Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: A multifactorial decision-making guide for the thyroid cancer care collaborative
Mark L. Urken MD
Department of Otolaryngology – Head and Neck Surgery, Beth Israel Medical Center, New York, New York
Search for more papers by this authorMira Milas MD
Department of Surgery, Oregon Health and Science University, Portland, Oregon
Search for more papers by this authorGregory W. Randolph MD
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
Search for more papers by this authorRalph Tufano MD
Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Outpatient Center, Baltimore, Maryland
Search for more papers by this authorDonald Bergman MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorVictor Bernet MD
Department of Endocrinology, Mayo Clinic, Jacksonville, Florida
Search for more papers by this authorElise M. Brett MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorJames D. Brierley MD
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRhoda Cobin MD
Department of Medicine, Mount Sinai School of Medicine, Ridgewood, New Jersey
Search for more papers by this authorGerard Doherty MD
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
Search for more papers by this authorJoshua Klopper MD
Department of Endocrinology, University of Colorado School of Medicine, Denver, Colorado
Search for more papers by this authorStephanie Lee MD, PhD
Department of Endocrinology, Boston University School of Medicine, Boston, Massachusetts
Search for more papers by this authorJosef Machac MD
Department of Radiology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorJeffrey I. Mechanick MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorLisa A. Orloff MD
Department of Otolaryngology – Head and Neck Surgery, University of California San Francisco Medical Center, San Francisco, California
Search for more papers by this authorDouglas Ross MD
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
Search for more papers by this authorRobert C. Smallridge MD
Department of Endocrinology, Mayo Clinic, Jacksonville, Florida
Search for more papers by this authorDavid J Terris MD
Department of Otolaryngology, Georgia Regents University, Augusta, Georgia
Search for more papers by this authorCorresponding Author
Jason B Clain BS
Head and Neck Oncology, Thyroid Head and Neck Cancer Foundation, New York, New York
Corresponding author: J. B. Clain, Head and Neck Oncology, Thyroid Head and Neck Cancer Foundation, 10 Union Square East, Suite 5B, New York, NY 10003. E-mail: [email protected]Search for more papers by this authorMichael Tuttle MD
Department of Endocrinology, Memorial Sloan–Kettering Cancer Center, New York, New York
Search for more papers by this authorMark L. Urken MD
Department of Otolaryngology – Head and Neck Surgery, Beth Israel Medical Center, New York, New York
Search for more papers by this authorMira Milas MD
Department of Surgery, Oregon Health and Science University, Portland, Oregon
Search for more papers by this authorGregory W. Randolph MD
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
Search for more papers by this authorRalph Tufano MD
Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins School of Medicine, Outpatient Center, Baltimore, Maryland
Search for more papers by this authorDonald Bergman MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorVictor Bernet MD
Department of Endocrinology, Mayo Clinic, Jacksonville, Florida
Search for more papers by this authorElise M. Brett MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorJames D. Brierley MD
Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
Search for more papers by this authorRhoda Cobin MD
Department of Medicine, Mount Sinai School of Medicine, Ridgewood, New Jersey
Search for more papers by this authorGerard Doherty MD
Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
Search for more papers by this authorJoshua Klopper MD
Department of Endocrinology, University of Colorado School of Medicine, Denver, Colorado
Search for more papers by this authorStephanie Lee MD, PhD
Department of Endocrinology, Boston University School of Medicine, Boston, Massachusetts
Search for more papers by this authorJosef Machac MD
Department of Radiology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorJeffrey I. Mechanick MD
Department of Endocrinology, Mount Sinai School of Medicine, New York, New York
Search for more papers by this authorLisa A. Orloff MD
Department of Otolaryngology – Head and Neck Surgery, University of California San Francisco Medical Center, San Francisco, California
Search for more papers by this authorDouglas Ross MD
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
Search for more papers by this authorRobert C. Smallridge MD
Department of Endocrinology, Mayo Clinic, Jacksonville, Florida
Search for more papers by this authorDavid J Terris MD
Department of Otolaryngology, Georgia Regents University, Augusta, Georgia
Search for more papers by this authorCorresponding Author
Jason B Clain BS
Head and Neck Oncology, Thyroid Head and Neck Cancer Foundation, New York, New York
Corresponding author: J. B. Clain, Head and Neck Oncology, Thyroid Head and Neck Cancer Foundation, 10 Union Square East, Suite 5B, New York, NY 10003. E-mail: [email protected]Search for more papers by this authorMichael Tuttle MD
Department of Endocrinology, Memorial Sloan–Kettering Cancer Center, New York, New York
Search for more papers by this authorAbstract
Background
Well-differentiated thyroid cancer (WDTC) recurs in up to 30% of patients. Guidelines from the American Thyroid Association (ATA) and the National Comprehensive Cancer Network (NCCN) provide valuable parameters for the management of recurrent disease, but fail to guide the clinician as to the multitude of factors that should be taken into account. The Thyroid Cancer Care Collaborative (TCCC) is a web-based repository of a patient's clinical information. Ten clinical decision-making modules (CDMMs) process this information and display individualized treatment recommendations.
Methods
We conducted a review of the literature and analysis of the management of patients with recurrent/persistent WDTC.
Results
Surgery remains the most common treatment in recurrent/persistent WDTC and can be performed with limited morbidity in experienced hands. However, careful observation may be the recommended course in select patients. Reoperation yields biochemical remission rates between 21% and 66%. There is a reported 1.2% incidence of permanent unexpected nerve paralysis and a 3.5% incidence of permanent hypoparathyroidism. External beam radiotherapy and percutaneous ethanol ablation have been reported as therapeutic alternatives. Radioactive iodine as a primary therapy has been reported previously for metastatic lymph nodes, but is currently advocated by the ATA as an adjuvant to surgery.
Conclusion
The management of recurrent lymph nodes is a multifactorial decision and is best determined by a multidisciplinary team. The CDMMs allow for easy adoption of contemporary knowledge, making this information accessible to both patient and clinician. © 2014 Wiley Periodicals, Inc. Head Neck 37: 605–614, 2015
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