Recurrent Well-differentiated Thyroid Cancer Research Articles

Risk Factors and Outcomes of Postoperative Recurrent Well-Differentiated Thyroid Cancer: A Single Institution's 15-Year Experience.

Identify risk factors and outcomes of recurrent well-differentiated thyroid cancer. Retrospective case-control analysis. Tertiary care academic center in Nashville, Tennessee. This single-center analysis reviews 478 patients who underwent initial surgical management of well-differentiated thyroid carcinoma between 2002 and 2017. Patients were dichotomized with or without recurrent well-differentiated thyroid cancer. Demographic and clinicopathologic risk factors were carefully reviewed. Univariate, multiple regression, and survival analyses were used to evaluate predictors of recurrence. Thirty-eight patients (7.9%) who received initial surgical intervention for well-differentiated thyroid carcinoma at our institution recurred, with an average time to recurrence of 24 months. Male sex, tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, number of positive lymph nodes, and low lymph node yield were all significantly associated with locoregional recurrence (P < .05). Multiple regression analysis showed that extrathyroidal extension, number of positive lymph nodes, and low lymph node yield were independent factors predictive of posttreatment recurrence (P < .05). Metastatic lymph node ratio, the ratio of positive lymph nodes extracted to lymph node yield, of ≥0.3 is associated with increased risk of recurrence (P < .001) and decreased 5-year recurrence free survival (P < .001). Extrathyroidal extension, number of positive lymph nodes, and low lymph node yield are independent clinicopathologic risk factors for postoperative recurrence of well-differentiated thyroid cancer. Metastatic lymph node ratio is uncommonly used but can be an important prognosticator of recurrence. Patients with metastatic lymph node ratio ≥0.3 should be counseled on their increased risk of recurrence and should undergo close surveillance following surgery.

Revision central neck dissection

Recurrent well-differentiated thyroid cancer is an important problem and incidence is on the rise. Recurrence preferentially involves lymph nodes of the central and lateral neck. Detection and surveillance of such disease is commonly performed via serum thyroglobulin and high-frequency neck ultrasonography. Management options include: active surveillance, local ablative techniques, RAI, external beam radiotherapy, and surgery. The gold standard of care is surgical removal in the form of comprehensive neck dissection. Although revision surgery in the neck does carry increased risk, the use of well-established techniques can decrease this risk and allow surgeons to safely and effectively treat patients with recurrent neck disease.

18F‐fluorodeoxyglucose and 131I Radioguided Surgical Management of Thyroid Cancer

To describe a technique that assists in the surgical management of recurrent local regional well-differentiated thyroid cancer (WDTC). Case series with chart review. Two academic health centers from 2001 to 2009. Patients operated upon by the senior surgeon (BCS) for recurrent WDTC. Thirteen patients with recurrent WDTC were operated upon with radioguided surgical (RGS) technique to indentify recurrence for excision. Eight patients had iodine avid disease and were candidates for RGS with (131)I. The remaining 5 patients had cancer with a proven loss of iodine avidity and were, therefore, operated upon with a fluorodeoxygluocose (FDG) RGS technique. RGS is a feasible approach to identify recurrent disease in an operated field and ensure its successful excision. Although focal disease may be identified with this technique, this is not a tool for limited excisions ("berry picking").

Ultrasound-Guided Needle Localization of Recurrent Paratracheal Thyroid Cancer

Ultrasound-guided needle localization techniques have been used to direct the resection of targeted axillary lymph nodes in the management of breast cancer. To date, there has been only one other description of this technique as a localization method to direct cancer resection in the neck. We offer further support for the broader application of this technique by reporting its use in the successful identification and resection of recurrent papillary thyroid cancer after a paratracheal node dissection failed to localize the cancer. We report a case and discuss the relevant literature regarding ultrasound-guided localization and resection of recurrent well-differentiated thyroid cancer. We were able to achieve successful identification and resection of recurrent papillary thyroid cancer using this technique. This technique may be useful in the treatment of selected cases of recurrent thyroid cancer to increase the efficacy and safety of surgical resection.

Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma.

To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC). RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC. Twenty patients underwent treatment of biopsy-proven recurrent WTC in the neck. Sixteen of these patients had lesions treated by ultrasound-guided RFA (mean size, 17.0 mm; range, 8-40 mm), while 6 had ultrasound-guided EtOH injection treatment (mean size, 11.4 mm; range, 6-15 mm). Four patients underwent RFA treatment of focal distant metastases from WTC. Three of these patients had CT-guided RFA of bone metastases (mean size, 40.0 mm; range, 30-60 mm), and 1 patient underwent RFA for a solitary lung metastasis (size, 27 mm). Patients were then followed with routine ultrasound, I whole body scan, and/or serum thyroglobulin levels for recurrence at the treatment site. No recurrent disease was detected at the treatment site in 14 of the 16 patients treated with RFA and in all 6 patients treated with EtOH injection at a mean follow-up of 40.7 and 18.7 months, respectively. Two of the 3 patients treated for bone metastases are free of disease at the treatment site at 44 and 53 months of follow-up, respectively. The patient who underwent RFA for a solitary lung metastasis is free of disease at the treatment site at 10 months of follow-up. No complications were experienced in the group treated by EtOH injection, while 1 minor skin burn and 1 permanent vocal cord paralysis occurred in the RFA treatment group. RFA and EtOH ablation show promise as alternatives to surgical treatment of recurrent WTC in patients with difficult reoperations. Further long-term follow-up studies are necessary to determine the precise role these therapies should play in the treatment of recurrent WTC.

Prognostic Implications of Site of Recurrence in Patients with Recurrent Well-Differentiated Thyroid Cancer

The site of treatment failure in patients with recurrent well-differentiated thyroid carcinoma (WDTC) has implications for both the mode of salvage therapy and disease-specific prognosis. The objective of this study was to evaluate the prognostic significance of the site of failure in patients with recurrent WDTC. Patients with recurrent thyroid cancer were identified retrospectively from 1963 to 2000. Data were retrieved from the thyroid cancer database at the Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto (1963-2000). Patients were placed into four different groups according to their site of recurrence: group 1, local recurrence; group 2, regional recurrence; group 3, distant recurrence; and group 4, unspecified recurrence. Patient, tumour, and treatment data were collected and compared. The Kaplan-Meier method was used to calculate survival data, and curves were compared using the log rank test. Outcome included alive, no disease; alive with disease; dead, no disease; and dead of disease. Seventy-three patients (21 male, 52 female; median age 44 years, range 18-84 years) were eligible for inclusion in this study. Relevant data were divided according to group 1, 22 patients; group 2, 24 patients; group 3, 13 patients; and group 4, 14 patients. The groups were comparable in terms of primary tumour and treatment factors. The actuarial disease-specific survival rate after salvage therapy was less significant in patients who developed a distant recurrence versus a local recurrence, a regional recurrence, or an unspecified recurrence (ie, 66% vs 95%, 88%, and 92%, respectively; p = .06). Patients with distant recurrences have a poor prognosis, with a significant reduction in the actuarial disease-specific survival rate.

Radiofrequency ablation of regional recurrence from well-differentiated thyroid malignancy

Background. Regional recurrence of well-differentiated thyroid cancer (WTC) is primarily detected with ultrasonography (US), and current treatment is surgical. Radiofrequency ablation (RFA) has been used primarily for liver tumors as an alternative to a surgical procedure. We have applied RFA to a group of patients with locally recurrent WTC. Methods. Eight patients underwent percutaneous RFA for biopsy-proven recurrent WTC in the neck (mean size, 2.4 cm; range, 0.8-4.0 cm) while under intravenous conscious sedation and with US guidance. The RF electrode was inserted into the site of recurrence and treated with the maximum allowable current for between 2 and 12 minutes. Follow-up consisted of US in 8 patients, thyroglobulin levels in 6 patients, biopsy in 4 patients, and surgical treatment in 2 patients. Results. All 8 patients with no bleeding or infectious complications were treated as outpatients. A minor skin burn and 1 vocal cord paralysis occurred. No recurrent disease at the treatment site was detected, with a mean follow-up of 10.3 months. Histological examination showed no evidence of a tumor in the treated lymph nodes in 6 patients. Follow-up US examinations showed disappearance of previously detected color Doppler flow, as well as mass shrinkage and internal cystic change, or both. Conclusions. US-guided RFA is an exciting new treatment modality that appears to have a future role in treating locally recurrent WTC. (Surgery 2001;130:971-7.)