Pulmonary metastasectomy for thyroid cancer as salvage therapy for radioactive iodine-refractory metastases†

Moneke, Isabelle; Kaifi, Jussuf T.; Kloeser, Raphael; Samson, Patrick von; Haager, B; Wiesemann, Sebastian; Diederichs, Sven; Passlick, Bernward

doi:10.1093/ejcts/ezx367

Cited by 21 publications

(15 citation statements)

References 24 publications

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“…In most previous trials PM is also associated with little or no mortality, reasonable morbidity and, in selected cases, long-term survival ( 1 – 3 , 8 ). These findings contradict the notion of surgery being essentially more harmful when compared to systemic treatment and radiotherapy.…”

Section: Discussionmentioning

confidence: 97%

“…Pulmonary metastasectomy was associated with a survival benefit in selected patients in numerous retrospective trials; however, survival benefit has yet to be proven in prospective randomized studies (1)(2)(3)(4)(5)(6)(7)(8). Different surgical techniques are used for PM including staplers, cautery devices, Ligasure/Ultracision-System as well as Nd:YAG-Lasers.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Morbidity and Lung Function Changes After Laser–Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study

et al. 2021

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Objective: The surgical resection of pulmonary metastases is associated with a survival benefit in selected patients. The use of laser devices for pulmonary metastasectomy (PM) is believed to facilitate the complete resection of metastases while preserving a maximum of healthy parenchyma. This is a prospective study to evaluate surgical outcome including the changes of lung function after laser–assisted surgery (LAS).Methods: A total of 77 operations in 61 patients in which PM was carried out in a curative intent were analyzed. A 1.320 nm diode-pumped Nd: YAG-Laser was used for resection of the metastases. Surgical and clinical data were collected using a standardized form and postoperative lung function changes 3 and 6 months after surgery were assessed using whole body plethysmography and diffusion capacity for carbon monoxide (DLCO). Size and distance of metastases to the pleural surface were measured radiologically.Results: A median of two metastases were resected per operation (range 1–13). The median duration of postoperative air leak was 1 day (range 0–11). LAS associated postoperative minor and major complications were observed in 4 (5%) cases and 1 (1%) case, respectively; there were no mortalities. The analysis of perioperative lung function showed that mean VC 3 months after surgery was reduced by 11 %, FEV1 by 11% and median DLCO by 11% (all p < 0.0001). There was almost no recovery of lung function between 3 and 6 months in the whole cohort. Patients with two or less metastases showed a recovery of lung function after 3 months regarding DLCO (p = 0.003). Decline of DLCO in the whole cohort correlated with the number of resected metastases at 3 months (r = 0.45, p = 0.006) and at 6 months (r = 0.42, p = 0.02) as well as depth of metastases in the parenchyma at 6 months (r = 0.48, p = 0.001).Conclusions: LAS is a safe and effective method for PM even for higher numbers of metastases, with short duration of postoperative air leak and little morbidity. Number and depth, but not size of metastases affect lung function changes after resection.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Surgical Morbidity and Lung Function Changes After Laser–Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study

et al. 2021

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“…In terms of treatments, even though radioactive iodine therapy has great significance in TC patients with lung metastasis, more than half of the cases showed progressive metastasis (33). For TC patients with radioactive iodine ablation-refractory metastasis, Moneke et al (34) reported the effectiveness of surgical resection. More aggressive treatment could be arranged for individuals to balance the clinical benefits and harms and reach the optimal results.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Lymph Node Stage and Clinical Prognosis in Thyroid Cancer

et al. 2020

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Purpose: To investigate the association between lymph node (N) stage and clinical outcome in thyroid cancer patients with initial distant metastasis. Methods: A total of 3,198 cases (1,435 males and 1,763 females) between 2004 and 2015 with initial distant metastasis were obtained from the surveillance, epidemiology, and end results (SEER) database. Patients with a median follow up time of 13 months and a median age of 66 years were analyzed. A total of 1,407 cases had detailed information regarding the four most common metastatic organs after the year 2010. Kaplan-Meier (KM) analyses, log-rank tests, Cox regression, and logistic regression analyses were used.

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“…The current management options for patients with RAIR thyroid cancer are (1) watchful waiting in asymptomatic, non-progressive lesions; (2) local therapies, such as external beam radiation therapy [42] or stereotactic radiosurgery [43], ablation of tumor tissue with radiofrequency thermal ablation/cryoablation/ laser ablation [44][45][46], endotracheal stenting [47], percutaneous interventions such as chemoembolization, US-guided ethanol injection into lymph nodes, or bone cementoplasty [48], and metastectomy for bone and lung metastasis [49]; and (3) systemic therapies such as conventional chemotherapeutic agents, tyrosine kinase inhibitors, immune checkpoint inhibitors, and specific inhibitors of signaling pathways, such as the NTRK (tropomyosin receptor kinase), BRAF, mitogen-activated protein kinase-extracellular signal-regulated kinase (MAPK-ERK) kinase (MEK), RET receptor, and mammalian target of rapamycin (mTOR) pathways.…”

Section: Novel Therapeutic Targets In Thyroid Cancermentioning

confidence: 99%

Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer

et al. 2020

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The increased incidence of thyroid cancer is a worldwide phenomenon; however, the issue of overdiagnosis has been most prominent in South Korea. The age-standardized mortality rate of thyroid cancer in Korea steeply increased from 1985 to 2004 (from 0.17 per 100,000 to 0.85 per 100,000), and then decreased until 2015 to 0.42 per 100,000, suggesting that early detection reduced mortality. However, early detection of thyroid cancer may be cost-ineffective, considering its very high prevalence and indolent course. Therefore, risk stratification and tailored management are vitally important, but many prognostic markers can only be evaluated postoperatively. Discovery of preoperative marker(s), especially for small cancers, is the most important unmet clinical need for thyroid cancer. Herein, we discuss some such factors that we recently discovered. Another unmet clinical need is better treatment of radioiodine-refractory (RAIR) differentiated thyroid cancer (DTC) and undifferentiated cancers. Although sorafenib and lenvatinib are available, better drugs are needed. We found that phosphoglycerate dehydrogenase, a critical enzyme for serine biosynthesis, could be a novel therapeutic target, and that the lymphocyte-to-monocyte ratio is a prognostic marker of survival in patients with anaplastic thyroid carcinoma or RAIR DTC. Deeper insights are needed into tumor-host interactions in thyroid cancer to improve treatment.

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Pulmonary metastasectomy for thyroid cancer as salvage therapy for radioactive iodine-refractory metastases†

Cited by 21 publications

References 24 publications

Surgical Morbidity and Lung Function Changes After Laser–Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study

Surgical Morbidity and Lung Function Changes After Laser–Assisted Pulmonary Metastasectomy: A Prospective Bicentric Study

The Association Between Lymph Node Stage and Clinical Prognosis in Thyroid Cancer

Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer

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