Abstract Background Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence. Patients and Methods All DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied. Results Among 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and &lt; 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence ( p = 0.045). Conclusions A multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity. 

Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas.

Differentiated thyroid cancer is treated by surgery, radioiodine treatment, and Thyroid Stimulating Hormone (TSH) suppression. The role of external beam radiotherapy is mainly palliation of radio-iodine non avid metastatic lesions and in inoperable tumors. Metastasis involving weight-bearing bones and vertebral metastasis with impending spinal cord compression are primarily treated by external radiation. External Beam Radiotherapy improves loco-regional control in patients with gross residual disease after surgical resection. Patients with extra-thyroidal disease and positive margins are treated by adjuvant external beam radiotherapy, especially when the post op radio-iodine scan is negative. External beam radiotherapy is the treatment of choice for radio-iodine non avid inoperable loco-regional recurrence. SRS alone or surgery followed by SRS is the preferred treatment for solitary brain metastasis. Whole brain radiotherapy is the treatment of choice for multiple brain metastatic disease. 

External Beam Radiotherapy in Differentiated Thyroid Cancer

The role of external beam radiotherapy (EBRT) in thyroid cancer (TC) remains contentious due to limited data. Retrospective studies suggest adjuvant EBRT benefits high-risk differentiated thyroid cancer (DTC) and limited-stage anaplastic thyroid carcinoma (ATC), enhancing locoregional control and progression-free survival when combined with surgery and chemotherapy. Intensity-modulated radiotherapy (IMRT) and particle therapy (PT), including protons, carbon ions, and Boron Neutron Capture Therapy (BNCT), represent advances in TC treatment. Following PRISMA guidelines, we reviewed 471 studies from January 2002 to January 2024, selecting 14 articles (10 preclinical, 4 clinical). Preclinical research focused on BNCT in ATC mouse models, showing promising local control rates. Clinical studies explored proton, neutron, or photon radiotherapy, reporting favorable outcomes and manageable toxicity. While PT shows promise supported by biological rationale, further research is necessary to clarify its role and potential combination with systemic treatments in TC management. 

Charged Particle Radiotherapy for Thyroid Cancer. A systematic review

Background The low survival rate among patients with advanced thyroid cancer implies a dearth of effective treatment strategies. Research on advanced thyroid cancer has focused on targeted drugs, while neglecting the prognostic prediction for patients with advanced thyroid cancer who are undergoing surgical treatment. Consequently, further investigation into the prognostic implications of surgery for patients with advanced thyroid cancer is of great significance. Methods This study retrieved and screened all stage IV thyroid cancer patients between 2010 and 2020 in the SEER database, and finally included 670 patients in the study. Independent risk factors, which were used to develop a nomogram model predicting prognosis, were screened using univariate and multivariate Cox regression analyses. Furthermore, the log-rank test was used to compare differences in the Kaplan-Meier curves of overall survival (OS) and cancer-specific death (CSS) in different risk factor groups. Result Survival analysis was performed based on the OS and TCSS of the surgical and non-surgical groups, and the Kaplan-Meier curves were statistically significant. Cox multivariate analysis showed statistical significance in grade, T stage, surgery, and radiotherapy. When statistically significant variables were incorporated into the construction of the prediction model, the C-index of the training group was 0.857, and the areas under the ROC curve of the modeling group were 0.927, 0.925, and 0.919, respectively. The areas under the ROC curve for the validation group were 0.934, 0.937, and 0.944, respectively. The calibration curves and DCA curves showed excellent prediction effect in the prediction model. Conclusion The prognostic prediction model established in this study demonstrated higher predictive accuracy. 

Development and Validation of Prognostic Models in Patients With Stage IV Thyroid Cancer Undergoing Surgical Treatment

Radiotherapy and immunotherapy have shown promising efficacy for the treatment of solid malignancies. Here, we aim to clarify the potential of a combined application of radiotherapy and programmed cell death-ligand 1 (PD-L1) monoclonal antibody atezolizumab in primary anaplastic thyroid cancer (ATC) cells. The radiation caused a significant reduction in cell proliferation, measured by luminescence, and of the number of colonies. The addition of atezolizumab caused a further reduction in cell proliferation of the irradiated ATC cells. However, the combined treatment did not cause either the exposure of the phosphatidylserine or the necrosis, assessed by luminescence/fluorescence. Additionally, a reduction in both uncleaved and cleaved forms of caspases 8 and 3 proteins was detectable in radiated cells. The DNA damage evidenced the over-expression of TP53, CDKN1A and CDKN1B transcripts detected by RT-qPCR and the increase in the protein level of P-γH2AX and the DNA repair deputed kinases. PD-L1 protein level increased in ATC cells after radiation. Radiotherapy caused the reduction in cell viability and an increase of PD-L1-expression, but not apoptotic cell death in ATC cells. The further combination with the immunotherapeutic atezolizumab could increase the efficacy of radiotherapy in terms of reduction in cell proliferation. Further analysis of the involvement of alternative cell death mechanisms is necessary to clarify their cell demise mechanism of action. Their efficacy represents a promising therapy for patients affected by ATC.

/pdf/anti-proliferative-effect-of-radiotherapy-and-implication-of-3fz1749e.pdf

Anti-Proliferative Effect of Radiotherapy and Implication of Immunotherapy in Anaplastic Thyroid Cancer Cells

The use of external beam radiation therapy (EBRT) for the treatment of the different histologic subtypes of thyroid cancer is a matter of debate. This article provides an up-to-date review on the current evidence concerning the benefits of EBRT in thyroid cancer in specific indications.Based on retrospective studies, adjuvant EBRT lessens the risk of locoregional recurrence in locally advanced differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) with high-risk features. The effect of EBRT on overall survival remains uncertain. EBRT should also be part of the multimodality treatment in anaplastic thyroid cancer (ATC), as it improves survival rates in incompletely resected ATC.The role of EBRT in thyroid cancer remains unclear. To date, no randomized control studies are available. Retrospective data showed improved outcomes in patients with high-risk features for locoregional recurrence. 

Indications of external beams radiation for thyroid cancer

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Maher I. Boulos

Author Tools

Chat about Author

Papers

Indications of external beams radiation for thyroid cancer