Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review

Oded Cohen^{1

2}, Sharon Tzelnick³, Gregory Randolph⁴, Alessandra Rinaldo⁵, Fernando Álvarez⁶, Juan P Rodrigo⁶, Nabil F Saba⁷, Sandra Nuyts⁸, June Corry⁹, Antti A Mäkitie¹⁰, Vincent Vander Poorten¹¹, Cherie-Ann Nathan¹², Cesare Piazza¹³, Alfio Ferlito¹⁴

Affiliations

¹ Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
² Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
³ Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA.
⁵ ENT Unit, Policlinico Città di Udine, Udine, Italy.
⁶ Department of Otolaryngology, Hospital Universitario Central Asturias, Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Asturias, Spain.
⁷ Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
⁸ Laboratory of Experimental Radiotherapy, Department of Oncology, Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
⁹ Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹¹ Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium.
¹² Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA.
¹³ Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
¹⁴ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

PMID: 38472743
DOI: 10.1111/cen.15041

Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review

Oded Cohen et al. Clin Endocrinol (Oxf). 2024 May.

. 2024 May;100(5):468-476.

doi: 10.1111/cen.15041. Epub 2024 Mar 12.

Authors

Affiliations

¹ Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel.
² Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
³ Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA.
⁵ ENT Unit, Policlinico Città di Udine, Udine, Italy.
⁶ Department of Otolaryngology, Hospital Universitario Central Asturias, Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Asturias, Spain.
⁷ Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
⁸ Laboratory of Experimental Radiotherapy, Department of Oncology, Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
⁹ Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹¹ Section Head and Neck Oncology, Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium.
¹² Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Health Shreveport, Shreveport, Louisiana, USA.
¹³ Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
¹⁴ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

PMID: 38472743
DOI: 10.1111/cen.15041

Abstract

Introduction: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor from parafollicular cells that produce calcitonin (Ct). Despite several existing guidelines for the surgical management of sporadic MTC (sMTC), optimal initial surgical management of the thyroid, the central and the lateral neck remains a matter of debate.

Methods: A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines.

Results: Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old.

Conclusion: Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.

Keywords: cancer; guidelines; medullary; sporadic; thyroid.

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References

REFERENCES

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1. Romei C, Casella F, Tacito A, et al. New insights in the molecular signature of advanced medullary thyroid cancer: evidence of a bad outcome of cases with double RET mutations. J Med Genet. 2016;53(11):729‐734. doi:10.1136/jmedgenet-2016-103833
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Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review

Affiliations

Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Supplementary concepts

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous