Thyroid Cancer I 131 Dosing and Treatment: An update on risk stratification, RAI therapy optimization and radiation risk reduction
|
|
- Corey Burns
- 5 years ago
- Views:
Transcription
1 Thyroid Cancer I 131 Dosing and Treatment: An update on risk stratification, RAI therapy optimization and radiation risk reduction 2017 AACE Advances in Medical & Surgical Management of Thyroid Cancer, Tampa Stephanie L. Lee, MD, PhD, FACE, ECNU Director, Thyroid Health Center Section of Endocrinology, Diabetes and Nutrition Boston Medical Center
2 No disclosures Disclosures
3 Objectives Thyroid cancer I 131 dosing and treatment: An update on risk stratification, RAI therapy optimization and radiation risk reduction Judicious use of RAI with changes in practice style over the decades Current 2015 ATA recomendations Optimization of RAI treatment (avoiding under/overdosing) Lower dose I131 is equally effective as high doses Tg s can be used without RAI ablation Avoidance or reduction of collateral exposure to other tissue to reduce long term effects I131 complications are dose-related
4 Radioactive Iodine: The Original Molecularly Targeted Therapy Traditional Treatment Paradigm One Size Fits All Surgery Radioiodine Treatment RAI WBS Thyroid hormone therapy ANTERIOR POSTERIOR
5 Rise in the Numbers of Patients Treated with RAI in the US US National Cancer Database SEER Database Haymart JAMA 2011;306:721-8 Iyer and Tuttle Cancer 2011
6 CASE 1: Remnant Ablation With Radioiodine A 46 year-old female has a RIGHT 2.3 cm thyroid nodule with no adenopathy on US FNA is Bethesda VI: diagnostic for papillary thyroid cancer Total thyroidectomy removed a 2 cm FV-PTC Partially encapsulated, no ETE, no lymphovascular invasion, no nodes, BRAF neg Should she receive radioactive iodine for remnant ablation?
7 Haugen, et al. Thyroid 2016;26:1
8 Will You Recommend 131 I Therapy? No treatment protocols proven by published randomized controlled trials 1995: Test case of 2 cm PTC, 61% ATA recommended 131 I Rx but 30% did not Stephanie 2000 yes hypothyroid 100 mci Stephanie 2010 yes rhtsh 100mCi Stephanie 2011 yes rhtsh 50 mci Stephanie yes rhtsh 30 mci Stephanie 2013 maybe no Stephanie 2015 NO!!
9 Update on Thyroid Cancer Some Current Clinical Issues January 2016 American Thyroid Association Guideline for Thyroid Nodules & Cancer Moving toward a more individualized management approach Ongoing risk assessment: AJCC + ATA stage SIGNIFICANT CHANGE: LOW dose or NO RAI in low risk patients
10 2015 ATA Guidelines Suggestion for RAI Therapy ATA Risk Description Evidence Reduces DEATH Evidence Reduces RECURRENCE RAI indicated? INTRATHYROIDAL MICRO-ETE, + NODES BAD LOW <1cm uni or NO NO NO multifocal LOW >1-4 cm NO Conflicting Not routine; consider aggressive histology, vascular invasion LOW to INTERMEDIATE LOW to INTERMEDIATE LOW to INTERMEDIATE LOW to INTERMEDIATE >4 cm Conflicting Conflicting Not routine, consider if older Micro ETE NO Conflicting Generally favored for recurrence risk LEVEL VI metastases LATERAL or MEDIASTINAL metastases NO, except > 45 NO, except > 45 Conflicting Conflicting HIGH Gross ETE YES YES YES HIGH Distant YES YES YES metastasis Generally favored for recurrence risk, NOT <5 micro nodes Generally favored for recurrence risk, NOT <5 micro nodes
11 WE SHOULD GIVE EVERYONE RAI REMNANT ABLATION? OLD REASONING: Staging with post therapy scan Reduce recurrence Reduce disease specific death Remnant ablation allows for use of Tg testing for recurrence
12 Why You Should NOT Give All Patients High Dose RAI For Remnant Ablation? REASONS TO LIMIT RADIATION Low dose of RAI equally as effective as high dose for remnant ablation as long as you have a good surgeon RAI does not change recurrence rates or death in Low and Intermediate Risk thyroid cancer RAI is not necessary use Tg as a tumor marker as long as you have a good surgeon Avoid acute and long-term complications of RAI RX
13 131 I Therapy 250% increase in diagnosis of differentiated thyroid cancer in the last 30 years Incidental diagnosis from imaging studies Increase in numbers of 131 I therapies Results in large numbers of patients who are living longer with complications of 131 I therapy Early age of diagnosis compared to other cancers Longer time for complications to impact lives Review the short and long term risks of 131 I therapy American Cancer Society Facts and Figures 2016
14 Complications from I-131 RX Are Modifying Who and How Much I-131 Short term Nausea, emesis Long term Sialadenitis (chronic and acute) Dry mouth with difficulty speaking, eating Mouth pain Tooth loss Pulmonary fibrosis (only at very high dose therapies with military pulmonary mets) Fertility/fetal malformation Solid tumor induction and leukemia
15 Best way to manage side effects of radioiodine therapy is to avoid the side effects is by limiting RAI exposure Lee J Natl Comp Cancer Network 8(2010)1
16 Loss of Taste after I 131 Direct irradiation of lingual taste buds by I 131 secreted by salivary glands into saliva Loss of taste may occurs with or without metallic or chemical taste Varma reported 41/85 after mci Incidence is dose dependent Lost of taste generally lasts 1-2 months Long term changes in taste have not been reported Lee J Natl Comp Cancer Network 8(2010)1
17 Salivary Gland Complications of I 131 Therapy Salivary gland concentrates iodine 30-40x plasma by the sodium iodide symporter ( NIS) Parotid glands more sensitive than submandibular gland Parotid secretions are more watery Scans provided by Dr. Susan Mandel
18 Salivary Gland Complications of I 131 Therapy Dose related decrease in saliva function after I131 With salivary duct stricture and obstruction by mucous and stones causing symptoms Infection is secondary to the obstruction Most profound symptoms after higher doses of I-131, prior external radiation or preexisting sialadenitis Spiegel J Nucl Med 26(1985)816 Mandel and Mandel Thyroid 13(2003)265
19 Sialadenitis: Prevention of Long-Term Complications Conventional wisdom for I-131 RX: increase saliva with good hydration and frequent use of sour candy or lemons Radiation exposure = UPTK% Reduced permanent xerostomia if delay in starting sour candies (every 2-3 hrs for 5 d) 116 patients started immediately: 14.3% 139 patient started 24 hr later: 5.6% (p<0.05) Decrease in deliver of radiation to the salivary gland Nakada et al. J Nucl Med. 2005,46:261-6
20 Treatment of Sialoadenitis Treatment: parotid gland massage, hydration, sialogogues, parotid massage If persistent: antibiotics if infection, duct probing ~70% of symptoms responds to medical therapy or spontaneous improves Sialadenitis unresponsive to medical therapy 10 months after an average of 143 mci I-131 patient had sialendoscopy 32 glands in (20 parotid and 12 submandibular) treated Ductal stenosis 30% and mucus plugs 44% 75% improved symptoms Provided by Dr. Susan Mandel Bomeli Laryngoscope 119(2009)864; Kim Laryngoscope 117(2007)133
21 Nausea and Vomiting MIRD calculations show large GI radiation dose after I 131 Gut is radio-resistent so there is no direct effect Nausea is a common symptom but emesis is rare Prospective study: 50% of 50 patients given 150 mci Starting as early as 2 hr and lasting 2 days Usually no RX is needed but oral Ondansetron is very effective Van Nostrand J Nucl Med 27(1986)1519 Kahn J Nucl Med 35 (1994)15P
22 Nausea and Vomiting Acute radiation sickness with fatigue, nausea and vomiting if dose > 200 mci or exposure > 200cGy to the blood More severe than the usual nausea <5% if radiation exposure blood < 200 cgy 200 mci would exceed 200cGy with normal creatinine 8%-15% <70 y old 22%-38% > 70 y old Consider dose reduction in >70 yo Van Nostrand J Nucl Med 27(1986)1519 Kahn J Nucl Med 35 (1994)15P Tuttle J Nucl Med 47(2006)1587
23 Severe Nausea and Vomiting Mild-Mod N/V: Ondansetron 8-24 mg BID PO Moderate N/V: Ondansetron 8 mg PO or 0.15 mg/kg IV BID NCCN guidelines: Severe N/V BID-TID: Dexamethasone 4 mg IV Ativan ½ - 1 mg IV Metoclopramide 1-2 mg/kg but start with 10 mg and then increase to 20 mg Resistant N/V: Haldol mg BID Ettinger J Natl Compr Canc Netw. 5(2007)12; Hesketh NEJM 358(2008)2482
24 Gonadal Radiation and I 131 Radiation exposure from Free iodine in blood (short halflife) Iodinated protein in blood (long halflife) Urine Reduction in gonadal exposure in first 3 days after treatment with Good hydration Frequent urination
25 Testicular Function and Fertility Male fertility not changed with moderate doses 40 children treated mean dose 196 mci I 131 at 14.6 yo with 18.7 yr F/U Infertility 12%, miscarriage 1.4%, congenital abnormality 1.4% Two subjects with 454 and 691mCi were fertile Sawka 2008 performed systematic review of the literature Biochemical abnormalities usually resolve within 18 months after < 150 mci Persistent gonadal dysfunction increases after repeated or high cumulative RAI Ceccarelli J Nucl Med. 1999;40: Sarkar J Nucl Med 17(1976)460 Sawka Clin Endocrinol (Oxf). 2008,68:610-7
26 Female Fertility and I 131 Therapy 2008 Garci with 10 year update of Schlumberger s initial 1996 report 2673 pregnancies Contrary to initial report, no increase miscarriage within first year of up to 100mCi I-131 RX No difference in incidence of stillbirths, preterm births, low birth weight, congenital malformations, or death during the first year of life Thyroid and non-thyroid cancers were similar in children born either before or after the mother's exposure to radioiodine Dottorini J Nucl Med 36(1995)21 Schlumberger J Nucl Med. 1996;37: Garci J Nucl Med. 2008;49:845-52
27 Nasolacrimal Drainage System Obstruction Kloos described bilateral nasolacrimal duct obstruction 4 months after 450 mci 131 I 3% (10/390) patients with 131 I developed epiphora (watery eye, overflow of tears) Received multiple doses of 131 I Mean cumulative 131 I dose 467 mci with average individual dose mci Symptoms onset 18 5 months Management of partial obstruction is dilation or stent placement but complete obstruction requires surgery Kloos JCEM 87(2002)5817 Burns Ophthal Plast Reconstr Surg 20(2004):126-9
28 Increase Risk of Second Malignancy after I 131 Treatment POOLED EUROPEAN AND AMERICAN DATA HAVE GIVEN NEW INSIGHTS INTO SECOND MALIGNANCIES AFTER I-131 Conventional wisdom that malignancies occur only after 600 mci is INCORRECT Review by Elaine Ron and Editorial by Ernie Mazzaferri in Clinical Thyroidology August studies published between 2003 and did NOT show a significant increased risk of second malignancy 5 showed a significant increased risk leukemia and GI (stomach, duodenal, colon, rectal)
29 Risk of Second Malignancies from SEER Database 2008 Brown used data between ,278 patients 2338 (7%) second malignancies in 2158 patients Greatest risk in ages Period of 5 years after diagnosis Most radiation induce malignancies have latent periods >10-15 years (excepting Chernobyl) Brown et al. JCEM 2008,3:504
30 Brown et al. JCEM 2008,3:504
31 Increased Concerns of Solid Tumors After 131 I Rubino : 2003 European cohort of thyroid cancer patients 6841 patients with mean age of 44 years 17% external radiotherapy and 62% 131 I therapy 2 yr latency, mean follow up 13 yrs, mean dose 162 mci 576 patients with secondary primary malignancy (SPM) Compared to general population increased risk of SPM 27% (95% CI: 15-40) after RAI but not XRT Risk of solid tumor (bone, colorectal and salivary) and leukemia increases with higher I 131 dose Rubino Br J Cancer 2003,89:
32 What are the Real Numbers? Dose (mci) SOLID TUMORS LEUKEMIA # RR # RR <5 184/ / / / / / / >400 12/ /853 - Rubino Br J Cancer 2003,89:
33 Perspective Increase risk of uncommon tumors so small increase in # s leads to a large foldincrease Rubino s study predicts 16.2 excess stomach cancers over 20years in 1,000 people who received 162 mci Review of data suggests a dose response Risks are increased even before the 600 mci threshold How many of your patients have had leukemia or GI malignancies after RAI?
34 Considerations to Reduce Complications of RAI Need to be more thoughtful about the use of 131 I in low risk patients Consider NO therapy especially intrathyroidal tumors in the young Consider smaller doses for initial remnant ablation Consider therapy with rhtsh stimulation Significant decrease in whole body radiation because of faster clearance compared to hypothyroid Assure good hydration Sialogogues 24 hours after I-131 dose
35 Best way to manage side effects of radioiodine therapy is to avoid the side effects is by limiting RAI exposure Lee J Natl Comp Canc Network 8(2010)1
36 Why Less or No RAI? Less acute and long-term complications of RAI RX Low dose of RAI equally as effective as high dose for remnant ablation as long as you have a good surgeon
37
38 Factorial Design, Unblinded, Non-inferiority, Multi-center RCTs: Mallick et al. NEJM 2012, Schlumberger et al. NEJM 2012 Differentiated Thyroid Ca, No Aggressive Variants, No Residual Disease Total Thyroidectomy (w/ or w/o central LN dissection) Pathologic Stage: T1-T2, N0/Nx/N1a (T3 in Mallick trial only) Randomized rhtsh (on thyroid hormone) Thyroid Hormone Withdrawal I-131 Remnant Ablation: Randomize Dose I-131 Remnant Ablation: Randomize Dose 30 mci (Group A) 100 mci (Group B) 30 mci (Group C) 100 mci (Group D)
39 RRA TSH Stim Activity RCTs Review RCTs: TT/NTT, Stim Tg outcome < 2 ng/ml 2 RCTs evaluated remnant ablation success at 6-12 months: Similar remnant ablation success rate rhtsh vs THW using I-131 dose activities 30 to 100 mci Stage of disease included in trials: Most T1/T2, some T3, N0 or N1 (low volume N1a, not N1b) Short-term QOL better with rhtsh in weeks preceding RAI Rx, no difference 3 to 9 months Paucity long-term outcomes, no difference 1 trial N=51 Chianelli 2009, Lee 2010, Mallick 2012, Pacini 2006, Schlumberger 2012, Taieb 2009
40 Results RAI Remnant Ablation Dose RCTs Author (Year) (Country) Low Dose (mci) High Dose (mci) N analyze Percent success Low RAI group (6-12 months) Percent Success High RAI Group (6-12 months) Comparison Stat Caglar (2012) Fallahi (2012) % 64% P=NS % 61% P< Maenpaa (2008) % 56% P=NS Pilli (2007) % 67% P=0.46 Zaman (2006) Mallick (2012) Schlumberger (2012) % 60% % 89% % 94% No stats reported Not inferior (<10% margin) Not inferior (<10% margin)
41 Why Are Some Low Dose Ablation More Effective in Some Studies? Maxon answered this 20 years ago! Dosimetry performed to deliver 30,000 rad to thyroid remnant 30 = <45 = >45 mci Extent of thyroid surgery <2g 96% success >2g 67% success TT or NT 94% success Less surgery 29% success SUCCESS OF LOW DOSE RRA DEPENDS ON HAVING AN EXCELLENT SURGEON Maxon et al. J Nucl Med 1992;33:1132
42 What Happens to Low Risk Patients Who do NOT Receive RRA?
43 217 Low risk Patients with NO RRA Waisman et al, Clin Endo, 2012 AJCC:89% stage 1, 4% stage 2, 7% stage 3 % ATA 73% low risk, 27% intermediate risk. 4 yr median follow up Total thyroidectomy (n=217) Structural Recurrence 2.3% (n=5) No evidence Of Disease 97.7% (n=121) 2.3% structural disease detected by US 2 from low risk 3 from intermediate risk All patients with thyroglobulin <0.6 ng/ml 60% with structural disease with rising Tg F Waisman, A Shaha, S Fish, RM Tuttle. Clin Endo 2011
44 Don t We Need RAI Remnant Ablation to Follow Tg Levels?
45 Study of Natural History Tg, no RAI Durante et al, JCEM, 2012 Retrospective analysis ATA low risk pts after TT/NTT Multicenter study performed in Italy Median 5 year follow-up 290 consecutive RAI-Negative patients compared to 490 RAI-treated pts TG <1 in 99% RRA and 95% no RR patients after 6yr Durante et al, JCEM :
46 Serum basal Tg after TT without RAI in 78 patients For 78 RRA-neg patients, stimulated Tg <0.2 ng/ml: 60% at 3-12 months 79% after 5 yrs Durante et al, JCEM :
47 Thyroglobulin With or Without RAI RX Tg increased in 1 RRA-neg patient with disease recurrence Tg can be followed without RRA in low risk patients with an excellent total thyroidectomy Durante et al, JCEM : YEARS
48 CASE 1: Remnant Ablation With Radioiodine A 46 year-old female has a RIGHT 2.3 cm thyroid nodule with no adenopathy on US FNA is Bethesda VI: diagnostic for papillary thyroid cancer Total thyroidectomy removed a 2 cm FV-PTC Partially encapsulated, no ETE, no lymphovascular invasion, no nodes, BRAF neg Should she receive radioactive iodine for remnant ablation?
49 SUMMARY: Update on RAI RX and Thyroid Cancer Thyroid cancer I 131 dosing and treatment: An update on risk stratification, RAI therapy optimization and radiation risk reduction Judicious use of RAI with changes in practice style over the decades Current 2015 ATA recommendations Optimization of RAI treatment (avoiding under/overdosing) Lower dose I131 is equally effective as high doses Tg s can be used without RAI ablation Avoidance or reduction of collateral exposure to other tissue to reduce long term effects I131 complications are dose-related
50 Thank you for your attention! QUESTIONS?
I-131 ABLATION AND ADJUVANT THERAPY OF THYROID CANCER
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS Advances in Medical and Surgical Management of Thyroid Cancer January 23-24, 2015 I-131 ABLATION AND ADJUVANT THERAPY OF THYROID CANCER 2015 Leonard Wartofsky,
More informationRisk Adapted Follow-Up
Risk Adapted Follow-Up Individualizing Follow- Up Strategies R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Medical College
More informationStrategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer
Strategies for detection of recurrent disease in longterm follow-up of differentiated thyroid cancer A rational approach to longterm follow-up based on dynamic risk assessment. World Congress on Thyroid
More informationGerard M. Doherty, MD
Surgical Management of Differentiated Thyroid Cancer: Update on 2015 ATA Guidelines Gerard M. Doherty, MD Chair of Surgery Utley Professor of Surgery and Medicine Boston University Surgeon-in-Chief Boston
More informationThyroid Cancer: When to Treat? MEGAN R. HAYMART, MD
Thyroid Cancer: When to Treat? MEGAN R. HAYMART, MD ASSOCIATE PROFESSOR OF MEDICINE UNIVERSITY OF MICHIGAN MICHIGAN AACE 2018 ANNUAL MEETING Thyroid Cancer: When Not to Treat? FOCUS WILL BE ON LOW-RISK
More informationHow Will (Should) the Latest Guidelines Affect the Endocrinologist s Management of Thyroid Cancer? AACE 2017
How Will (Should) the Latest Guidelines Affect the Endocrinologist s Management of Thyroid Cancer? AACE 2017 Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some statistics New guidelines
More informationI treatment for differentiated thyroid carcinoma Current guidelines
131 I treatment for differentiated thyroid carcinoma Current guidelines François Jamar, UCL Brussels francois.jamar@uclouvain.be IAEA-Belnuc Theranostics course Brussels, October 5 th, 2017 131 I treatment
More informationDynamic Risk Stratification:
Dynamic Risk Stratification: Using Risk Estimates to Guide Initial Management R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine
More information(Not so) New Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer Minnesota/Midwest Chapter of AACE
(Not so) New Guidelines for Management of Thyroid Nodules and Differentiated Thyroid Cancer Minnesota/Midwest Chapter of AACE Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some
More informationWTC 2013 Panel Discussion: Minimal disease
WTC 2013 Panel Discussion: Minimal disease Susan J. Mandel MD MPH Panelists Ken Ain Yasuhiro Ito Stephanie Lee Erich Sturgis Mark Urken Faculty/Presenter Disclosure Relationships with commercial interests
More informationThyroid Cancer & rhtsh: When and How?
Thyroid Cancer & rhtsh: When and How? 8 th Postgraduate Course in Endocrine Surgery Capsis Beach, Crete, September 21, 2006 Quan-Yang Duh, Professor of Surgery, UCSF Increasing Incidence of Thyroid Cancer
More informationThe use of Radioactive Iodine (RAI) for Differentiated Thyroid Cancer
The use of Radioactive Iodine (RAI) for Differentiated Thyroid Cancer Wendy Sacks, M.D. Cedars Sinai Medical Center California Chapter Annual Meeting, AACE Nov 5, 2016 Increasing Incidence of Thyroid Cancer
More informationKey Topics in Thyroid Cancer Worldwide epidemic What Should the Endocrinologist and Surgeon do?
Key Topics in Thyroid Cancer Worldwide epidemic What Should the Endocrinologist and Surgeon do? Martin Schlumberger Gustave Presenter Roussy Name and Université Paris Saclay, Villejuif, France 1 Disclosure
More informationradioactive iodine (iodine-131) Knowing the benefits and risks of radioactive iodine enables you and your doctor to decide WHAT S RIGHT FOR YOU.
to consider if you should receive radioactive Knowing the benefits and risks of radioactive iodine enables you and your doctor to decide WHAT S RIGHT FOR YOU. It is in your best interest to have an active
More informationCLINICAL CONSIDERATIONS FOR I-131 THERAPY
CLINICAL CONSIDERATIONS FOR I-131 THERAPY Oneil Lee, MD, PhD Kaiser Permanente Orange County Department of Radiology/Nuclear Medicine GOAL Understand thyroid cancer: Biology, epidemiology, treatment strategies,
More informationTowards a selective use of postoperative radioiodine in thyroid cancer patients
Towards a selective use of postoperative radioiodine in thyroid cancer patients Martin Schlumberger Gustave Presenter Roussy Name and Université Paris Saclay, Villejuif, France 1 Disclosure Relevant financial
More information131-I Therapy Planning in Thyroid Cancer: The role of diagnostic radioiodine scans
131-I Therapy Planning in Thyroid Cancer: The role of diagnostic radioiodine scans Anca M. Avram, M.D. Associate Professor of Radiology Department of Nuclear Medicine University of Michigan Ann Arbor,
More informationCurrent Issues in Thyroid Cancer Surgery in 2017
Current Issues in Thyroid Cancer Surgery in 2017 Dr. David Goldstein MD Msc FRCSC FACS Associate Professor, Department Otolaryngology Head & Neck Surgery, U of T Department of Surgical Oncology, Princess
More informationDilemmas in Cytopathology and Histopathology
Dilemmas in Cytopathology and Histopathology Yuri E. Nikiforov, MD, PhD Division of Molecular & Genomic Pathology University of Pittsburgh Medical Center, USA Objectives Discuss new WHO classification
More informationImaging in Thyroid Cancer
Imaging in Thyroid Cancer Susan J. Mandel MD MPH University of Pennsylvania School of Medicine Philadelphia, PA I-123 Ultrasound Background Radioiodine ablation of thyroid remnants after surgery is a generally
More information저작권법에따른이용자의권리는위의내용에의하여영향을받지않습니다.
저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,
More informationTHYROID CANCER IN CHILDREN
THYROID CANCER IN CHILDREN Isabel ROCA, Montserrat NEGRE Joan CASTELL HU VALL HEBRON BARCELONA EPIDEMIOLOGY ADULTS males 1,2-2,6 cases /100.000 females 2,0-3,8 cases /100.000 0,02-0,3 / 100.000 children
More informationAnca M. Avram, M.D. Professor of Radiology
Thyroid Cancer Theranostics: the case for pre-treatment diagnostic staging 131-I scans for 131-I therapy planning Anca M. Avram, M.D. Professor of Radiology Department of Nuclear Medicine University of
More informationHow good are we at finding nodules? Thyroid Nodules Thyroid Cancer Epidemiology Initial management Long-term follow up Disease-free status
New Perspectives in Thyroid Cancer Jennifer Sipos, MD Assistant Professor of Medicine Division of Endocrinology The Ohio State University Outline Thyroid Nodules Thyroid Cancer Epidemiology Initial management
More informationCarcinoma tiroideo differenziato: gestione della persistenza biochimica di malattia
Carcinoma tiroideo differenziato: gestione della persistenza biochimica di malattia Massimo Torlontano U.O. Endocrinologia IRCCS Casa Sollievo della Sofferenza Thyroid cancer Incidence 1975-2009 (USA)
More informationSialadenitis without Stones. Case. University of California, San Francisco 11/6/2014
Andrew H. Murr, MD Professor and Chairman Roger Boles, MD Endowed Chair in Otolaryngology Education Department of Otolaryngology- Head and Neck Surgery Sialadenitis without Stones: RAI, Autoimmune, and
More informationMegan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013
Megan R. Haymart, MD 83 rd Annual Meeting of the ATA October 16, 2013 Disclosure: Nothing to Disclose Learning Objectives Thyroid cancer - diagnosis - prognosis - treatment - follow-up Thyroid function
More informationAdjuvant therapy for thyroid cancer
Carcinoma of the thyroid Adjuvant therapy for thyroid cancer John Hay Department of Radiation Oncology Vancouver Cancer Centre Department of Surgery UBC 1% of all new malignancies 0.5% in men 1.5% in women
More informationDifferentiated Thyroid Carcinoma
Differentiated Thyroid Carcinoma The GOOD cancer? Jennifer Sipos, MD Associate Professor of Medicine Director, Benign Thyroid Program Division of Endocrinology, Diabetes and Metabolism The Ohio State University
More informationA Review of Differentiated Thyroid Cancer
A Review of Differentiated Thyroid Cancer April 21 st, 2016 FPON Webcast Jonn Wu BMSc MD FRCPC Radiation Oncologist, Vancouver Centre Chair, Provincial H&N Tumour Group, BCCA Clinical Associate Professor,
More information1. Protocol Summary Summary of Trial Design. IoN
1. Protocol Summary 1.1. Summary of Trial Design Title: Short Title/acronym: IoN Is ablative radioiodine Necessary for low risk differentiated thyroid cancer patients IoN EUDRACT no: 2011-000144-21 Sponsor
More information2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines
2015 American Thyroid Association Thyroid Nodule and Cancer Guidelines Angela M. Leung, MD, MSc, ECNU November 5, 2016 Outline Workup of nontoxic thyroid nodule(s) Ultrasound FNAB Management of FNAB results
More informationMinimalistic Initial Therapy Options For Low Risk Papillary Thyroid Cancer
Minimalistic Initial Therapy Options For Low Risk Papillary Thyroid Cancer An emphasis on proper patient selection R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering
More informationManagement of Recurrent Thyroid Cancer
Management of Recurrent Thyroid Cancer Eric Genden, MD, MHA Isidore Professor and Chairman Department of Otolaryngology- Head and Neck Surgery Senior Associate Dean for Clinical Affairs The Icahn School
More informationPediatric Thyroid Cancer Lung Metastases. Liora Lazar MD
Pediatric Thyroid Cancer Lung Metastases Liora Lazar MD Differentiated thyroid cancer (DTC) The 3rd most common solid tumor in childhood and adolescence Accounting for 1.5%-3% of all childhood cancers
More information2015 ATA Thyroid Nodule and DTC Guidelines: Perspectives from the Chair What were you thinking????
2015 ATA Thyroid Nodule and DTC Guidelines: Perspectives from the Chair What were you thinking???? Bryan R. Haugen, MD University of Colorado, School of Medicine Outline Some statistics New guidelines
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationPreoperative Evaluation
Preoperative Evaluation Lateral compartment lymph nodes are easier to detect and are amenable to FNA Central compartment lymph nodes are much more difficult to detect and FNA (Tg washout testing is compromised)
More informationPEDIATRIC Ariel Katz MD
PEDIATRIC Ariel Katz MD Dept. Otolaryngology Head &Neck Surgery Wolfson Medical Center Holon, Israel OBJECTIVES Overview/Background Epidemiology/Etiology Intro to Guidelines Workup Treatment Follow-Up
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationPersistent & Recurrent Differentiated Thyroid Cancer
Persistent & Recurrent Differentiated Thyroid Cancer Electron Kebebew University of California, San Francisco Department of Surgery Objectives Risk factors for persistent & recurrent disease Causes of
More informationThyroid remnant volume and Radioiodine ablation in Differentiated thyroid carcinoma.
ORIGINAL ARTICLE Thyroid remnant volume and Radioiodine ablation in Differentiated thyroid carcinoma. Md. Sayedur Rahman Miah, Md. Reajul Islam, Tanjim Siddika Institute of Nuclear Medicine & Allied Sciences,
More informationA Risk-Adapted Approach to the Use of Radioactive Iodine and External Beam Radiation in the Treatment of Well-Differentiated Thyroid Cancer
Both radioactive iodine and external beam radiation can play roles in well-differentiated thyroid cancer. Rebecca Kinkead. Hula No. 3 (detail), 2010. Oil on canvas, 45 37. A Risk-Adapted Approach to the
More informationProphylactic Central Compartment Neck Dissection(CCND) for Papillary Thyroid Cancer: Con
Prophylactic Central Compartment Neck Dissection(CCND) for Papillary Thyroid Cancer: Con Christopher R. McHenry, M.D. Vice Chairman Department of Surgery MetroHealth Medical Center Professor of Surgery
More informationAustin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide)
Austin Radiological Association Nuclear Medicine Procedure THERAPY FOR THYROID CANCER (I-131 as Sodium Iodide) Overview Indications I-131 therapy for Thyroid Cancer, of the papillo-follicular type, is
More informationWhat s an NIFTP? Keeping Up To Date in Thyroid 2018
What s an NIFTP? Keeping Up To Date in Thyroid 2018 Kathleen Hands, MD, FACE, ECNU Director, Thyroid Center of South Texas Assistant Clinical Professor UTHSCSA DrHands@Thyroid-Center.com 210-844-6163 text
More informationTHYROID CANCER IN CHILDREN. Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine
THYROID CANCER IN CHILDREN Humberto Lugo-Vicente MD FACS FAAP Professor Pediatric Surgery UPR School of Medicine Thyroid nodules Rare Female predominance 4-fold as likely to be malignant Hx Radiation exposure?
More informationDifferentiated Thyroid Cancer: Initial Management
Page 1 ATA HOME GIVE ONLINE ABOUT THE ATA JOIN THE ATA MEMBER SIGN-IN INFORMATION FOR PATIENTS FIND A THYROID SPECIALIST Home Management Guidelines for Patients with Thyroid Nodules and Differentiated
More informationCase-Based Discussion of Thyroid Cancer Therapy
Case-Based Discussion of Thyroid Cancer Therapy Matthew D. Ringel, MD Ralph W. Kurtz Chair and Professor of Medicine Director, Division of Endocrinology The Ohio State University Co-Leader, Molecular Biology
More informationRESEARCH ARTICLE. Comparison of Presentation and Clinical Outcome between Children and Young Adults with Differentiated Thyroid Cancer
RESEARCH ARTICLE Comparison of Presentation and Clinical Outcome between Children and Young Adults with Jian-Tao Wang 1,2&, Rui Huang 1&, An-Ren Kuang 1 * Abstract Background: The aim of the present study
More informationThyroid Surgery: Lobectomy, total thyroidectomy, LN biopsies or only watchful waiting?
Thyroid Surgery: Lobectomy, total thyroidectomy, LN biopsies or only watchful waiting? Jacob Moalem, MD, FACS Associate Professor Endocrine Surgery and Endocrinology URMC Agenda 1. When is lobectomy alone
More informationIJC International Journal of Cancer
IJC International Journal of Cancer Short Report Birth rates after radioactive iodine treatment for differentiated thyroid cancer Chelsea Anderson 1, Stephanie M. Engel 1, Mark A. Weaver 2, Jose P. Zevallos
More informationRESEARCH ARTICLE. Importance of Postoperative Stimulated Thyroglobulin Level at the Time of 131 I Ablation Therapy for Differentiated Thyroid Cancer
RESEARCH ARTICLE Importance of Postoperative Stimulated Thyroglobulin Level at the Time of 131 I Ablation Therapy for Differentiated Thyroid Cancer Zekiye Hasbek 1 *, Bulent Turgut 1, Fatih Kilicli 2,
More informationReference No: Author(s) Approval date: October committee. September Operational Date: Review:
Reference No: Title: Author(s) Systemic Anti-Cancer Therapy (SACT) guidelines for Thyroid cancer Dr Fionnuala Houghton Consultant Clinical Oncologist & Dr Lois Mulholland Consultant Clinical Oncologist
More informationSCIENTIFIC DISCUSSION
London, 20 January 2005 Product Name: THYROGEN Procedure No.: EMEA/H/C/220/II/18 SCIENTIFIC DISCUSSION 7 Westferry Circus, Canary Wharf, London E14 4HB, UK Tel. (44-20) 74 18 84 00 Fax (44-20) 74 18 86
More informationNew York, the nation s thyroid gland. Christopher Morley ( ), "Shore Leave"
New York, the nation s thyroid gland Christopher Morley (1890-1957), "Shore Leave" Thyroid Literature Medline Thyroid disease 136,053 Thyroid tumors 33,554 New Paper on Thyroid Disease Every 3 Hours New
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationMINI-REVIEW. Controversies about Radioactive Iodine-131 Remnant Ablation in Low Risk Thyroid Cancers: Are We Near A Consensus?
MINI-REVIEW Controversies about Radioactive Iodine-131 Remnant Ablation in Low Risk Thyroid Cancers: Are We Near A Consensus? Maseeh Uz Zaman 1 *, Nosheen Fatima 2, Ajit Kumar Padhy 3, Unaiza Zaman 4 Abstract
More information- RET/PTC rearrangement: 20% papillary thyroid cancer - RET: medullary thyroid cancer
Thyroid Cancer UpToDate: Introduction: Risk Factors: Biology: Symptoms: Diagnosis: 1. Lenvina is the first line therapy with powerful durable response and superior PFS in pts with RAI-refractory disease.
More informationImproving the Long Term Management of Benign Thyroid Nodules
25 th Annual Scientific AACE Clinical Congress Improving the Long Term Management of Benign Thyroid Nodules Stephanie L. Lee, MD, PhD Director, Thyroid Health Center Section of Endocrinology, Diabetes
More informationPathological N1b Node Metastasis Itself Can Be Still a Valid Prognostic Factor in PTC after High Dose RAI Therapy
ORIGINAL ARTICLE pissn: 2384-3799 eissn: 2466-1899 Int J Thyroidol 2016 November 9(2): 159-167 https://doi.org/10.11106/ijt.2016.9.2.159 Pathological N1b Node Metastasis Itself Can Be Still a Valid Prognostic
More informationSuccess rate of thyroid remnant ablation for differentiated thyroid cancer based on 5550 MBq post-therapy scan
ORIGINAL ARTICLE Success rate of thyroid remnant ablation for differentiated thyroid cancer based on 5550 MBq post-therapy scan I. Hommel 1 *, G.F. Pieters 1, A.J.M. Rijnders 2, M.M. van Borren 3, H. de
More information4/22/2010. Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey.
Management of Differentiated Thyroid Cancer: Head Neck Surgeon Perspective Hakan Korkmaz, MD Assoc. Prof. of Otolaryngology Ankara Dıșkapı Training Hospital-Turkey Thyroid gland Small endocrine gland:
More informationDisclosures Nodal Management in Differentiated Thyroid Carcinoma
Disclosures Nodal Management in Differentiated Thyroid Carcinoma Nothing to disclose Jonathan George, MD, MPH Assistant Professor UCSF Head and Neck Oncologic & Endocrine Surgery Objectives Overview Describe
More informationNuclear Medicine in Thyroid Cancer. Phillip J. Koo, MD Division Chief of Diagnostic Imaging
Nuclear Medicine in Thyroid Cancer Phillip J. Koo, MD Division Chief of Diagnostic Imaging Financial Disclosures Bayer Janssen Learning Objectives To learn the advantages and disadvantages of SPECT/CT
More informationThyroid Cancer: Imaging Techniques (Nuclear Medicine)
Thyroid Cancer: Imaging Techniques (Nuclear Medicine) Andrei Iagaru, MD MIPS Molecular Imaging Program at Stanford Stanford University School of Medicine Department of Radiology Introduction Ø There are
More informationInitial surgery for differentiated thyroid cancer: What is the appropriate extent and attendant risks and benefits?
Initial surgery for differentiated thyroid cancer: What is the appropriate extent and attendant risks and benefits? Julie Ann Sosa, MD MA FACS Professor of Surgery and Medicine Chief, Section of Endocrine
More informationRadiation Therapy for Thyroid Cancer. When is Radiation Therapy indicated in Thyroid Cancer of Follicular or Parafollicular Cell Origin?
When is Radiation Therapy indicated in Thyroid Cancer of Follicular or Parafollicular Cell Origin? Jeanne Marie Quivey MD FACR October 200 Radiation Therapy for Thyroid Cancer Radioactive 3- I (RAI) External
More informationUltrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer
Ultrasound for Pre-operative Evaluation of Well Differentiated Thyroid Cancer Its Not Just About the Nodes AACE Advances in Medical and Surgical Management of Thyroid Cancer - 2017 Robert A. Levine, MD,
More informationCorrespondence should be addressed to Stan H. M. Van Uum;
Oncology Volume 2016, Article ID 6496750, 6 pages http://dx.doi.org/10.1155/2016/6496750 Research Article Recombinant Human Thyroid Stimulating Hormone versus Thyroid Hormone Withdrawal for Radioactive
More informationObjectives. How to Investigate Thyroid Nodules like A Pro
How to Investigate Thyroid Nodules like A Pro Chris Sadler, MA, PA C, CDE, DFAAPA Medical Science Outcomes Liaison Intarcia Diabetes and Endocrine Associates La Jolla, CA Past President ASEPA Disclosures
More informationCED-SOS Advice Report 5 EDUCATION AND INFORMATION 2012
CED-SOS Advice Report 5 EDUCATION AND INFORMATION 2012 Recombinant Humanized Thyroid Stimulating Hormone () Preparation Prior To Radioiodine Ablation in Patients Who Have Undergone Thyroidectomy for Papillary
More informationRising Incidence of Second Cancers in Patients With Low-Risk (T1N0) Thyroid Cancer Who Receive Radioactive Iodine Therapy
Rising Incidence of Second Cancers in Patients With Low-Risk (T1N0) Thyroid Cancer Who Receive Radioactive Iodine Therapy N. Gopalakrishna Iyer, MD, PhD 1 ; Luc G. T. Morris, MD 1 ; R. Michael Tuttle,
More informationTHYROID FUNCTION TEST and RADIONUCLIDE THERAPY
THYROID FUNCTION TEST and RADIONUCLIDE THERAPY Ajalaya Teyateeti, M.D. Division of Nuclear Medicine Department of Radiology I. Thyroid function test OUTLINE Application and interpretation of in vitro TFT
More informationDisclosures. Learning objectives. Case 1A. Autoimmune Thyroid Disease: Medical and Surgical Issues. I have nothing to disclose.
Disclosures Autoimmune Thyroid Disease: Medical and Surgical Issues I have nothing to disclose. Chrysoula Dosiou, MD, MS Clinical Assistant Professor Division of Endocrinology Stanford University School
More informationA variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study
ORIGINAL ARTICLE A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study Joon-Hyop Lee, MD, Yoo Seung Chung, MD, PhD,* Young Don Lee, MD, PhD
More informationOver the last several decades, the incidence of differentiated
SPECIAL FEATURE Review Low-Risk Differentiated Thyroid Cancer and Radioiodine Remnant Ablation: A Systematic Review of the Literature Livia Lamartina, Cosimo Durante, Sebastiano Filetti, and David S. Cooper
More informationJournal of Nuclear Medicine, published on August 14, 2008 as doi: /jnumed
Journal of Nuclear Medicine, published on August 14, 2008 as doi:10.2967/jnumed.108.052464 I Effective Half-Life and Dosimetry in Thyroid Cancer Patients Hervé Remy 1, Isabelle Borget 2, Sophie Leboulleux
More informationAlthough adequate treatment of differentiated thyroid
Serum Thyroglobulin Concentrations and 131 I Whole-Body Scan Results in Patients with Differentiated Thyroid Carcinoma After Administration of Recombinant Human Thyroid-Stimulating Hormone Alessia David,
More informationCase 5: Thyroid cancer in 42 yr-old woman with Graves disease
Case 5: Thyroid cancer in 42 yr-old woman with Graves disease Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) Thyroid cancer in 42 yr-old woman with
More informationCase 4: Disseminated bone metastases from differentiated follicular thyroid cancer
Case 4: Disseminated bone metastases from differentiated follicular thyroid cancer Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) Disseminated bone
More informationSurgical Management of Thyroid Disease. Tom Shi Connally, MD, FACS
Surgical Management of Thyroid Disease Tom Shi Connally, MD, FACS Disclosures Speaker Bureau: Veracyte Castle Diagnostics Objectives Understand the role of ultrasound and FNA in managing thyroid cancer
More informationApproach to Thyroid Nodules
Approach to Thyroid Nodules Alice Y.Y. Cheng, MD, FRCPC Twitter: @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationIntegrating Guidelines, Experience, and Clinical Judgment in the Management of Thyroid Cancer AACE Annual Meeting May 5, 2016
Integrating Guidelines, Experience, and Clinical Judgment in the Management of Thyroid Cancer AACE Annual Meeting May 5, 2016 Bryan Haugen, M.D. Julie Ann Sosa, M.D. Mike Tuttle, M.D. Peter A. Singer,
More informationThyroid Nodule. Disclosure. Learning Objectives P A P A P A 3/18/2014. Nothing to disclose.
Thyroid Nodule Evaluating the patient with a thyroid nodule and some management options. Miguel V. Valdez PA C Disclosure Nothing to disclose. Learning Objectives Examination of thyroid gland Options for
More informationThyroid Cancer: Overview And Peculiar Aspects In Philippines Nemencio A. Nicodemus Jr., MD
16 April 2016, Manila, Philippines Thyroid Cancer: Overview And Peculiar Aspects In Philippines Nemencio A. Nicodemus Jr., MD IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION www.excemed.org Learning
More informationLow - dose radioiodine ablation of remnant thyroid in high - risk differentiated thyroid carcinoma
K. SUZUKI, et al : radioiodine ablation in DTC 141 J. Tokyo Med. Univ., 72 2 : 141-147, 2014 Low - dose radioiodine ablation of remnant thyroid in high - risk differentiated thyroid carcinoma Kunihito
More informationInternational Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer
Nuclear Medicine Review 2006 Vol. 9, No. 1, pp. 84 88 Copyright 2006 Via Medica ISSN 1506 9680 International Czech and Slovak cooperation in the treatment of patients with differentiated thyroid cancer
More informationKey Words. Thyroid cancer Age Prognostic indicators Cancer stage
The Oncologist The Oncologist CME Program is located online at http://cme.theoncologist.com/. To take the CME activity related to this article, you must be a registered user. Endocrinology Understanding
More informationWork Up & Evaluation of Thyroid Nodules In 2013: State of The Art
Work Up & Evaluation of Thyroid Nodules In 2013: State of The Art BC Surgical Oncology Network, Fall Update Todd McMullen MD PhD FRCSC FACS Endocrine Surgeon Divisions of General Surgery and Oncology Director,
More informationObjectives. 1)To recall thyroid nodule ultrasound characteristics that increase the risk of malignancy
Evaluation and Management of Thyroid Nodules in Primary Care Chris Sadler, MA, PA C, CDE, DFAAPA Medical Science Outcomes Liaison Intarcia Diabetes and Endocrine Associates La Jolla, CA Past President
More informationThyroid Nodules. Hossein Gharib, MD, MACP, MACE
Thyroid Nodules Hossein Gharib, MD, MACP, MACE Professor of Medicine Mayo Clinic College of Medicine President Elect, American College of Endocrinology University Course January 2008 CP1294362-1 Thyroid
More informationoriginal article INTRODUCTION According to the American Thyroid Association ABSTRACT
original article Recombinant human TSH versus thyroid hormone withdrawal in adjuvant therapy with radioactive iodine of patients with papillary thyroid carcinoma and clinically apparent lymph node metastases
More informationOh, I get it, the TSH goes up and down
Evaluation and Management of the Thyroid Nodule Oh, I get it, the TSH goes up and down UCSF Head and Neck Conference October 24, 2008 Peter A. Singer, M.D. Professor and Chief Clinical Endocrinology University
More informationThis was a multinational, multicenter study conducted at 14 sites in both the United States (US) and Europe (EU).
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription. NAME OF SPONSOR/COMPANY: Genzyme Corporation,
More information34 year-old Female with Thyroid Cancer
34 year-old Female with Thyroid Cancer KATIE O SULLIVAN, MD FELLOW, ADULT/PEDIATRIC ENDOCRINOLOGY UNIVERSITY OF CHICAGO ENDORAMA THURSDAY, SEPTEMBER 15 TH, 2016 Disclosures: I do not have any relevant
More informationSredišnja medicinska knjižnica
Središnja medicinska knjižnica Prpić M., Kruljac I., Kust D., Kirigin L. S., Jukić T., Dabelić N., Bolanča A., Kusić Z. (2016) Re-ablation I-131 activity does not predict treatment success in low- and
More informationThyroid Update. Timothy C. Petersen, MD, ECNU
Thyroid Update Timothy C. Petersen, MD, ECNU TPMG Coastal Endocrinology Virginia Beach, VA About Me Board Certified Endocrinology, Diabetes, and Metabolism Internal Medicine ECNU Certified Endocrine Certification
More informationRadioiodine-refractory DTC
Oncology: Radioiodine-refractory DTC New Developments in Giuseppe COSTANTE, MD, Head, Endocrinology Clinic Institut Jules Bordet Université Libre de Bruxelles (U.L.B.) Targeted Therapies Targeted Treatments
More informationDifferentiated Thyroid Cancer: Reclassification of the Risk of Recurrence Based on the Response to Initial Treatment
ORIGINAL ARTICLE Differentiated Thyroid Cancer: Reclassification of the Risk of Recurrence Based on the Response to Initial Treatment Martínez MP, Lozano Bullrich MP, Rey M, Ridruejo MC, Bomarito MJ, Claus
More information