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, Mira Milas, Gregory W. Randolph, Ralph Tufano, Donald Bergman, Victor Bernet, Elise M. Brett, James D. Brierley, Rhoda Cobin, Gerard Doherty, Joshua Klopper, Stephanie Lee, Josef Machac, Jeffrey I. Mechanick, Lisa A. Orloff, Douglas Ross, Robert C. Smallridge, David J Terris, Jason B. Clain, Michael Tuttle

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)605-614
Number of pages10
JournalHead and Neck
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2015

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Thyroid Neoplasms
Decision Making
Lymph Nodes
Data Display
Hypoparathyroidism
Incidence
Therapeutics
Disease Management
Reoperation
Paralysis
Iodine
Thyroid Gland
Ethanol
Radiotherapy
Observation
Guidelines
Morbidity
Neoplasms
Clinical Decision-Making

Keywords

  • clinical decision-making modules (CDMMs)
  • persistent thyroid cancer
  • recurrent thyroid cancer
  • reoperation
  • thyroid cancer care collaborative (TCCC)

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer : A multifactorial decision-making guide for the thyroid cancer care collaborative. / Urken, Mark L.; Milas, Mira; Randolph, Gregory W.; Tufano, Ralph; Bergman, Donald; Bernet, Victor; Brett, Elise M.; Brierley, James D.; Cobin, Rhoda; Doherty, Gerard; Klopper, Joshua; Lee, Stephanie; Machac, Josef; Mechanick, Jeffrey I.; Orloff, Lisa A.; Ross, Douglas; Smallridge, Robert C.; Terris, David J; Clain, Jason B.; Tuttle, Michael.

In: Head and Neck, Vol. 37, No. 4, 01.04.2015, p. 605-614.

Research output: Contribution to journalReview article

Urken, ML, Milas, M, Randolph, GW, Tufano, R, Bergman, D, Bernet, V, Brett, EM, Brierley, JD, Cobin, R, Doherty, G, Klopper, J, Lee, S, Machac, J, Mechanick, JI, Orloff, LA, Ross, D, Smallridge, RC, Terris, DJ, Clain, JB & Tuttle, M 2015, 'Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: A multifactorial decision-making guide for the thyroid cancer care collaborative', Head and Neck, vol. 37, no. 4, pp. 605-614. https://doi.org/10.1002/hed.23615
Urken, Mark L. ; Milas, Mira ; Randolph, Gregory W. ; Tufano, Ralph ; Bergman, Donald ; Bernet, Victor ; Brett, Elise M. ; Brierley, James D. ; Cobin, Rhoda ; Doherty, Gerard ; Klopper, Joshua ; Lee, Stephanie ; Machac, Josef ; Mechanick, Jeffrey I. ; Orloff, Lisa A. ; Ross, Douglas ; Smallridge, Robert C. ; Terris, David J ; Clain, Jason B. ; Tuttle, Michael. / Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer : A multifactorial decision-making guide for the thyroid cancer care collaborative. In: Head and Neck. 2015 ; Vol. 37, No. 4. pp. 605-614.
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abstract = "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.",
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T1 - Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer

T2 - A multifactorial decision-making guide for the thyroid cancer care collaborative

AU - Urken, Mark L.

AU - Milas, Mira

AU - Randolph, Gregory W.

AU - Tufano, Ralph

AU - Bergman, Donald

AU - Bernet, Victor

AU - Brett, Elise M.

AU - Brierley, James D.

AU - Cobin, Rhoda

AU - Doherty, Gerard

AU - Klopper, Joshua

AU - Lee, Stephanie

AU - Machac, Josef

AU - Mechanick, Jeffrey I.

AU - Orloff, Lisa A.

AU - Ross, Douglas

AU - Smallridge, Robert C.

AU - Terris, David J

AU - Clain, Jason B.

AU - Tuttle, Michael

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

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