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, Kresimira 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 journalArticle

    33 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

    Fingerprint

    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, Kresimira; 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 journalArticle

    Urken, ML, Milas, K, 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, Kresimira ; 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.
    @article{0e20cdf77cf643b89d452a2c503bda64,
    title = "Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: A multifactorial decision-making guide for the thyroid cancer care collaborative",
    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.",
    keywords = "clinical decision-making modules (CDMMs), persistent thyroid cancer, recurrent thyroid cancer, reoperation, thyroid cancer care collaborative (TCCC)",
    author = "Urken, {Mark L.} and Kresimira Milas and Randolph, {Gregory W.} and Ralph Tufano and Donald Bergman and Victor Bernet and Brett, {Elise M.} and Brierley, {James D.} and Rhoda Cobin and Gerard Doherty and Joshua Klopper and Stephanie Lee and Josef Machac and Mechanick, {Jeffrey I.} and Orloff, {Lisa A.} and Douglas Ross and Smallridge, {Robert C.} and Terris, {David J.} and Clain, {Jason B.} and Michael Tuttle",
    year = "2015",
    month = "4",
    day = "1",
    doi = "10.1002/hed.23615",
    language = "English (US)",
    volume = "37",
    pages = "605--614",
    journal = "Head and Neck",
    issn = "1043-3074",
    publisher = "Wiley-Liss Inc.",
    number = "4",

    }

    TY - JOUR

    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, Kresimira

    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.

    KW - clinical decision-making modules (CDMMs)

    KW - persistent thyroid cancer

    KW - recurrent thyroid cancer

    KW - reoperation

    KW - thyroid cancer care collaborative (TCCC)

    UR - http://www.scopus.com/inward/record.url?scp=84925670414&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84925670414&partnerID=8YFLogxK

    U2 - 10.1002/hed.23615

    DO - 10.1002/hed.23615

    M3 - Article

    VL - 37

    SP - 605

    EP - 614

    JO - Head and Neck

    JF - Head and Neck

    SN - 1043-3074

    IS - 4

    ER -