Evolving management considerations in active surveillance for micropapillary thyroid carcinoma
| Autor: | Irene Chen, Wendy Sacks, Michelle Melany, Allen S. Ho |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Oncology
medicine.medical_specialty Endocrinology Diabetes and Metabolism MEDLINE 030209 endocrinology & metabolism Risk Assessment Thyroid carcinoma 03 medical and health sciences 0302 clinical medicine Endocrinology Risk Factors Internal medicine Internal Medicine medicine Carcinoma Humans Thyroid Neoplasms Watchful Waiting Monitoring Physiologic Nutrition and Dietetics business.industry Patient Selection Thyroid Disease progression medicine.disease Carcinoma Papillary medicine.anatomical_structure 030220 oncology & carcinogenesis Risk stratification Disease Progression business |
| Zdroj: | Current Opinion in Endocrinology & Diabetes and Obesity. 25:353-359 |
| ISSN: | 1752-296X |
| Popis: | To summarize developments on active surveillance for micropapillary thyroid cancers, with a focus on strategies for optimal risk stratification and caveats that currently limit adoption.Observational trials encompassing thousands of active surveillance patients worldwide have increasingly demonstrated the viability of active surveillance for small, low-risk thyroid cancers. Collectively, these data have established that with proper patient selection and strict monitoring, more than 85% of such cases remain indolent no meaningful clinical growth over at least 10 years. Moreover, to date no cases of symptomatic progression or distant metastasis have been reported, and that delayed treatment when needed has not led to unresectable disease or higher risk of complications. Deeper investigation to better predict clinical progression is necessary to improve patient selection, given concerns regarding patient anxiety, age eligibility, and underestimation of true disease extent.Compelling data from ongoing trials support active surveillance as a first-line management option for micropapillary thyroid carcinomas. Proper risk stratification and strict monitoring protocols will be necessary to sustain the excellent results achieved to date. Broad adoption of active surveillance will require further education, collaboration, and equipoise between physicians and patients to optimize such individualized treatment plans. |
| Databáze: | OpenAIRE |
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