Thyroid metastasectomy.

Metastases to the thyroid gland are uncommon. Renal, lung, breast, and colon cancer and melanoma are the most common primary diseases implicated. Few retrospective series have been reported.

A phase 1 study of everolimus + weekly cisplatin + intensity modulated radiation therapy in head-and-neck cancer.

Purpose: Elevated expression of eukaryotic protein synthesis initiation factor 4E (eIF4E) in histologically cancer-free margins of resected head and neck squamous cell carcinomas (HNSCCs) is mediated by mammalian target of rapamycin complex 1 (mTORC1) and has been associated with increased risk of disease recurrence. Preclinically, inhibition of mTORC1 with everolimus sensitizes cancer cells to cisplatin and radiation.

Methods And Materials: This was single-institution phase 1 study to establish the maximum tolerated dose of daily everolimus given with fixed dose cisplatin (30 mg/m(2) weekly × 6) and concurrent intensity modulated radiation therapy for patients with locally and/or regionally advanced head-and-neck cancer.

Surgical decision making in the management of well-differentiated thyroid cancer.

The incidence of thyroid cancer in the United States has been increasing. The biologic behavior of well-differentiated thyroid cancer (WDTC) can vary from indolent tumor to an aggressive disease with invasion of critical structures and/or widespread distant metastasis. Therefore, the risk stratification is crucial in understanding the biology of thyroid cancer, its prognosis and appropriate therapeutic interventions.

The controversy in the management of the N0 neck for squamous cell carcinoma of the maxillary sinus.

Squamous cell carcinoma (SCC) of the maxillary sinus is a relatively rare disease. As the reported incidence of regional metastasis varies widely, controversy exists as to whether or not the N0 classified neck should be treated electively. In this review, the data from published series are analyzed to decide on a recommendation of elective treatment of the neck in maxillary SCC.

The results of selective use of radioactive iodine on survival and on recurrence in the management of papillary thyroid cancer, based on Memorial Sloan-Kettering Cancer Center risk group stratification.

Background: The American Thyroid Association guidelines recommend the routine use of radioactive iodine for remnant ablation (RRA) in all T3 or greater primary tumors, and selective use in patients with intrathyroidal disease >1 cm, or evidence of nodal metastases. The guidelines recognize that there is conflicting and inadequate data to make firm recommendations for most patients. The aim of this study was to analyze our institutional experience of the use of RRA in the management of papillary thyroid cancer, with a particular focus on outcomes for those patients selected not to receive RRA.

Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature.

One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility.

Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials.

Neuromonitoring in thyroid surgery has been employed to make nerve identification easier and decrease the rates of laryngeal nerve injuries. Several individual randomized controlled trials (RCTs) have been published, which did not identify statistical differences in the rates of recurrent laryngeal nerve (RLN) or external branch of the superior laryngeal nerve (EBSLN) injuries. The objective of this report is to perform meta-analysis of the combined results of individual studies to measure the frequency of RLN and EBSLN injuries in patients who underwent thyroidectomy with routine neuromonitoring in comparison with common practice of search and identification.

Anaplastic thyroid cancer.

Purpose: Anaplastic thyroid cancer (ATC) is a lethal disease causing a global disproportionate number of thyroid cancer-related deaths. The American Thyroid Association (ATA) has recently produced clear and comprehensive guidelines to assist physicians treating ATC.

Methods: The recent ATA guideline publication was reviewed.

Management of regional nodes in thyroid cancer.

Thyroid cancer metastasizes to regional lymph nodes early and often. The impact of these metastases on outcome depends on the histological subtype and the size, number and location of those metastases, as well as patient's age. Whilst clinically apparent lateral nodal metastases have a significant impact on both survival and recurrence, microscopic metastases to the central as well as lateral neck in well differentiated thyroid cancer (WDTC) do not affect outcome.

Targeted therapy in thyroid cancer.

Purpose Of Review: Recent advances in the understanding of the biological basis for thyroid cancer have identified molecular changes in thyroid cancer cells. These changes form the basis for targeted therapies, which have been investigated with some success in patients with advanced, inoperable thyroid cancers and are the subject of this review.

Recent Findings: For patients with advanced differentiated thyroid cancers, sorafenib, selumetinib, pazopanib and sunitinib have been investigated with promising results.

Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence.

An area of ongoing controversy in the management of patients with differentiated thyroid cancer is the role of prophylactic central neck dissection (pCND). This review describes the natural history of differentiated thyroid cancer and provides the limited data regarding the role of routine pCND. An evidence-based analysis was performed of the rationale for routine pCND was performed, including reduced rates of central neck recurrence, reduced morbidity with secondary central neck lymphadenectomy, improved rates of postoperative athyroglobulinemia, and improved stratification of radioactive iodine (RAI) dosage.

Selective use of radioactive iodine in intermediate-risk papillary thyroid cancer.

OBJECTIVE To describe the outcomes with the selective use of radioactive iodine (RAI) in patients who are at intermediate risk of death from papillary thyroid cancer, focusing on 2 subgroups: patients older than 45 years with low-risk tumors and patients younger than 45 years with high-risk tumors. DESIGN Retrospective case review. SETTING Tertiary referral US cancer center.

Poorly differentiated thyroid carcinoma presenting with gross extrathyroidal extension: 1986-2009 Memorial Sloan-Kettering Cancer Center experience.

Purpose: To describe the outcome of patients with poorly differentiated thyroid cancer (PDTC) presenting with gross extrathyroidal extension (ETE).

Materials And Methods: After obtaining Institutional Review Board approval, we performed a retrospective review of a consecutive series of thyroid cancer patients treated by primary surgical resection with or without adjuvant therapy at Memorial Sloan-Kettering Cancer Center from 1986 to 2009. Out of 91 PDTC patients, 27 (30%) had gross ETE (T4a), and they formed the basis of our study.

Evaluation of romidepsin for clinical activity and radioactive iodine reuptake in radioactive iodine-refractory thyroid carcinoma.

Background: Historically, systemic therapy for radioactive iodine (RAI)-refractory thyroid cancer has been understudied. Available drugs have modest efficacy. Romidepsin is a histone deacetylase inhibitor with potent antitumor effects both in vitro and in vivo.

Undetectable thyroglobulin after total thyroidectomy in patients with low- and intermediate-risk papillary thyroid cancer--is there a need for radioactive iodine therapy?

Background: The efficacy of radioactive iodine therapy (RAI) in patients who have an undetectable thyroglobulin (Tg) level after total thyroidectomy in well-differentiated papillary thyroid cancer (PTC) is questionable. The objectives of this study were to report the risk of recurrence in patients with PTC who had an undetectable Tg level after total thyroidectomy managed with postoperative RAI and without RAI.

Methods: After approval by the institutional review board, 751 consecutive patients who had total thyroidectomy for PTC as well as postoperative Tg measurement were identified from our institutional database of 1163 patients treated for well-differentiated thyroid carcinoma at Memorial Sloan Kettering Cancer Center between 1999 and 2005.

American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer.

Background: Anaplastic thyroid cancer (ATC) is a rare but highly lethal form of thyroid cancer. Rapid evaluation and establishment of treatment goals are imperative for optimum patient management and require a multidisciplinary team approach. Here we present guidelines for the management of ATC.

Changing trends in well differentiated thyroid carcinoma over eight decades.

Introduction: The incidence of well differentiated thyroid cancer (WDTC) is rising in the USA. The objective of this study is to present the changes in incidence, presentation, management and outcomes of WDTC within our institution over the past 8 decades.

Methods: 2797 patients managed between 1932 and 2005 at Memorial Sloan Kettering Cancer Center were identified from our institutional database.