Active Surveillance of Thyroid Microcarcinomas: a Critical View.

PURPOSE OF THE REVIEW: There has been an increasing interest on active surveillance for papillary thyroid microcarcinomas (PTMC) in the literature. We will analyze the contributions of those authors who support this approach in most patients with low-risk tumors. RECENT FINDINGS: The development of molecular methods to effectively detect aggressive PTMC at the fine-needle aspiration biopsy will enable the sound indication of immediate surgery in those patients, assuring the other individuals with the far more frequent indolent PTMC will undergo active surveillance with less anxiety. Several studies compared the quality of life between patients with PTMC who underwent active surveillance with immediate total thyroidectomy. However, thyroid lobectomy is a quite acceptable intermediate alternative for most patients with PTMC, with less surgical morbidity. It is important to wait for worldwide validation, with reports from low- and middle-income areas, before recommending the routine adoption of active surveillance for patients with PTMC, due to difficult logistic obstacles in those environments.

Intratumor cisplatin nephrotoxicity in combined laser-induced thermal therapy for cancer treatment.

INTRODUCTION: Thermal ablation of tumors by Nd:YAG laser has been growing as a multidisciplinary subspecialty defined as laser-induced thermal therapy (LITT), and has been increasingly accepted as a minimally invasive method for palliation of advanced or recurrent cancer. Previous studies have shown that adjuvant chemotherapy can potentiate laser thermal ablation of tumors leading to improved palliation in advanced cancer patients. OBJECTIVE: Evaluate nephrotoxicity by early markers of renal function in treating head and neck cancer using intra-tumor injections of cisplatin combined with laser-induced thermal therapy (CDDP-LITT). METHODS: Nine patients with recurrent head and neck tumors were treated by CDDP-LITT in order to determine nephrotoxicity related to this synergistic association. Among the tests requested to detect early were creatinine, magnesium, creatinine clearance, serum urea-BUN, type I urine, and proteinuria at 24 hours. RESULTS: Twelve recurrent tumors in nine patients were treated by CDDP-LITT. Pain was the major complaint (four patients), while other symptoms included dysphagia, dyspnea, bleeding, and difficulties in chewing. Fifteen laser procedures were performed and maximal CDDP dose was 50 mg. None of the markers for nephrotoxicity showed changes at these levels of CDDP intra-tumor injections. CONCLUSION: This initial experience with (CDDP-LITT) indicates both safety and therapeutic potential for palliation of advanced head and neck cancer. However, safety and feasibility must be confirmed by longer follow-up and further escalation of CDDP doses in a Phase I study to determine maximum tolerated dose (MTD) and demonstrate tangible benefits for patients. Lasers Surg. Med. 49:756-762, 2017. © 2017 Wiley Periodicals, Inc.

Reabordagem cirúrgica do nível VI para carcinoma de tiroide: experiência de um hospital universitário / Reoperation of the level VI for thyroid carcinomas: our experience

Introdução: A neoplasia de tiroide é a segunda neoplasiaendócrina maligna mais comum, sendo o carcinoma papilíferode tiroide o mais comum. Esses tumores costumam cursar commetástases linfonodais em 30 a 80% dos casos, havendo recidivascervicais em 5 a 15% dos pacientes. Nos casos de recidivas, areabordagem costuma ser necessária, aumentando a morbidadedesses pacientes. Objetivo: mostrar a experiência de nossoserviço nos casos de reabordagem do nível VI e descrever suascomplicações. Método: Estudo retrospectivo a partir da análisede prontuários dos pacientes submetidos à reabordagem do nívelVI entre abril de 2007 e abril de 2009. Todos os pacientes forampreviamente tratados com tiroidectomia total, sem abordagemdo nível VI. Pacientes: Foram 10 operações em 10 pacientes,com predominância do sexo feminino, 9:1, com idade média de48,3 anos. O seguimento médio dos pacientes foi de 8,1 meses.Resultados: O tempo médio de recidiva foi de 6,9 anos. A taxade complicações foi de 20%, com 2 casos com hipoparatiroidismodefinitivo, 1 caso com paralisia do nervo laríngeo, e nesse mesmopaciente, necessidade de sacrifício do laríngeo por invasãotumoral. Conclusão: A reabordagem do nível VI é uma cirurgiaque implica uma maior morbidade pelo risco aumentado dehipoparatiroidismo e lesão de nervo laríngeo inferior. No entanto,ela é passível de ser realizada nos casos indicados, sempre porum cirurgião experiente, para minimizar esses riscos.

Introduction: The thyroid neoplasms corresponds to the secondmost common endocrine tumors, while the papillary carcinoma isthe most common type. This tumors tend to have cervical metastasisin 30 to 80 % of the cases, with local reccurrence or persistencein about 5 to 15 % of the patients. In this cases, a new surgeryis necessary, wich implicates in higher complications. Objective:Describe the experience of our hospital in reoperation of the levelVI as well as it?s complications. Method: Retrospective studywith review of the pronctuaries of patients who were submitted toreoperation of the level VI between april of 2007 and april of 2009.All patients had been previous treated with total thiroidectomywithout dissection of the level VI. Patients: It was performed 10surgeries in 10 patients, being 9 females and 1 male. Average agewas 48,3 years, with average follow up of 8,1 months. Results: Themean time of reccurrence was 6,9 years. Our complications rateswere 20% of definitive hypoparathyroidism (2 cases) and 20% oflaryngeal nerve paralysis ( 2 cases). Conclusion: Reoperation ofthe level VI is a surgery with a higher risk of complications, suchas definitive hypoparathyroidism and/or laryngeal nerve paralysis.However, it?s still the current treatment for tumor reccurrence,and need to be performed by a experienced surgeon in order tominimize the risk.