Response to initial therapy predicts clinical outcomes in medullary thyroid cancer.

Background: Risk stratification in medullary thyroid cancer (MTC) has traditionally relied on standardized anatomic staging systems that, despite providing valuable prognostic information, do not adequately predict the risk of persistent or recurrent disease. As dynamic risk stratification has been demonstrated to be clinically valuable in nonmedullary thyroid cancer, we adapted our response to therapy definitions in order to apply them to MTC. In this study, we evaluate and compare the clinical utility of our previously proposed MTC response to therapy stratification with a traditional standardized anatomic staging system.

Association between BRAF V600E mutation and recurrence of papillary thyroid cancer.

Purpose: To investigate the prognostic value of BRAF V600E mutation for the recurrence of papillary thyroid cancer (PTC).

Patients And Methods: This was a retrospective multicenter study of the relationship between BRAF V600E mutation and recurrence of PTC in 2,099 patients (1,615 women and 484 men), with a median age of 45 years (interquartile range [IQR], 34 to 58 years) and a median follow-up time of 36 months (IQR, 14 to 75 months).

Results: The overall BRAF V600E mutation prevalence was 48.

Central lymph node characteristics predictive of outcome in patients with differentiated thyroid cancer.

Background: The aim of our study was to determine central compartment lymph node (LN) characteristics predictive of outcomes in patients with differentiated thyroid cancer (DTC) and pathologically confirmed positive central LNs, in the absence of lateral neck disease or distant metastases at presentation.

Methods: An institutional database of 3664 previously untreated patients with DTC operated between 1986 and 2010 was reviewed. Six hundred patients with central compartment nodal disease on histopathology were identified.

Management of recurrent/persistent nodal disease in patients with differentiated thyroid cancer: a critical review of the risks and benefits of surgical intervention versus active surveillance.

Background: The primary goals of this interdisciplinary consensus statement are to define the eligibility criteria for management of recurrent and persistent cervical nodal disease in patients with differentiated thyroid cancer (DTC) and to review the risks and benefits of surgical intervention versus active surveillance.

Methods: A writing group was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with identifying the important clinical elements to consider when managing recurrent/persistent nodal disease in patients with DTC based on the available evidence in the literature and the group's collective experience.

Summary: The decision on how best to manage individual patients with suspected recurrent/persistent nodal disease is challenging and requires the consideration of a significant number of variables outlined by the members of the interdisciplinary team.

Prevalence of diabetes mellitus in patients with newly evaluated papillary thyroid cancer.

Background: This study investigates whether diabetes mellitus is a risk factor for the development of papillary thyroid cancer, using an age-, gender-, and race-matched analysis.

Methods: We retrospectively reviewed the charts of 1559 patients with newly evaluated thyroid cancer over a 4-year period at our institution and identified 1313 patients (84%) with papillary thyroid carcinoma. Characteristics of patients with diabetes versus those without diabetes were compared with a chi-square test for categorical variables and the Wilcoxon Rank Sum test for numeric variables.

Level 7 disease does not confer worse outcome than level 6 disease in differentiated thyroid cancer.

Background: Level 7 nodal disease increases patients from N1a to N1b in the American Joint Committee on Cancer (AJCC) TNM classification of differentiated thyroid cancers (DTCs). This results in upstaging of patients older than 45 years of age from stage III to IV. Our objective was to determine if patients with level 7 disease had poorer outcome in comparison to patients with isolated level 6 disease.

Multi-organ distant metastases confer worse disease-specific survival in differentiated thyroid cancer.

Background: Differentiated thyroid cancer (DTC) is usually associated with an excellent prognosis. With appropriate management of disease in the neck, death from thyroid cancer is more commonly related to the impact of distant metastases rather than locoregional recurrence. However, many patients with distant metastases can have very long periods of progression-free survival.

Ablative therapy for esophageal dysplasia and early malignancy: focus on RFA.

Ablative therapies have been utilized with increasing frequency for the treatment of Barrett's esophagus with and without dysplasia. Multiple modalities are available for topical ablation of the esophagus, but radiofrequency ablation (RFA) remains the most commonly used. There have been significant advances in technique since the introduction of RFA.

Preoperative neck ultrasound in clinical node-negative differentiated thyroid cancer.

Background: The impact of preoperative neck ultrasound (US) on management of the lateral neck in patients with differentiated thyroid cancer is unclear. The objective of this study was to assess the impact of preoperative neck US on the rate of lateral neck dissection in clinical N0 neck and initial response to therapy.

Methods: An institutional review board-approved retrospective review of 890 patients that had thyroid surgery for differentiated thyroid cancer between 2009 and 2010 was performed at our institution.

What is the gold standard for comprehensive interinstitutional communication of perioperative information for thyroid cancer patients? A comparison of existing electronic health records with the current American Thyroid Association recommendations.

Background: Appropriate management of well-differentiated thyroid cancer requires treating clinicians to have access to critical elements of the patient's presentation, surgical management, postoperative course, and pathologic assessment. Electronic health records (EHRs) provide an effective method for the storage and transmission of patient information, although most commercially available EHRs are not intended to be disease-specific. In addition, there are significant challenges for the sharing of relevant clinical information when providers involved in the care of a patient with thyroid cancer are not connected by a common EHR.

External beam radiotherapy with or without concurrent chemotherapy in advanced or recurrent non-anaplastic non-medullary thyroid cancer.

Background And Objectives: To review clinical outcomes and toxicities in locally advanced differentiated thyroid cancer patients treated with external beam radiotherapy (EBRT) with or without concurrent chemotherapy (CCRT).

Methods: Between 1990 and 2012, 66 patients with gross residual/unresectable non-anaplastic non-medullary thyroid cancer were treated with EBRT.

Results: The median overall survival was 42.

Update on differentiated thyroid cancer staging.

In this review, we demonstrate how initial estimates of the risk of disease-specific mortality and recurrent/persistent disease should be used to guide initial treatment recommendations and early management decisions and to set appropriate patient expectations with regard to likely outcomes after initial therapy of thyroid cancer. The use of ongoing risk stratification to modify these initial risk estimates is also discussed. Novel response to therapy definitions are proposed that can be used for ongoing risk stratification in thyroid cancer patients treated with lobectomy or total thyroidectomy without radioactive iodine remnant ablation.

The impact of nodal status on outcome in older patients with papillary thyroid cancer.

Background: The impact of clinically or radiologically detected nodal metastases on survival in patients with papillary thyroid cancer (PTC) is controversial but seems more important and relevant in older patients. The objective of this study was to determine the impact of clinically or radiologically detected nodal metastases on outcome in patients 45 years of age or older.

Methods: Retrospective analysis of 834 patients 45 years or older who underwent operation for PTC between 1986 and 2005.

Summary of proceedings of the second World Congress on Thyroid Cancer.

The second World Congress on Thyroid Cancer was held from July 10 to July 14, 2013, in Toronto, Canada. Its purpose was to provide a platform for the multidisciplinary discussion on research, education, and patient management of thyroid malignancy. Herein, we summarize the latest major trends and controversies within the field of thyroid oncology as discussed in the Congress including the use of ultrasound, standardization of cytology, role of molecular testing, treatment options for small recurrence including ablation and observation, management of recurrent laryngeal nerve injury, importance of identification of the external branch of the superior laryngeal nerve, role of minimally invasive thyroid surgery, trends in radioactive iodine treatment, advancements in targeted agents, and the importance of personalizing treatment to individual patients.

Higher administered activities of radioactive iodine are associated with less structural persistent response in older, but not younger, papillary thyroid cancer patients with lateral neck lymph node metastases.

Background: While radioactive iodine (RAI) adjuvant therapy is commonly recommended for most papillary thyroid cancer patients presenting with large volume nodal involvement, it remains unclear if such therapy impacts the disease-specific recurrence rate and overall survival. In this study, we compared the risk of achieving a structural persistent response after low administered activity (100 mCi), intermediate administered activity (150 mCi), and high administered activity (>200 mCi) RAI adjuvant therapy in patients presenting with pathologic N1b disease.

Methods: This was a retrospective review of 181 papillary thyroid cancer patients with N1b disease treated with total thyroidectomy, neck dissection, and RAI remnant ablation.

Anaplastic thyroid carcinoma: a 25-year single-institution experience.

Background: Anaplastic thyroid carcinoma (ATC) is among the most aggressive solid tumors accounting for 1-5 % of primary thyroid malignancies. In this retrospective review, we aim to evaluate the prognostic factors, treatment approaches, and outcomes of patients with ATC treated at a single institution.

Materials And Methods: We retrospectively identified 95 patients with ATC from an institutional database between 1985 and 2010.

Outcomes in patients with poorly differentiated thyroid carcinoma.

Background: Poorly differentiated thyroid cancer (PDTC) accounts for only 1-15% of all thyroid cancers. Our objective is to report outcomes in a large series of patients with PDTC treated at a single tertiary care cancer center.

Methods: A total of 91 patients with primary PDTC were treated by initial surgery with or without adjuvant therapy at Memorial Sloan-Kettering Cancer Center from 1986 to 2009.

Improving the quality of thyroid cancer care: how does the Thyroid Cancer Care Collaborative cross the Institute of Medicine's Quality Chasm?

Background: The current systems of healthcare delivery in the United States suffer from problems that often leave patients with inadequate quality of care. In their report entitled "Crossing the Quality Chasm," the Institute of Medicine (IOM) identified reasons for poor and/or inconsistent quality of healthcare delivery and provided recommendations to improve it. The purpose of this review is to describe features of an innovative web-based program called the Thyroid Cancer Care Collaborative (TCCC) and see how it addresses IOM recommendations to improve the quality of healthcare delivery.

Hospital-based, acute care encounters after radiofrequency ablation of hepatic tumours.

Background: The use of radiofrequency ablation (RFA) for cancer is increasing; however, post-discharge outcomes have not been well described. The aim of the present study was to determine rates of hospital-based, acute care utilization within 30 days of discharge after RFA.

Methods: Using state-level data from California, patients were identified who were at least 40 years of age who underwent RFA of hepatic tumours without a concurrent liver resection from 2007-2011.

Thyroid Lobectomy Is Associated with Excellent Clinical Outcomes in Properly Selected Differentiated Thyroid Cancer Patients with Primary Tumors Greater Than 1 cm.

Background and Objective. An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature. However, controversies about the ideal surgical approach remain an important issue with regard to the impact on prognosis and follow-up strategies.

Biomechanical Analysis of Concealed Pack Load Influences on Terrorist Gait Signatures Derived from Gröbner Basis Theory.

This project examines kinematic gait parameters as forensic predictors of the influence associated with individuals carrying concealed weighted packs up to 20% of their body weight. An initial inverse dynamics approach combined with computational algebra provided lower limb joint angles during the stance phase of gait as measured from 12 human subjects during normal walking. The following paper describes the additional biomechanical analysis of the joint angle data to produce kinetic and kinematic parameters further characterizing human motion.