Management of the compromised airway and role of tracheotomy in anaplastic thyroid carcinoma

Mani, Navin; McNamara, Katherine; Lowe, Natalie; Loughran, Sean; Yap, Beng K

doi:10.1002/hed.23857

Cited by 28 publications

(15 citation statements)

References 13 publications

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“…Once a fistula develops, frequent dose interruptions are required to prevent the spread of the fistula (29). Recent guidelines published by the ATA discuss the management of the compromised airway in such patients, and suggest that a tracheotomy should be performed to secure the airway in circumstances of life-threatening airway obstruction (30). Airway compromise with a thyroid mass may be a presenting feature of ATC, or it may occur in a patient with a pre-existing diagnosis of the disease (30).…”

Section: Discussionmentioning

confidence: 99%

Lenvatinib as a novel treatment for anaplastic thyroid cancer: A retrospective study

et al. 2018

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Anaplastic thyroid cancer (ATC) is associated with an extremely poor prognosis and is resistant to the majority of chemotherapies. In 2015, lenvatinib was approved for treating ATC in Japan. The present study aimed to evaluate the overall survival (OS) of patients with ATC treated with lenvatinib. A total of 23 patients with a definitive histological diagnosis of ATC who were treated at Kanagawa Cancer Center (Yokohama, Kanagawa. Japan) were enrolled. Surgical treatment was possible in 10 patients (including one debulking surgery), and lenvatinib treatment was postoperatively started. The remaining 13 patients were not eligible for debulking surgery; thus, lenvatinib was promptly approved as a life-saving treatment. The therapeutic effect was determined according to the Response Evaluation Criteria In Solid Tumors criteria (ver.1.1). The patients exhibited a lenvatinib response rate of 17.4% and a disease control rate of 43.5%. However, lenvatinib was associated with a 100% incidence of treatment-related adverse events (AEs), with hypertension being the most common AE (91.3%). Additionally, dose interruptions and reductions were required due to the development of tumor fistulas or other tumor-related AEs, and 9 (39.1%) patients discontinued treatment due to grade 3 or higher AEs. The median OS time was 166 days. Overall, the present study demonstrated the effectiveness of lenvatinib against ATC, which is often chemotherapy-resistant. Successful treatment of fistulas developing due to tumor necrosis at the site of the primary lesion is crucial for improving the patient outcome. The response to lenvatinib in patients with ATC varies on a case-by-case basis and requires further investigation in future studies.

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Section: Discussionmentioning

confidence: 99%

Lenvatinib as a novel treatment for anaplastic thyroid cancer: A retrospective study

et al. 2018

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“…Another problem is the displacement of the trachea due to the compression effect of the mass during tracheotomy. ATA recommends that tracheotomy should be performed under operating conditions and under general anesthesia as we did in our case (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 79%

“…In sagittal view of computed tomography scan of head and neck; it is observed that the same mass has filled the thyroid space and narrowed the tracheal lumen Figure 3. A view of tracheotomy after partially tumor excision of the istmus region, severe destructive mass in the trachea drastically eliminated the anatomical guiding points found to be shorter than in patients who underwent "debulking" surgery (9). However, it is important to note that in patients with ATC, respiratory problems are likely to occur until the tracheotomy stage.…”

Section: Discussionmentioning

confidence: 99%

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Difficult Tracheotomy in Advanced Anaplastic Thyroid Carcinoma

Aydın¹,

Paksoy²,

Uysal³

2019

Istanbul Med J

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“…Критически важно после постановки диагноза подробно объяснить пациенту и его семье, как будет развиваться его заболевание, предупредить их о риске развития удушья, описать пути его предотвращения и устранения. Трахеостомия лишь временно решает эту проблему, и часто пациент считает ее болезненной и эмоционально непереносимой, поэтому может не дать согласия на ее выполнение [19,23]. Пациенты, испытывающие сложности с глотанием пищи, могут нуждаться в энтеральном питании.…”

Section: Introductionunclassified

Anaplastic thyroid cancer. Is there a light at the end of the tunnel?

Pylev

Жандарова

Петров³

et al. 2020

Opuholi golovy i šei

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Anaplastic thyroid cancer is one of the most prognostically unfavorable tumors. This disadvantage traditionally consisted of a rapid increase in the size of the primary tumor with a tendency to the development of asphyxia and the rapid appearance of distant metastases, as well as a poor response to the recommended treatment methods. The result of many years of efforts by oncologists around the world were several treatment regimens, including an ideal amount of surgical intervention, chemotherapy and radiation therapy, but the effectiveness of this treatment, as well as the patient’s life expectancy after it, could not be called satisfactory. Improving the understanding of the molecular genetic characteristics of tumors, including anaplastic thyroid cancer, provided us with information on two possible features of the genetic apparatus of tumor cells that can have clinical significance: V600E mutations in the BRAF gene and fusion of NTRK genes. The clinical example described in this article is probably the first Russian illustration of the effectiveness of anti-BRAF therapy in a patient with anaplastic thyroid cancer. From our point of view, the benefit of this example is not only to demonstrate the effectiveness of modern targeted therapy, but also the need not to abandon other treatment methods, in this case, radiation therapy to the area of the primary tumor (and by analogy with this, surgical removal of the thyroid tumor glands in case of its resectability).

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Management of the compromised airway and role of tracheotomy in anaplastic thyroid carcinoma

Abstract: Tracheotomy can facilitate completion of palliative treatment in those patients with ATC and stridor. Given the short life expectancy of these patients, a balanced decision must be made regarding the role and timing of tracheotomy.

Cited by 28 publications

References 13 publications

Lenvatinib as a novel treatment for anaplastic thyroid cancer: A retrospective study

Lenvatinib as a novel treatment for anaplastic thyroid cancer: A retrospective study

Difficult Tracheotomy in Advanced Anaplastic Thyroid Carcinoma

Anaplastic thyroid cancer. Is there a light at the end of the tunnel?

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