phase III randomized, open-label, multicenter trial R. Motzer, D.

More information

Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases

Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases I Congresso de Oncologia D Or July 5-6, 2013 Integrating Chemotherapy and Liver Surgery for the Management of Colorectal Metastases Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University

More information

Survival analysis of 220 patients with completely resected stage II non small cell lung cancer

Survival analysis of 220 patients with completely resected stage II non small cell lung cancer 窑 Original Article 窑 Chinese Journal of Cancer Survival analysis of 22 patients with completely resected stage II non small cell lung cancer Yun Dai,2,3, Xiao Dong Su,2,3, Hao Long,2,3, Peng Lin,2,3, Jian

More information

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008

Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,

More information

Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach

Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach Kerry C. Councilman, MD Assistant Professor University of Colorado Denver Goals: BRAF Mutation

More information

The Relationship Between Lymphocytic Infiltration in the Thyroid Gland and Tumor Recurrence in Papillary Thyroid Carcinoma

The Relationship Between Lymphocytic Infiltration in the Thyroid Gland and Tumor Recurrence in Papillary Thyroid Carcinoma Turkish Journal of Endocrinology and Metabolism, (1999) 3 : 113-117 ORIGINAL ARTICLE The Relationship Between Lymphocytic Infiltration in the Thyroid Gland and Tumor Recurrence in Papillary Thyroid Carcinoma

More information

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology

Oncology Annual Report: Prostate Cancer 2005 Update By: John Konefal, MD, Radiation Oncology Oncology Annual Report: Prostate Cancer 25 Update By: John Konefal, MD, Radiation Oncology Prostate cancer is the most common cancer in men, with 232,9 new cases projected to be diagnosed in the U.S. in

More information

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma.

These rare variants often act aggressively and may respond differently to therapy than the more common prostate adenocarcinoma. Prostate Cancer OVERVIEW Prostate cancer is the second most common cancer diagnosed among American men, accounting for nearly 200,000 new cancer cases in the United States each year. Greater than 65% of

More information

Sentinel Lymph Node Mapping for Endometrial Cancer. Locke Uppendahl, MD Grand Rounds

Sentinel Lymph Node Mapping for Endometrial Cancer. Locke Uppendahl, MD Grand Rounds Sentinel Lymph Node Mapping for Endometrial Cancer Locke Uppendahl, MD Grand Rounds Endometrial Cancer Most common gynecologic malignancy in US estimated 52,630 new cases in 2014 estimated 8,590 deaths

More information

Cancer of the Thyroid Explained

Cancer of the Thyroid Explained Cancer of the Thyroid Explained Patient Information Introduction This leaflet tells you about the condition known as thyroid cancer. We hope it will answer some of the questions that you or those who care

More information

Understanding ductal carcinoma in situ (DCIS) and deciding about treatment

Understanding ductal carcinoma in situ (DCIS) and deciding about treatment Understanding ductal carcinoma in situ (DCIS) and deciding about treatment Developed by National Breast and Ovarian Cancer Centre Funded by the Australian Government Department of Health and Ageing Understanding

More information

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases.

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Abstract This paper describes the staging, imaging, treatment, and prognosis of renal cell carcinoma. Three case studies

More information

Molecular Diagnostics in Thyroid Cancer

Molecular Diagnostics in Thyroid Cancer Disclosure Nothing to disclose Jonathan George, MD, MPH Assistant Professor Head and Neck Oncologic & Endocrine Surgery Molecular Diagnostics in Thyroid Cancer Current Practices & Future Trends UCSF Medical

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

Chemotherapy or Not? Anthracycline or Not? Taxane or Not? Does Density Matter? Chemotherapy in Luminal Breast Cancer: Choice of Regimen.

Chemotherapy or Not? Anthracycline or Not? Taxane or Not? Does Density Matter? Chemotherapy in Luminal Breast Cancer: Choice of Regimen. Chemotherapy in Luminal Breast Cancer: Choice of Regimen Andrew D. Seidman, MD Attending Physician Breast Cancer Medicine Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Cornell

More information

Low-dose CT Imaging. Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital

Low-dose CT Imaging. Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital Lung Cancer Screening with Low-dose CT Imaging Edgar Fearnow, M.D. Section Chief, Computed Tomography, Lancaster General Hospital Despite recent declines in the incidence of lung cancer related to the

More information

CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015. 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV

CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015. 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV CANCER PULMON: ESTADIOS INICIALES POSTMUNDIAL PULMON DENVER 2015 8-10-2015.Manuel Cobo Dols S. Oncología Médica HU Málaga Regional y VV Meta-analisis LACE: adyuvancia vs no adyuvancia Pignon JP, et al.

More information

0013-7227/01/$03.00/0 The Journal of Clinical Endocrinology & Metabolism 86(9):4092 4097 Copyright 2001 by The Endocrine Society

0013-7227/01/$03.00/0 The Journal of Clinical Endocrinology & Metabolism 86(9):4092 4097 Copyright 2001 by The Endocrine Society 0013-7227/01/$03.00/0 The Journal of Clinical Endocrinology & Metabolism 86(9):4092 4097 Printed in U.S.A. Copyright 2001 by The Endocrine Society Outcome of Differentiated Thyroid Cancer with Detectable

More information

Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical

Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical Summary. 111 Detection and staging of recurrent prostate cancer is still one of the important clinical problems in prostate cancer. A rise in PSA or biochemical recurrence (BCR) is the first sign of recurrent

More information

European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium

European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium European Journal of Endocrinology (2006) 154 787 803 ISSN 0804-4643 CONSENSUS STATEMENT European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium

More information

GENETICS AND GENOMICS OF THYROID NEOPLASMS MOVING CLOSER TOWARDS PERSONALIZED PATIENT CARE

GENETICS AND GENOMICS OF THYROID NEOPLASMS MOVING CLOSER TOWARDS PERSONALIZED PATIENT CARE Genomics in Medicine Series GENETICS AND GENOMICS OF THYROID NEOPLASMS MOVING CLOSER TOWARDS PERSONALIZED PATIENT CARE Electron Kebebew, MD, FACS Outline To assess the change in thyroid cancer epidemiology

More information