Contemporary post surgical management of differentiated thyroid carcinoma Journal Article

Authors: Tala, H.; Tuttle, R. M.
Article Title: Contemporary post surgical management of differentiated thyroid carcinoma
Abstract: Risk assessment is the cornerstone of contemporary management of thyroid cancer. Following thyroid surgery, an initial risk assessment of recurrence and disease-specific mortality is made using important intra-operative findings, histologic characteristics of the tumor, molecular profile of the tumor, post-operative serum thyroglobulin and any available cross-sectional imaging studies. This initial risk assessment is used to guide recommendations regarding the need for remnant ablation, external beam irradiation, systemic therapy, degree of TSH suppression, and follow-up disease detection strategy over the first 2 years after initial therapy.While this initial risk stratification provides valuable information, it is a static representation of the patient in the first few weeks post-operatively that does not change over time. Depending on how the patient responds to our initial therapies, the risk of recurrence and death may change significantly during follow-up. In order to account for differences in response to therapy in individual patients and to incorporate the impact of treatment on our initial risk estimates, we recommend a re-stratification of risk at the 2-year point of follow-up. This re-stratification provides an updated risk estimate that can be used to guide ongoing management recommendations including the frequency and intensity of follow-up, degree of ongoing TSH suppression, and need for additional therapies.Ongoing management recommendations must be tailored to realistic, evolving risk estimates that are actively updated during follow-up. By individualizing therapy on the basis of initial and ongoing risk assessments, we can maximize the beneficial effects of aggressive therapy in patients with thyroid cancer who are likely to benefit from it, while minimizing potential complications and side effects in low-risk patients destined to have a full healthy and productive life after minimal therapeutic intervention. © 2010 The Royal College of Radiologists.
Keywords: cancer surgery; postoperative period; cancer risk; cancer patient; cancer radiotherapy; postoperative care; follow up; cancer diagnosis; neoplasm recurrence, local; cancer mortality; risk assessment; cross-sectional study; thyroid cancer; thyroid neoplasms; external beam radiotherapy; disease management; molecular biology; thyroglobulin; thyroglobulin blood level; recombinant thyrotropin; thyrotropin; follow-up; risk-adapted management; differentiated thyroid carcinoma
Journal Title: Clinical Oncology
Volume: 22
Issue: 6
ISSN: 0936-6555
Publisher: Elsevier Science, Inc.  
Date Published: 2010-08-01
Start Page: 419
End Page: 429
Language: English
DOI: 10.1016/j.clon.2010.04.005
PUBMED: 20605708
PROVIDER: scopus
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CLIOE" - "Source: Scopus"
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  1. Robert M Tuttle
    362 Tuttle