Thyroid Cancer Survivors Research Articles

Income disparities have a significant impact on thyroid cancer recurrence and survival

PurposeIncome inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data. Methods139,302 thyroid cancer patients undergoing surgery from 2000 to 2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (> or <$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality. ResultsHigher-income patients had 26 % lower recurrence odds (OR 0.74, 95 %CI 0.55–0.99, p=0.042) and longer median survival (18.1 vs 17.7 years, p<0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95 %CI=0.81–0.87, p<0.001). Cancer-directed surgery (HR=0.28, 95 %CI=0.26–0.30, p<0.001) and radioactive iodine (HR=0.69, 95 %CI=0.66–0.71, p<0.001) were associated with lower mortality risk. ConclusionsIncome disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.

Predictors of thyroid cancer survival in Saudi Arabia: A retrospective 10-year analysis.

Thyroid cancer (TC) is becoming more prevalent in Saudi Arabia, currently ranking among the top three cancers affecting women. Despite its rising prevalence, there has been limited assessment of the factors influencing the survival rate (SR) among the Saudi population over an extended period. Therefore, this study aims to address this critical gap in knowledge by identifying the factors affecting the SR of TC, comparing the SR with previous studies, and exploring potential areas for improving the SR of patients. A retrospective study analyzed secondary data from patients diagnosed with TC, as recorded in the King Abdulaziz Medical City Cancer Registry in Riyadh, Saudi Arabia, over 10 years from 2009 to 2018. Of the total 665 TC cases, the mean age at diagnosis was 46.2 years (±SD 16), and most patients were women (78.5%), with the majority being under 50 years old. The most common type of cancer was papillary thyroid carcinoma, comprising 88.6% of all TCs. Over half of the cases were localized to one of the lobes of the thyroid gland, with almost equal frequency between the two lobes. The 5-year SR of localized papillary thyroid carcinoma reached 96.5%, in contrast to the extremely low SR of anaplastic thyroid carcinoma, where most patients died within a few months of the diagnosis. Factors such as morphology, tumor extension, male gender, and age at diagnosis significantly impacted patient survival, as analyzed by the Kaplan-Meier test (p < 0.001). Compared to other types of cancer, those with anaplastic thyroid carcinoma had a lower SR. The SR of TC patients is predicted by factors such as their age, morphological type, and the presence of distant metastasis.

8061 Factors Affecting Survival of Metastatic Medullary Thyroid Cancer: A Population-Based Study From Surveillance, Epidemiology, and End Results (SEER) Program

Abstract Disclosure: A. Abdelhameed: None. H. Ibrahim: None. M. Mortagy: None. Introduction: Medullary thyroid cancer (MTC) arises from parafollicular cells of the thyroid. 43% of patients with MTC have metastasis. It was shown that the overall 5-year survival of patients with MTC is 40.4%. The clinical course of MTC is highly variable. The Aim is to identify factors affecting survival of the metastatic MTC sub-population. Understanding these factors is important in treating these patients. Methods 340 patients: with metastatic MTC who were diagnosed from 1975 to 2020 were extracted from SEER after removing duplicates and those not diagnosed by positive histology or cytology. Survival analysis was conducted, and Kaplan-Meier graph was generated. Univariate Cox regression was performed for all variables and respective hazard ratios (HR) were produced. Multivariable cox regression was performed for statistically significant variables. Results: The cohort were 59% males with a median age of 60 years. Median survival for the cohort was 20 months with survival of 63%, 41% and 31% at 1, 3, and 5 years respectively. Univariate Cox regression was statistically significant for age (HR 1.02), brain metastasis (HR 2.70), liver metastasis (1.65), lung metastasis (1.42), not performing total thyroidectomy (HR 2.77), lymph node ratio (HR 2.45), and systemic therapy after surgery (HR 0.34). Univariate Cox regression was not statistically significant for sex, grade, radiotherapy, chemotherapy, treatment delay, bone metastasis, distant lymph node metastasis, multifocal cancer, total number of benign and malignant tumors, race/ethnicity, income, tumor size and living in rural areas. Multivariable cox regression was done after inclusion of all significant variables from univariate Cox regression. It was only significant for age (HR 1.04), presence of lung metastasis (HR 1.91), and systemic therapy before surgery (HR 14.41). Conclusion: Increasing age, presence of lung metastasis and systemic therapy before surgery lead to worse prognosis in metastatic MTC. Gender, grade, radiotherapy, chemotherapy, treatment delay, bone or brain or liver metastasis, presence of multifocal cancer, race, tumor size and surgery don't affect survival according to multivariable cox regression. Future research is needed to study this group of patients. Presentation: 6/2/2024

7161 Similar Progression-Free Survival in Familial Non-medullary Thyroid Cancer and Sporadic Differentiated Thyroid Cancer Patients

Abstract Disclosure: E. Chuki: None. N. Behairy: None. S. Auh: None. A. Makarewicz: None. N. Uttarkar Vikram: None. P. Padmasree: None. C. Cochran: None. S. Gubbi: None. J. Klubo-Gwiezdzinska: None. Background: There is conflicting data on the disease aggressiveness in patients with Familial Non-medullary Thyroid Cancer (FNMTC) as compared with sporadic differentiated thyroid cancer (sDTC). Moreover, limited evidence exists comparing FNMTC and sDTC responsiveness to treatment. Therefore, the goal of this study was to compare response to standard therapy, defined as progression-free survival (PFS), in patients with FNMTC and sDTC. Methods: This was a single-center Institutional Review Board-approved cohort study, including patients diagnosed with FNMTC or sDTC, subjected to standard therapy with a median follow-up of 4.8 years (range 2.1-10 years). Patients with FNMTC were matched to patients with sDTC in a 1:2 ratio using the Ccoptimalmatch package in R based on age, sex, and American Thyroid Association (ATA) risk stratification at presentation. PFS was defined from the date of initial thyroid surgery to the first evidence of progression, assessed by RECIST 1.1 criteria. Demographics, cancer characteristics, and treatment modalities were collected and compared. Kaplan-Meier curves and log-rank tests were employed to assess differences in PFS. SAS 9.4 software was used for analyses, with a p-value set at 0.05. Results: The study consisted of 198 subjects, with 66 patients affected by FNMTC and 132 sDTC cases, aged 43.1±14.3, 69.7% female, 47% low, 45.5% intermediate and 7.6% high ATA risk for recurrence. Within the FNMTC cohort 26 (39.4%) cancer cases were detected by screening. There were no differences in age, sex and ATA risk stratification between the study groups due to exact matching (±1 year for age). No significant differences were observed in histology type (p = 0.49), multifocality (p = 0.59), gross extrathyroidal extension (p = 0.76), or presence of distant metastases (p = 0.09). FNMTC exhibited smaller tumor size at diagnosis (mean 1.2±0.96 vs 1.8±1.5 cm, p &amp;lt; 0.01), and fewer positive lymph nodes (p = 0.02). Initial surgery extent favored more total thyroidectomies in the FNMTC group (p &amp;lt; 0.01), and there was a higher prevalence of repeat neck surgeries in the sDTC group (p = 0.045). There was no difference in utilization of RAI therapy between the groups (p = 0.68). During follow up 15.2% of FNMTC and 12.9% of sDTC patients presented with disease progression. PFS probabilities at 5, 10, 15, 20, and 25 years were similar between both groups (0.8 and 0.85 at 5 years, 0.8 and 0.78 for subsequent years) (p = 0.99). Conclusions: The initial surgical treatment for FNMTC tends to be more extensive than applied in sDTC, despite a smaller tumor size and lower number of metastatic lymph nodes at diagnosis. This strategy could lead to a lower need for repeat neck surgeries. The smaller tumor size at diagnosis of FNMTC might be a result of an active screening of affected families. The similar PFS in patients with FNMTC and sDTC suggests a comparable tumor biology and similar responsiveness to standard therapy. Presentation: 6/3/2024

Survival in Thyroid Cancer in Sweden From 1999 To 2018.

Thyroid cancer (TC) is diagnosed in several histological types which differ in their clinical characteristics and survival. We aim to describe how they influence TC survival in Sweden. Cancer data were obtained from the Swedish cancer registry between years 1999 and 2018, and these were used to analyze relative survival. Relative survival for all TC improved when analyzed in 10-year periods, and female survival improved more than male survival. Female survival advantage appeared to be present also for specific histological types, although case numbers were low for rare types. Female 5-year relative survival for TC was 100% for follicular, 95.1% for oncocytic, 93.4% for papillary, 89.7% for medullary, and 6.1% for anaplastic cancer. Among the clinical TNM classes, only T4 and M1 stages were associated with decreased survival compared to T1-3 and M0. Anaplastic cancer presented most often at high T and M1 stages, in contrast to other TC. Curiously, the diagnostic age for anaplastic M1 patients was lower than that for M0 patients. Both anaplastic and medullary cancers did not show age-dependent increases in the probability of metastases, in contrast to the main histological types. This could indicate the presence of several types of anaplastic and medullary cancers. The poor survival for anaplastic TC is an extreme contrast to the excellent survival of differentiated TC. As less than 20% of anaplastic cancer patients survived one year, urgent diagnosis and initiation of treatment are important. Facilitated treatment pathways have been instituted in Denmark resulting in improved survival. Anaplastic cancer should be a target of a major research focus.

Oncogenic mutations in the TP53 and PI-3 kinase/AKT pathway are independent predictors of survival for advanced thyroid cancer: Analysis from the Molecular Screening and Therapeutics (MoST) program

BackgroundThyroid cancers with mutations in the phosphatidylinositol-3 kinase/AKT pathway have a poorer prognosis. However, knowledge about the relationship between histology, mutation profile, and outcomes is still developing. This study assessed the prognostic value of genomic profiles for patients with advanced thyroid cancer who experienced progression on conventional treatment. MethodsPatients recruited to a national clinical oncology program for treatment-refractory locally advanced, recurrent or metastatic cancers were analyzed. Patients' archival tumor samples underwent comprehensive genomic profiling. Specific oncogenic mutations and the presence of cancer related pathways were correlated with overall survival. ResultsFrom 2018 to 2021, 4,955 patients were recruited, with 44 (0.9%) having a diagnosis of thyroid cancer with 4 medullary and the remaining follicular derived: 17 differentiated, 13 poorly differentiated, and 10 anaplastic thyroid cancers. Of the 40 follicular-derived thyroid cancer samples, 17 (42.5%) carried TP53 mutations, followed by 11 with BRAF V600E (27.5%), 9 with NRAS (22.5%), 9 with mutations in the phosphatidylinositol-3 kinase/AKT pathway (22.5%), and 7 with TERT promoter mutations (17.5%). Both TP53 and phosphatidylinositol-3 kinase/AKT pathway alterations were associated with reduced overall survival (hazard ratio, 5.19; 95% confidence interval, 1.59–16.70, P = .02 and hazard ratio, 10.12; 95% confidence interval, 1.61–63.76, P = .01). Cox regression showed histologic type anaplastic thyroid cancer (hazard ratio, 12.93, P = .004), poorly differentiated thyroid cancer (hazard ratio, 5.19, P = .039), and TP53 and/or phosphatidylinositol-3 kinase/AKT pathway mutations (hazard ratio, 4.73, P = .017) were independently associated with overall survival. ConclusionTP53 and/or phosphatidylinositol-3 kinase/AKT pathway mutations correlated with overall survival independently of histotype in patients with advanced thyroid cancer. Comprehensive genomic profiling has potential to inform prognosis, as well as identifying treatment targets for patients with advanced thyroid cancer.

Predicting overall survival in anaplastic thyroid cancer using machine learning approaches

Predicting overall survival in anaplastic thyroid cancer using machine learning approaches

"No such thing as good cancer": a qualitative exploration of the experience of early-onset thyroid cancer in survivors.

The incidence of thyroid cancer has increased exponentially in recent decades. At the same time, there is a growing concern surrounding the overdiagnosis of indolent thyroid cancer, leading to invasive and potentially unnecessary interventions that can significantly impact young patients' lives. Yet, the experiences of survivors of thyroid cancer have been largely understudied. The purpose of this study was to explore the experiences of survivors of early-onset thyroid cancer. The qualitative research design of hermeneutic phenomenology guided this study. Participants completed a demographic survey and semi-structured interview that was subsequently transcribed verbatim and analyzed using reflexive thematic analysis. Thirty-six survivors of thyroid cancer (83% female, median age at diagnosis: 37.1years, median age at interview: 43.5years) participated. Participants' experiences were characterized by two themes: (1) reconciling the meaning of the "c" word (cancer) as a dangerous and life-threatening diagnosis with lived experience of thyroid cancer and (2) thyroid cancer leaves patients with lifelong physical and emotional scars. Survivors of early-onset thyroid cancer experience significant short and late effects on their physical and psychosocial well-being. Survivors shared some of the difficulties of having to reconcile what they were told was a "good cancer" and their previously held beliefs of cancer, including feeling lost in the healthcare system and like they could not access services or be impacted because they had been told they had "good cancer." Increased communication of risks and acknowledgement of the perceptions surrounding cancer is needed to help patients make better informed decisions and feel supported throughout their thyroid cancer journey. Gaps in care pathways, especially adjustments post-treatment, should be filled to help support these survivors.

558: Impact of Immunotherapy on Overall Survival in Anaplastic Thyroid Cancer

558: Impact of Immunotherapy on Overall Survival in Anaplastic Thyroid Cancer

Improved Survival of Advanced-Stage Anaplastic Thyroid Cancer With Systemic Therapy.

Anaplastic thyroid cancer (ATC) is the most aggressive and fatal thyroid malignancy. Currently, there still exists a paucity of literature studying the relationship between available ATC-targeted therapy, immunotherapy, and survival. We aim to investigate how systemic therapies affect survival outcomes in ATC. A single-tertiary-institution chart review of patients diagnosed with advanced-stage ATC, and who underwent surgery as part of their treatment, was performed between 2000 and 2023, with 41 patients included. Demographics, clinical characteristics, and survival data were collected and analyzed via Kaplan-Meier and Cox proportional hazards analyses. 54% of patients were female, and average age was 67.4 years old. The most common mutations identified were BRAF (15 patients), p53 (9 patients), and p63 (2 patients). A total of 18 patients utilized targeted or immunotherapy, with Trametinib and Dabrafenib (9 patients) as the most common agents used. Two-year overall survival was 24%, and 5-year overall survival was 23%, with median survival time of 7.6 months. Kaplan-Meier analysis demonstrated improved survival in patients who received chemotherapy (p = 0.048). Cox proportional hazards analysis demonstrated that patients treated with immunotherapy or targeted therapy had a statistically significant increase in survival compared with patients who did not receive these therapies (p = 0.016). Additionally, females and those with a p63 mutation demonstrated improved survival outcomes (p = 0.010, p = 0.001). Targeted therapy and immunotherapy use should be strongly considered when treating patients with ATC. Further studies into novel drugs targeting immune checkpoints and combination therapy are needed to better optimize treatment of patients with ATC. 3 Laryngoscope, 2024.

Trends in papillary thyroid cancer mortality in Denmark according to stage and education.

Few studies exist on trends in papillary thyroid cancer (PTC) survival and mortality according to stage and level of socioeconomic status. Nationwide cohort study. Patients diagnosed with PTC during 2000-2015 in Denmark were identified from the Danish Cancer Registry and followed until the end of 2020. We evaluated 5-year all-cause mortality and relative survival according to stage and 5-year mortality rates with corresponding average annual percentage changes (AAPCs) according to stage and education. Finally, we assessed the association between several factors and mortality of PTC using Cox regression. For the 2006 cases of PTC diagnosed during 2000-2015, relative survival tended to increaseand mortality rates tended to decrease for all stages. For localized PTC, mortality rates tended to decrease among individuals with medium education (AAPC = -7.0, 95% confidence interval [CI]: -14.7 to 1.5), but showed an increasing pattern among individuals with long education (AAPC = 19.8, 95%CI: -4.2 to 50.0). For nonlocalized PTC, mortality rates showed a decreasing tendency among individuals with medium and long education (AAPC = -5.5, 95%CI: -13.2 to 2.9, and AAPC = -10.4, 95%CI: -20.8 to 1.4, respectively). Being diagnosed with PTC in a more recent calendar period and long education were associated with a lower mortality rate in the Cox regression analysis. A pattern of an increasing relative survival and decreasing mortality rates of PTC across all stages was seen in Denmark during 2000-2015. The decreasing pattern in mortality rates was most evident in individuals with localized stage and medium education, and in individuals with nonlocalized stage and medium or long education.

Prevalence of drugs used for chronic conditions after diagnosis of thyroid cancer: a register-based cohort study.

Little is known about thyroid cancer survivors' risk of chronic conditions. We, therefore, investigated the prevalence of drugs used for chronic conditions among thyroid cancer patients using population-wide register data. We linked data from the Cancer Registry of Norway to the Norwegian Prescription Database and other databases for a study population of 3.52 million individuals, including 3486 individuals with thyroid cancer diagnosed during 2005-2019. Prevalence ratios (PRs) with 95% CIs of reimbursed prescribed drugs in thyroid cancer patients up to 15 years after thyroid cancer diagnosis were estimated by log-binomial regression, with the cancer-free population as reference. Individuals (both males and females) with thyroid cancer had higher use of drugs for several chronic conditions in the years after diagnosis; eg, 5 years after thyroid cancer diagnosis, there was elevated use of drugs for hypoparathyroidism (PRmales = 35.4, 95% CI, 25.2-49.7; PRfemales = 42.8, 95% CI, 34.2-53.6), hypertension (PRfemales = 1.20, 95% CI, 1.12-1.28), anxiety and tension (PRmales = 4.01, 95% CI, 1.80-8.92; PRfemales = 2.01, 95% CI, 1.15-3.52), gastric acid disorders (PRmales = 1.52, 95% CI, 1.22-1.91; PRfemales = 1.45, 95% CI, 1.27-1.66), and pain (PRmales = 1.48, 95% CI, 1.11-1.97; PRfemales = 1.24, 95% CI, 1.08-1.42) as compared with the cancer-free population. In addition, males with thyroid cancer had long-term elevated use of drugs for depression (eg, year 10+, PRmales = 1.66, 95% CI, 1.06-2.59). Individuals with thyroid cancer also had higher use of drugs for several conditions prior to the thyroid cancer diagnosis, eg, hypertension, gastric acid disorders, and pain. Individuals diagnosed with thyroid cancer had elevated long-term use of drugs for several chronic conditions, as compared with the cancer-free population.

Revisiting the Relationship Between Tumor Size and Risk in Well-Differentiated Thyroid Cancer.

Introduction: Large tumor size is associated with poorer outcomes in well-differentiated thyroid cancer, yet it remains unclear whether size >4 cm alone confers increased risk, independent of other markers of aggressive disease. The goal of this study was to assess the relationship between tumor size, other high-risk histopathological features, and survival in well-differentiated thyroid cancer and to evaluate the significance of 4 cm as a cutoff for management decisions. Methods: Patients with well-differentiated thyroid cancer were identified from the National Cancer Database (2010-2015) and categorized by tumor size (i.e., small [≤4 cm] or large [>4 cm]) and presence of high-risk histopathological features (e.g., extrathyroidal extension). First, propensity score matching was used to identify patients who were similar across all other observed characteristics except for small versus large tumor size, and a multivariable Cox proportional hazards model was used to estimate the relationship between tumor size and survival. Second, we assessed whether the presence of high-risk features demonstrates conditional effects on survival based on the presence of tumor size >4 cm using an interaction term. Finally, additional models assessed the relationship between incremental 1 cm increases in tumor size and survival. Analyses were repeated using a validation cohort from the Surveillance, Epidemiology, and End Results Program (2008-2013). Results: Of 193,133 patients in the primary cohort, 7.9% had tumors >4 cm, and 30% had at least one high-risk feature. After matching, tumor size >4 cm was independently associated with worse survival (HR 1.63, p < 0.001). However, tumor size >4 cm and one or more other high-risk features together yielded worse survival than either size >4 cm alone (MMD: 0.70, p < 0.001) or other high-risk features alone (MMD: 0.49, p < 0.001). When assessed in 1 cm increments, the largest increases in hazard of death occurred at 2 cm and 5 cm, not 4 cm. Results from the validation cohort were largely consistent with our primary findings. Conclusions: Concomitant high-risk features confer worse survival than large tumor size alone, and a 4 cm cutoff is not associated with the greatest increase in risk. These findings support a more nuanced approach to tumor size in the management of well-differentiated thyroid cancer.

Levothyroxine Dosage and the Increased Risk of Second Primary Malignancy in Thyroid Cancer Survivors

Levothyroxine Dosage and the Increased Risk of Second Primary Malignancy in Thyroid Cancer Survivors

Clinical and molecular features and survival in thyroid cancer with brain metastases.

2023 Background: Brain metastases (BM) in advanced thyroid cancer are rare; however, they may be underreported as staging brain imaging is not routine. Prognostic features and molecular alterations for this group are poorly described. We characterized the clinical and molecular features of thyroid cancer with BM and evaluated differences in survival. Methods: In this single-center retrospective analysis, patients with metastatic radioactive iodine refractory well-differentiated, poorly-differentiated, or medullary thyroid carcinoma seen at the Princess Margaret Cancer Center from 2007-2022 were included. Electronic medical records were reviewed to collect clinicopathologic and treatment data. All patients had tumor next-generation sequencing (NGS) by a targeted gene panel. Overall survival (OS) from initial medical oncology consultation was analyzed using the Kaplan-Meier method and univariate and multivariate Cox proportional hazards models. Results: Of 248 patients with advanced thyroid cancer, 41(17%) were diagnosed with BM. The median interval from thyroid cancer diagnosis to BM development was 6.49 years (y) (IQR 3.51- 14.35 y). The median age at the time of BM diagnosis was 63.6 y and 23 (56%) were male. Most (76%) were asymptomatic at the diagnosis of BM and 80% had an ECOG of 0-1. Among patients with well-differentiated histology, 27 (18%) developed BM, while 7 (12%) with poorly-differentiated and 7 (19%) with medullary thyroid cancer developed BM. The most common molecular alterations included BRAFV600E (n=19), TERT (n=11), RAS (n=9), RET (n=8), and FANCA (n=3). Patients were treated with surgery (n=5), stereotactic radiation (n=21), whole brain radiation therapy (n=12), or a combination of both (n=2). OS was similar in patients with BM compared to those without (6.05 vs 6.45 y). There were no differences in histology or molecular alterations between patients that developed BM compared to those who did not. The median survival from the time of BM was 3.23 y. Patients with BM with ≥4 lesions had worse survival (0.52 vs 5.09 y, p=0.01). There were no differences in survival based on histology, symptoms, treatment or molecular alterations among those with BM. Conclusions: This is one of the largest reported thyroid BM cohorts and the first with complete NGS. The prevalence of BM in our cohort was higher than previously described, often diagnosed incidentally. Screening for BM in advanced thyroid cancer may detect higher rates, offering prognostic insights. While the number of BM was predictive of survival, molecular alterations did not predict BM development or survival and larger studies are needed.

Protocolo diagnóstico y tratamiento del nódulo tiroideo

A thyroid nodule consists of the growth of a thyroid lesion that is delimited and distinguished from the normal thyroid parenchyma. Its incidence is increasing due to the increase in imaging tests (incidental thyroid tumors), with no impact on thyroid cancer survival. A thyroid function test with a thyroid stimulating hormone (TSH) measurement should be performed, thus verifying nodule functionality. In addition, an initial approach should be made to the probability of malignancy via a thyroid ultrasound that categorizes each nodule according to the European Thyroid Imaging and Reporting Data System (EU-TIRADS), indicating the risk of malignancy and also the size at which a thyroid cytology (via fine-needle aspiration) should be performed. Cytology allows for classifying the nodules according to the Bethesda categories that will provide an estimate of the risk of malignancy, which will be of utmost importance when deciding on management (observation versus surgery).

Utilizing stereotactic body radiation therapy in combination with tyrosine kinase inhibitors for therapeutic benefit in thyroid cancer.

e18065 Background: Tyrosine kinase inhibitors improve overall survival (OS) and progression free survival (PFS) in metastatic thyroid cancer. Additionally, studies have shown success of hypo-fractionated radiotherapy in controlling local disease not responsive to systemic therapies. However, there is limited data assessing the combined benefits of radiation therapy (RT) and systemic therapy. This study aimed to determine the effects of adding radiation to tyrosine kinase inhibitors (TKIs) for symptomatic locoregional/metastatic iodine-refractory thyroid cancer. Methods: 21 patients with metastatic/loco-regionally advanced thyroid cancer were treated with radiation to areas of symptomatic disease alone or along with continuation of oral TKIs between March 2016 and December 2023. 18 were treated with RT + TKIs, while 3 were treated with RT only. Response to treatment was assessed 3 months post- RT treatment via imaging and clinical examination. The primary endpoint was assessing overall response rate as per RECIST 1.1. Secondary endpoints included local control, adverse effects, progression-free survival, and overall survival. Results: Median age of patients was 70. 12 patients were male, 14 patients had distant metastases. Histologic types include 12 papillary thyroid cancers, 4 anaplastic, and 5 others. 18 patients (85.7%) received treatment to thyroid mass, others were treated for nodal, soft tissue, and/or bone metastases. Most patients (90.5%) received stereotactic body radiation therapy (SBRT), while 2 patients received intensity-modulated radiation therapy (IMRT) due to insurance denial. The regimen that was frequently used (52.4%) was SBRT 800cGy in 5 fractions. 5 patients were treated with lenvatinib, 5 with dabrafenib/trametinib, and 4 with cabozantinib. 4 patients developed severe AEs requiring discontinuation or change in treatment plan. 74% of patients had documented response at 3 months post-treatment. 19 patients had additional follow up imaging and at median follow up of 16 months, 14 patients had continued clinical response with 9 complete responses (47.4%) and 5 partial responses (26.3%). The median duration of disease control at the site of RT was 23.4 months. Treatment was well-tolerated in general. 13/20 (65%) patients completed treatment without any interruptions or delays. Conclusions: SBRT can be effectively and safely administered to achieve durable disease control in patients with aggressive thyroid cancer histology when combined with tyrosine kinase inhibitors. This strategy warrants evaluation in prospective clinical trials.

Thyroid / Video Endocrinology Social Media Editor’s Pick: Mortality Rate and Cause of Death Among Low-Risk Thyroid Cancer Survivors

Thyroid / Video Endocrinology Social Media Editor’s Pick: Mortality Rate and Cause of Death Among Low-Risk Thyroid Cancer Survivors

Time to treatment and follicular thyroid cancer survival: A SEER database analysis.

e13794 Background: Follicular thyroid cancer (FTC) is a prevalent endocrine malignancy, typically managed with surgical resection. Few studies have investigated the optimal time of surgery for FTC at a national registry level. The aim of this study is to examine the impact of delaying surgical intervention on survival in FTC. Methods: Patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with FTC between 2000-2020 were selected. Additional variables were collected including age, sex, race, stage, surgical status, radiation status, time to treatment, household income, and population size. Kaplan-Meier, and one- and five-year logistic regression analyses were performed. Results: A total of 10,478 patients were included of which 95.5% underwent surgical management. There was a 98.3% and 96.4% survival rate at one- and five-years, respectively. On Kaplan-Meier, those who underwent surgery survived longer (p&lt;0.001). Additionally, patients treated within one month of diagnosis survived significantly better than those treated later (p&lt;0.001). On one-year logistic regression, higher staging was associated with worse survival while those who received surgery, radiation, and lived in counties with a median household income &gt;$75,000 had better survival (p’s&lt;0.05). On five-year logistic regression, patients older than 50 years old and higher staging were associated with worse survival while those who received surgery had better survival (p’s&lt;0.001). No differences were observed for time to treatment at one or five years. Conclusions: Our results show that surgical management is associated with improved survival in patients with FTC. On univariate analysis, a duration of one month or less between diagnosis and treatment was associated with improved survival. However, on multivariate analysis, only surgical management, radiation, and median household income &gt;$75,000 were associated with improved survival.

Effect of Rehabilitation Training for Pregnancy Outcomes and Postpartum Quality of Life in Thyroid Cancer Survivors: A Propensity Score-Matched Cohort Study

Effect of Rehabilitation Training for Pregnancy Outcomes and Postpartum Quality of Life in Thyroid Cancer Survivors: A Propensity Score-Matched Cohort Study