Tumori maligni della tiroide

Quadro clinico, diagnostica pre-operatoria, più recenti orientamenti in tema di terapia e follow-up dei diversi tipi istologici del carcinoma tiroideo

Thyroid stunning in clinical practice: Is it a real problem?

Stunning is a phenomenon of reducing 131I uptaking activity by residual or metastatic tissue during the follow-up of patients after total thyroidectomy for differentiated thyroid carcinoma. It was observed at whole body scintigraphy performed after therapeutic dose, administered for remnant ablation, in patients who were previously given a 131I dose for diagnostic purpose. This phenomenon could influence the efficacy of radioisotopic therapy, making it unsuccessful. Stunning was observed also in case of hyperthyroidism treated by fractionated doses of 131I. After a careful revision of literature, Authors report their last 10 years-experience about very few cases of supposed stunning, observed in oncological and hyperthyroidal patients who underwent diagnostic scan and radioiodine therapy. In case of differentiated thyroid carcinoma, we recommended a careful selection of patients who will be given ablative therapy using very low diagnostic doses and administering further therapeutic dose in a short time. In case of hyperthyroidism treatment, it is confirmed the opportunity of a single therapeutic dose with TSH value within the normal range. Because it was found out a very small number of cases in our wide population, we conclude that stunning is not influent in clinical practice, above all if "well- practice" diagnostic-therapeutical procedures are strictly observed

Recidive locoregionali e metastasi a distanza: quali strumenti diagnostici?

Nel follow-up dei carcinomi tiroidei differenziati, che presentano netta prevalenza delle forme papillifere molto spesso a basso richio, il dosaggio della Tg e l'esame ecografico del collo sembrano oggi soddisfare le esigenze diagnostiche. L'esame scintigrafico corporeo globale (WBS) trova indicazione relativa in presenza di AbhTg e assoluta in caso di Tg elevata. La sensibilità di Tg e WBS aumenta significativamente con l'incremento dei valori del TSH. Un valido contributo di imaging può essere offerto da TC e PET in caso di metastasi non captanti il 131I. In presenza di diagnsoi istologica di carcinoma midollare un ruolo fondamentale nel follow-up è assolto dal dosaggio della calcitonina, in condizioni di base e/o sotto stimolo della pentagastrina o del calcio, e da quello del CEA. Le comuni metodiche della diagnostica per immagini (ecografia, TC, RM, PET) possono essere utili in questi casi e in quelli con diagnosi di carcinoma anaplastico

Lymph Node Metastases from Differentiated Thyroid Carcinoma: does Radioiodine still play a role?

Ultrasonography and surgery have now become the elective diagnostic and therapeutic tools for neck lymph node (LN) metastases from differentiated thyroid carcinoma (DTC), reserving radioiodine therapy (RAI) for surgery failures. Aim of the present retrospective study was to evaluate results of RAI in cases of LN metastases displaying 131I uptake over a long-term observation period and its possible role today. From a series of 1276 patients who had undergone surgery for DTC, 130 cases were selected showing 131I uptaking LN metastases, detected during follow-up scans and who were then submitted to surgery and/or RAI. Patients were divided into groups according both to extent of surgery, with/without lymphectomy, and to following treatment and outcome. The initial surgical approach does not seem to significantly influence the outcome. 131I therapy alone, sometimes at low doses, can be very effective in the management of LN metastases detected at Whole Body Scan, but multiple doses are often needed. The age at diagnosis is confirmed as a negative prognostic factor. Considered radioprotection questions, RAI may solve 131I uptaking LN metastases, above all if < 10 mm. For larger LN metastases and in the case of failure of RAI surgical excision is mandatory, while a subsequent therapeutic dose of 131I could be useful to reveal incomplete excision

Our experience on pain palliation of bone metastasis with Sr-89 or Sm-153 in cancer patients resistant to a conventional analgesic therapy. A retrospective study

These retrospective study is aimed to evaluate the efficacy of therapy with Stronthium-chloride 89 (89SrCl) and Samarium 153 conjugated with ethylenediaminetetramethylene phosphonic acid (153Sm–EDTMP) in the palliation of bone pain due to metastatic malignancy. The study refers to a presentation sample of 27 patients with bone metastases caused by different cancers (16 prostate, 5 breast, 6 lung) who were enrolled and followed-up for 11.5 ± 6.3 months. 89SrCl (150MBq) was administered in 17 pts, 153Sm–EDTMP (37 MBq/Kg) in 10 pts. All patients showed multiple metastatic sites of 99Tc-HDP uptake documented by a standard bone scintigraphy. Effectiveness of treatment was evaluated by questionnaires about pain and quality of life, Karnofsky index, specific cancer markers, a post-treatment bone scintigraphy. Presence of flare reaction and haematological toxicity were evaluated too. Questionnaire scores decreased both in patients treated with 89SrCl and in those given 153Sm–EDTM, without significant difference. Karnofsky index significantly increased only in patients with prostate cancer. After therapy, there were no significant changes of tumor marker levels, neither in bone scintigraphic pattern. Flare reaction occurred in 44% of the cases within 2 weeks from the therapy. Remarkable variations of platelets and leukocytes occurred in 33.3% and 18.5% of patients, respectively, independently of the radiopharmaceutical used, but reversed within 6 weeks after therapy. Conclusions. Radionuclide therapy with bone-seeker agents 89Sr and 153Sm in the palliation of painful bone metastases allows a partial/total relief of pain with an improvement of quality of life. No tumoricid effect was found. Haematological toxicity was limited and reversible. Patients with prostate cancer seem to have a higher response rate

Papillary Thyroid Cancer: Time Course of Recurrences During Postsurgery Surveillance.

Context:The current use of life-long follow-up in patients with papillary thyroid cancer (PTC) is based largely on the study of individuals diagnosed and treated in the latter half of the 20th century when recurrence rates were approximately 20% and relapses detected up to 20-30 years after surgery. Since then, however, diagnosis, treatment, and postoperative monitoring of PTC patients have evolved significantly.Objectives:The objective of the study was to identify times to PTC recurrence and rates by which these relapses occurred in a more recent patient cohort.Patients and Design:We retrospectively analyzed follow-up data for 1020 PTC patients consecutively diagnosed in 1990-2008 in 8 Italian hospital centers for thyroid disease. Patients underwent thyroidectomy, with or without radioiodine ablation of residual thyroid tissue and were followed up with periodic serum thyroglobulin assays and neck sonography.Results:At the initial posttreatment (≤12 months) examination, 948 patients had no structural/functional evidence of disease. During follow-up (5.1-20.4 years; median 10.4 years), recurrence (cervical lymph nodes, thyroid bed) was diagnosed in 13 (1.4%) of these patients. All relapses occurred 8 or fewer years after treatment (10 within the first 5 years, 6 within the first 3 years). Recurrence was unrelated to the use/omission of postoperative radioiodine ablation.Conclusion:In PTC patients whose initial treatment produces disease remission (no structural evidence of disease), recurrent disease is rare, and it usually occurs during the early postoperative period. The picture of recurrence timing during the follow-up provides a foundation for the design of more cost-effective surveillance protocols for PTC patients

The prognostic role of end of treatment FDG-PET-CT in patients with diffuse large B cell lymphoma can be improved by considering it with absolute monocyte count at diagnosis

It is well established that some patients with diffuse large B-cell lymphoma (DLBCL) and the negative end of treatment PET-CT (EOT-PET-CT) will relapse, while a proportion with positive uptake can still obtain long-term EFS. We reviewed data of 200 consecutive, previously untreated patients with DLBCL recorded in Italy and Israel between 2007 and 2015. We found that patients with negative EOT-PET-CT with AMC &gt; 630/mmc have a 3-years EFS of 72%, compared to those with AMC 64 630/mmc that have an EFS of 84%. Furthermore, considering patients with positive EOT-PET-CT, those with AMC &gt; 630/mmc have a 3-years EFS of 8%, while those with AMC 64 630/mmc have an EFS of 38%. Thus, it appears that combining the gold standard for response evaluation EOT-PET-CT with a simple and inexpensive parameter like AMC at diagnosis, further improves prognostication in DLBCL. Applying this simple method can be useful for all doctors working in lymphoma clinical practice