Venous obstruction of thyroid malignancy origin: the Antoine Lacassagne Institute experience

<p>Abstract</p> <p>Background and aims</p> <p>To show the benefits of Ultrasonography in the diagnosis of great vein involvement in the neck and mediastinum in thyroid malignancies (primary or secondary) in our experience and to report patient outcomes.</p> <p>Methods</p> <p>Clinical data were collected from the thyroid unit database of the Antoine Lacassagne Institute.</p> <p>Results</p> <p>Of 1171 patients with thyroid cancer treated at our institution over the last 18 years, we retrospectively identified nine patients (0.8%), three women and six men, aged 34–81 years (median age: 70 years) presenting with malignant thyroid tumor of median diameter 45 mm (range: 23–87) having venous obstruction of thyroid malignancy origin. Two patients underwent multimodal therapy. All other patients underwent external beam radiation therapy alone ± chemotherapy or palliative care. Ultrasound (US) provided particularly useful information on venous involvement characteristics. Median survival was 7 months and median progression-free survival was 6 months. Survival in our series was worse than that of previously reported series despite diagnosis of vein involvement at an early stage in 2/3 cases using US.</p> <p>Conclusion</p> <p>Despite small numbers of patients, it seems that aggressive treatment modalities including surgery are required to improve survival. In our experience, US was a useful non-invasive method to describe tumor extensions to great veins of the neck (invasion versus compression, tumor thrombus versus blood clot) and should be recommended to depict early venous invasion in cases of suspected thyroid malignancy.</p

Association entre facteurs de risque génétique de thrombophilie et âge (Etude PATHROS) (thèse)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Quality of life, clinical outcomes and safety of early prophylactic ă levothyroxine administration in patients with Graves' hyperthyroidism ă undergoing radioiodine therapy: a randomized controlled study

International audienceObjective: While radioiodine therapy is commonly used for treating ă Graves' disease, a prolonged and clinical hypothyroidism may result in ă disabling symptoms leading to deterioration of quality of life (QoL) of ă patients. Introducing levothyroxine (LT4) treatment in the early ă post-therapeutic period may be an interesting approach to limit this ă phenomenon. ă Methods: A multicenter, prospective, open-label randomized controlled ă trial enrolled 94 patients with Graves' hyperthyroidism randomly ă assigned to the experimental group (n=46) (group A: early prophylactic ă LT4 treatment) or the control group (n=48) (group B: standard ă follow-up). The primary endpoint was the 6-month QoL. The secondary ă endpoints were other QoL scores such as Graves' ophthalmopathy (GO) ă outcomes, thyroid function tests and safety. ă Results: The primary endpoint at 6 months was achieved: the mental ă composite score (MCS) of Short Form 36 (SF-36) was significantly higher ă in group A compared to group B (P=0.009). Four other dimension scores of ă the SF-36 and four dimension scores of the thyroid-specific ă patient-reportedoutcome (ThyPRO) significantly differed between the two ă groups, indicating better QoL in group A. After adjustment for ă variables, the early LT4 administration strategy was found as an ă independent factor for only two scores of SF-36: the MCS and the general ă health (GH) score. There were no differences in GO, final thyroid status ă and changes in the anti-TSH receptor antibodies (TRAbs) levels between ă the two groups. No adverse cardiovascular event was reported. ă Conclusion: Early LT4 administration post-radioactive iodine (RAI) could ă represent a safe potential benefit for patients with regard to QoL. The ă optimal strategy taking into account administered RAI activities and LT4 ă treatment dosage and timing remains to be determined

Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial

International audienc

Strategies of radioiodine ablation in patients with low-risk thyroid cancer.

International audienc

Strategies of radioiodine ablation in patients with low-risk thyroid cancer.

International audienc

Effect of Buparlisib, a Pan-Class I PI3K Inhibitor, in Refractory Follicular and Poorly Differentiated Thyroid Cancer

International audienc

MERAIODE: A Phase II Redifferentiation Trial with Trametinib and 131 I in Metastatic Radioactive Iodine Refractory RAS Mutated Differentiated thyroid Cancer

International audienceAbstract Purpose: To evaluate the efficacy and safety of dabrafenib-trametinib-131I for the treatment of radioactive iodine refractory metastatic differentiated thyroid cancer (DTC) with a BRAF p.V600E mutation. Patients and Methods: A prospective phase II trial including patients with RECIST progression within 18 months and no lesion &gt; 3 cm. Following a baseline recombinant human (rh)TSH-stimulated diagnostic whole-body scan (dc1-WBS), dabrafenib and trametinib were given for 42 days. A second rhTSH-stimulated dc WBS (dc2-WBS) was done at day 28 and 131I (5.5 GBq–150 mCi after rhTSH) was administered at day 35. Primary endpoint was the 6-month RECIST objective response rate. In case of partial response (PR) at 6 or 12 months, a second treatment course could be given. Among 24 enrolled patients, 21 were evaluable at 6 months. Results: Abnormal 131I uptake was present on 5%, 65%, and 95% of the dc1-WBS, dc2-WBS, and post-therapy scans, respectively. At 6 months, PR was achieved in 38%, stable disease in 52%, and progressive disease (PD) in 10%. Ten patients received a second treatment course: one complete response and 6 PRs were observed at 6 months. The median progression-free survival (PFS) was not reached. The 12- and 24-month PFS were 82% and 68%, respectively. One death due to PD occurred at 24 months. Adverse events (AE) occurred in 96% of the patients, with 10 grade 3–4 AEs in 7 patients. Conclusions: Dabrafenib-trametinib is effective in BRAF p.V600E-mutated DTC patients for restoring 131I uptake with PR observed 6 months after 131I administration in 38% of the patients