Thyroid Lobectomy for Low to Intermediate Risk Differentiated Thyroid Cancer

Many recent publications and guidelines have promoted a “more is less” approach in terms of treatment for low to intermediate risk differentiated thyroid cancer (DTC), which comprise the vast majority of thyroid cancers: less extensive surgery, less radioactive iodine, less or no thyroid hormone suppression, and less frequent or stringent follow-up. Following this approach, thyroid lobectomy has been proposed as a means of decreasing short- and long-term postoperative morbidity while maintaining an excellent prognosis for tumors meeting specific macroscopic and microscopic criteria. This article will examine the pros and cons of thyroid lobectomy for low to intermediate risk cancers and discuss, in detail, criteria for patient selection and oncological outcomes

Anti-angiogenic Tyrosine Kinase Inhibitors: occurrence and risk factors of hemoptysis in refractory thyroid cancer

BACKGROUND: Anti-angiogenic Tyrosine Kinase Inhibitors (TKI) are the mainstay of advanced thyroid cancer (TC) treatment. Concern is rising about TKI-related toxicity. OBJECTIVE: to determine the incidence and to investigate the risk factors of hemoptysis in TC patients during TKI treatment. METHODS: We analyzed consecutive TC patients treated with TKI in our center between 2005 and 2013 and performed an independent review of CT-scan images for airway invasion assessment. Occurrence of grade 1-2 or grade 3-5 hemoptysis according to CTCAE version 4.03 and risk factors for hemoptysis were investigated. RESULTS: 140 patients (89 males, median age: 52 years) with medullary (56%), differentiated (33%) and poorly differentiated TC (11%) were enrolled. Thyroidectomy±neck dissection was performed in 123 patients and neck/mediastinum external-beam radiotherapy (EBRT) in 41 (32% with therapeutic purpose and 68% with adjuvant purpose). Patients received from 1 to 4 lines of TKI (median 1). Median follow-up was 24 months. Airway invasion was found in 65 (46%) cases. Hemoptysis occurred in 9 patients: grade 1-2 in 7 cases (5%) and grade 3-5 in 2 (1.4%) cases (fatal in one). Hemoptysis was associated with presence of airway invasion [p= 0.04], poorly differentiated pathology [0.03], history of therapeutic EBRT [p= 0.003] and thyroidectomy without neck dissection [p= 0.02]. CONCLUSION: Airway invasion, poorly differentiated pathology, therapeutic EBRT and thyroidectomy without neck dissection are associated with and increased risk of hemoptysis in TC patients during anti-angiogenic TKI treatment. Further research is needed to confirm this data and to sort out interactions between these risk factors. A careful assessment of airway invasion is mandatory before TKI introduction