Iain J Nixon1, Ricard Simo2, Kate Newbold3, Alessandra Rinaldo4, Carlos Suarez5, Luiz P Kowalski6, Carl Silver7, Jatin P Shah8, Alfio Ferlito9. 1. 1 NHS Lothian/Edinburgh University , Edinburgh, United Kingdom . 2. 2 Head and Neck Cancer Unit, Guy's and St Thomas' Hospital , NHS Foundation Trust, London, United Kingdom . 3. 3 NIHR Royal Marsden Hospital and Institute of Cancer Research BRC , London, United Kingdom . 4. 4 University of Udine School of Medicine , Udine, Italy . 5. 5 Department of Surgery, Universidad de Oviedo , Oviedo, Spain . 6. 6 Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center , São Paulo, Brazil . 7. 7 Departments of Surgery and Otolaryngology - Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, New York. 8. 8 Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center , New York, New York. 9. 9 Former Director of the Department of Surgical Sciences and Chairman of the ENT Clinic at the University of Udine School of Medicine , Udine, Italy .
Abstract
BACKGROUND: Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing death for patients presenting in this manner. Advances in assessment and management of such cases have led to significant improvements in outcome for this patient group. This article reviews the patterns of invasion and a contemporary approach to investigation and treatment of patients with invasive DTC. SUMMARY: Aerodigestive tract invasion is reported in around 10% of case series of DTC. Assessment should include not only clinical history and physical examination with endoscopy as indicated, but ultrasound and contrast-enhanced cross-sectional imaging. Further studies including positron emission tomography should be considered, particularly in recurrent cases that are radioactive iodine (RAI) resistant. Both the patient and the extent of disease should be carefully assessed prior to embarking on surgery. The aim of surgery is to resect all gross disease. When minimal visceral invasion is encountered early, "shave" procedures are recommended. In the setting of transmural invasion of the airway or esophagus, however, full thickness excision is required. For intermediate cases in which invasion of the viscera has penetrated the superficial layers but is not evident in the submucosa, opinion is divided. Early reports recommended an aggressive approach. More recently authors have tended to recommend less aggressive resections with postoperative adjuvant therapies. The role of external beam radiotherapy continues to evolve in DTC with support for its use in patients considered to have RAI-resistant tumors. CONCLUSIONS: Patients with invasive DTC require a multidisciplinary approach to investigation and treatment. With detailed assessment, appropriate surgery, and adjuvant therapy when indicated, this patient group can expect durable control of central neck disease, despite the aggressive nature of their primary tumors.
BACKGROUND: Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing death for patients presenting in this manner. Advances in assessment and management of such cases have led to significant improvements in outcome for this patient group. This article reviews the patterns of invasion and a contemporary approach to investigation and treatment of patients with invasive DTC. SUMMARY: Aerodigestive tract invasion is reported in around 10% of case series of DTC. Assessment should include not only clinical history and physical examination with endoscopy as indicated, but ultrasound and contrast-enhanced cross-sectional imaging. Further studies including positron emission tomography should be considered, particularly in recurrent cases that are radioactive iodine (RAI) resistant. Both the patient and the extent of disease should be carefully assessed prior to embarking on surgery. The aim of surgery is to resect all gross disease. When minimal visceral invasion is encountered early, "shave" procedures are recommended. In the setting of transmural invasion of the airway or esophagus, however, full thickness excision is required. For intermediate cases in which invasion of the viscera has penetrated the superficial layers but is not evident in the submucosa, opinion is divided. Early reports recommended an aggressive approach. More recently authors have tended to recommend less aggressive resections with postoperative adjuvant therapies. The role of external beam radiotherapy continues to evolve in DTC with support for its use in patients considered to have RAI-resistant tumors. CONCLUSIONS:Patients with invasive DTC require a multidisciplinary approach to investigation and treatment. With detailed assessment, appropriate surgery, and adjuvant therapy when indicated, this patient group can expect durable control of central neck disease, despite the aggressive nature of their primary tumors.
Authors: Maisie L Shindo; Salvatore M Caruana; Emad Kandil; Judith C McCaffrey; Lisa A Orloff; John R Porterfield; Ashok Shaha; Jennifer Shin; David Terris; Gregory Randolph Journal: Head Neck Date: 2014-08-23 Impact factor: 3.147
Authors: Sin-Ming Chow; Stephen Yau; Chung-Kong Kwan; Patricia C M Poon; Stephen C K Law Journal: Endocr Relat Cancer Date: 2006-12 Impact factor: 5.678
Authors: Linda M Youngwirth; Mohamed A Adam; Randall P Scheri; Sanziana A Roman; Julie A Sosa Journal: Ann Surg Oncol Date: 2015-09-28 Impact factor: 5.344
Authors: Iain J Nixon; Ian Ganly; Snehal G Patel; Frank L Palmer; Monica M Whitcher; Rony Ghossein; R Michael Tuttle; Ashok R Shaha; Jatin P Shah Journal: Int J Surg Date: 2012-11-02 Impact factor: 6.071
Authors: Sujana S Chandrasekhar; Gregory W Randolph; Michael D Seidman; Richard M Rosenfeld; Peter Angelos; Julie Barkmeier-Kraemer; Michael S Benninger; Joel H Blumin; Gregory Dennis; John Hanks; Megan R Haymart; Richard T Kloos; Brenda Seals; Jerry M Schreibstein; Mack A Thomas; Carolyn Waddington; Barbara Warren; Peter J Robertson Journal: Otolaryngol Head Neck Surg Date: 2013-06 Impact factor: 3.497
Authors: Edwina C Moore; Samuel Zolin; Vikram Krishnamurthy; Judy Jin; Joyce Shin; Eren Berber; Allan Siperstein Journal: World J Surg Date: 2020-02 Impact factor: 3.352
Authors: S Mazzeo; R Cervelli; R Elisei; G Tarantini; C Cappelli; E Molinaro; D Galleri; L De Napoli; C Comite; R Cioni; P Vitti; D Caramella Journal: J Endocrinol Invest Date: 2018-04-23 Impact factor: 4.256
Authors: Dauren Adilbay; Avery Yuan; Paul B Romesser; Richard J Wong; Jatin P Shah; Ashok R Shaha; Michael R Tuttle; Snehal Patel; Nancy Y Lee; Ian Ganly Journal: Ann Surg Oncol Date: 2022-05-18 Impact factor: 4.339
Authors: Peter Zbären; Jatin P Shah; Gregory W Randolph; Carl E Silver; Kerry D Olsen; Ashok R Shaha; Mark Zafereo; Luiz P Kowalski; Carlos Suarez; Alvaro Sanabria; Vincent Vander Poorten; Iain Nixon; Alessandra Rinaldo; Alfio Ferlito Journal: Adv Ther Date: 2019-08-10 Impact factor: 3.845
Authors: Cesare Piazza; Davide Lancini; Michele Tomasoni; Anil D'Cruz; Dana M Hartl; Luiz P Kowalski; Gregory W Randolph; Alessandra Rinaldo; Jatin P Shah; Ashok R Shaha; Ricard Simo; Vincent Vander Poorten; Mark Zafereo; Alfio Ferlito Journal: Front Endocrinol (Lausanne) Date: 2021-11-11 Impact factor: 5.555