대한갑상선학회 갑상선분화암 진료권고안; Part I. 갑상선분화암의 초기치료 - 제7장 갑상선분화암에서 수술 후 추가적인 외부 방사선조사나 항암 치료의 역할 2024

문신제 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Surgical resection is typically the primary treatment for differentiated thyroid cancer (DTC), followed by radioactive iodine (RAI) and thyroid-stimulating hormone suppression therapies based on the cancer stage and risk of recurrence. Nevertheless, further treatment may be necessary for patients exhibiting persistent disease following RAI therapy, residual disease refractory to RAI, or unresectable locoregional lesions. This guideline discusses the role of external beam radiotherapy and chemotherapy following surgical resection in patients with DTC. External beam radiotherapy is ineffective if DTC has been entirely excised (Grade 2). Adjuvant external beam radiotherapy may be optionally performed in patients with incomplete surgical resection or frequently recurrent disease (Grade 2). In patients at high risk of recurrence following surgery and RAI therapy, adjuvant external beam radiotherapy may be optionally considered (Grade 3). However, external beam radiotherapy may increase the risk of serious adverse events after tyrosine kinase inhibitor therapy. Therefore, careful consideration is needed when prescribing external beam radiotherapy for patients planning to undergo tyrosine kinase inhibitor therapy. There is no evidence supporting the benefits of the routine use of adjuvant chemotherapy for DTC treatment (Grade 2).

Survival and Compliance with the Use of Radiation Therapy for Anaplastic Thyroid Carcinoma

Yoon-Kyeong Oh(오윤경),Ji-Young Jang(장지영),Woong-Ki Chung(정웅기) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.4

Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6∼70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1∼104 months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1∼104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (≤5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered 목 적: 본 연구는 미분화 갑상선암 환자에서 방사선치료에 대한 치료순응도와 치료 성적을 분석하고자 하였다. 대상 및 방법: 1993년부터 2002년까지 미분화 갑상선암으로 외부방사선치료를 시행받았던 17명을 대상으로 후향적으로 분석하였다. 외부방사선치료는 14명에서 수술 후에 시행하였고, 3명에서 조직검사 후에 시행하였다. 수술이 시행되었던 14명의 수술 방법은 9명은 근치적절제술, 5명은 고식적절제술이었다. 고분화 갑상선암이 6명에서 동반되어 있었고, 진단 당시 암의 크기가 5 cm보다 컸던 경우는 14명이었다. 총방사선량은 6∼70 Gy (중앙선량, 37.5 Gy)이었고, 11명은 예정된 방사선치료를 끝낼 수 있었고, 6명에서는 방사선치료가 중단되었다. 추적기간은 1∼104개월로 중앙값이 5개월, 평균값이 20개월이었다. 결 과: 5명에서는 방사선치료를 시작할 당시에 육안적 종양이 없었으며, 5명 모두 종양의 재성장 없이 방사선치료를 잘 끝낼 수 있었다. 나머지 12명에서는 방사선치료를 시작할 당시 육안적 종양이 있었는데, 이 중 4명은 근치적절제술 후에 바로 암이 자란 경우였고, 5명은 고식적절제술, 3명은 조직검사만을 받은 상태였다. 육안적 종양이 있었던12명 중 6명 만이 예정된 방사선치료를 끝낼 수 있었는데, 2명에서는 방사선치료로 종양의 크기가 현저히 감소하였 고, 2명은 약간 감소, 2명은 무반응이었다. 전체 환자의 생존기간은 1∼104개월의 범위로 중앙 생존기간은 5개월이 었고, 평균 생존기간은 21개월이었다. 1년, 2년, 5년 생존율은 41%, 24%, 12%이었다. 원발암수, 종양크기, 수술, 방 사선치료 완료가 의미있는 예후인자였다. 장기 생존자는 단기 생존자에 비해 진단 당시와 방사선치료 시작 당시에 암 의 크기가 작은 경향이 있었다. 결 론: 진단 당시 암의 크기가 5 cm 이하, 방사선치료 전에 수술 시행(근치적 또는 고식적), 수술 부위에 종양의 빠른 재성장이 없는 환자들이 수술후 방사선치료의 좋은 지원자가 될 수 있음을 시사하며, 그와 반대인 경우는 방사선치료가 중단되기 쉽고 생존기간이 짧았기 때문에 방사선치료의 역할이 매우 부족하여 방사선치료를 시행하지 않을 수도 있겠다.

대한갑상선학회 갑상선분화암 진료권고안; Part I. 갑상선분화암의 초기치료 - 제5장 갑상선분화암의 수술 후 초기 질병 상태와 재발위험도 평가 및 초기위험군 분류 2024

이은경 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging classification of thyroid cancer can predict death but cannot determine the type and frequency of follow-up testing. Risk stratification is a concept proposed by the American Thyroid Association that uses additional prognostic factors that are not included in the AJCC/UICC classification, such as number or size of metastatic lymph nodes, genetic mutations, and vascular invasion in follicular cancer, to further refine the prognosis of thyroid cancer. The risk of recurrence was categorized as low, intermediate, and high risk, and the need for total thyroidectomy, radioiodine therapy, or thyroid-stimulating hormone suppression was determined depending on each risk level. This approach has been accepted worldwide, and the previous recommendations of the Korean Thyroid Association followed a similar line of thinking but these have been modified in the revised 2024 guidelines. For the revised initial risk stratification, after careful review of the results of the recent meta-analyses and large observational studies and after a multidisciplinary meeting, four major changes were made: 1) thyroid cancer was reclassified according to the World Health Organization (WHO) 2022 tumor classification system; 2) recurrence risk was stratified by combining encapsulated follicular variant papillary thyroid cancer, follicular thyroid cancer, and oncocytic thyroid cancer, which have similar recurrence risk and associated factors, into follicular-patterned tumor; 3) low-risk groups were defined as those with a known recurrence rate of ≤5%, high-risk groups were upgraded to those with a known recurrence rate of ≥30%, and intermediate-risk groups were those with a recurrence risk of 5–30%; and 4) the intermediate risk group had the recurrence rate presented according to various clinicopathological factors, mainly based on reports from Korea. Thus, it is recommended to evaluate the initial risk group by predicting the recurrence rate by combining each clinical factor in individual patients, rather than applying the recurrence rate caused by single risk factor.

대한갑상선학회 갑상선분화암 진료권고안; Part V. 소아 갑상선분화암 2024

문정은 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Pediatric differentiated thyroid cancers (DTCs), mostly papillary thyroid cancer (PTC, 80-90%), are diagnosed at more advanced stages with larger tumor sizes and higher rates of locoregional and/or lung metastasis. Despite the higher recurrence rates of pediatric cancers than of adult thyroid cancers, pediatric patients demonstrate a lower mortality rate and more favorable prognosis. Considering the more advanced stage at diagnosis in pediatric patients, preoperative evaluation is crucial to determine the extent of surgery required. Furthermore, if hereditary tumor syndrome is suspected, genetic testing is required. Recommendations for pediatric DTCs focus on the surgical principles, radioiodine therapy according to the postoperative risk level, treatment and follow-up of recurrent or persistent diseases, and treatment of patients with radioiodine-refractory PTCs on the basis of genetic drivers that are unique to pediatric patients.

원발성 유두 갑상선암의 수술적 치료 후 측경부 전이 림프절에서 발생한 미분화 갑상선암 3예

성태연,홍순원<SUP>1<.SUP>,강상욱,이승철,정종주,이용상,남기현,장항석,정웅윤,박정수,Tae-Yon Sung,Soon-Won Hong<SUP>1<.SUP>,Sang- Wook Kang,Seung Chul Lee,Jong Ju Jeong,Yong Sang Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,M.D. 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3

Anaplastic thyroid carcinoma (ATC) is a rare disease that shows very aggressive behavior. Most ATCs arise from pre-existing thyroid carcinomas. However, anaplastic transformation occurring in metastatic cervical nodes is extremely rare. We report herein on 3 cases of anaplastic transformation of metastatic lateral cervical lymph nodes from primary papillary thyroid carcinoma (PTC), which happened long after the initial surgical treatment. All the patients died of disease within 4 months in spite of aggressive treatment for the lesions. Our experience supports that appropriate lymph node dissection is mandatory at the time of initial surgery even for differentiated thyroid carcinomas. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:210-214)</B>

대한갑상선학회 갑상선분화암 진료권고안; Part III. 진행성 갑상선분화암의 치료 - 제1-2장 갑상선 수술부위 재발 또는 경부 전이림프절에 대한 수술 및 비수술적 치료 2024

원호륜 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

These guidelines aim to establish the standard practice for diagnosing and treating patients with differentiated thyroid cancer (DTC). Based on the Korean Thyroid Association (KTA) Guidelines on DTC management, the “Treatment of Advanced DTC” section was revised in 2024 and has been provided through this chapter. Especially, this chapter covers surgical and nonsurgical treatments for the local (previous surgery site) or regional (cervical lymph node metastasis) recurrences. After drafting the guidelines, it was finalized by collecting opinions from KTA members and related societies. Surgical resection is the preferred treatment for local or regional recurrence of advanced DTC. If surgical resection is not possible, nonsurgical resection treatment under ultrasonography guidance may be considered as an alternative treatment for local or regional recurrence of DTC. Furthermore, if residual lesions are suspected even after surgical resection or respiratory-digestive organ invasion, additional radioactive iodine and external radiation treatments are considered.

대한갑상선학회 갑상선분화암 진료권고안; Part II. 갑상선분화암의 추적 2024

김미진 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Based on the clinical, histopathological, and perioperative data of a patient with differentiated thyroid cancer (DTC), risk stratification based on their initial recurrence risk is a crucial follow-up (FU) strategy during the first 1–2 years after initial therapy. However, restratifiying the recurrence risk on the basis of current clinical data that becomes available after considering the response to treatment (ongoing risk stratification, ORS) provides a more accurate prediction of the status at the final FU and a more tailored management approach. Since the 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and DTC, the latest guidelines that include the National Comprehensive Cancer Network clinical practice and European Association for Medical Oncology guidelines have been updated to reflect several recent evidence in ORS and thyroid-stimulating hormone (TSH) suppression of DTC. The current clinical practice guideline was developed by extracting FU surveillance after the initial treatment section from the previous version of guidelines and updating it to reflect recent evidence. The current revised guideline includes recommendations for recent ORS, TSH target level based on risk stratification, FU tools for detection of recurrence and assessment of disease status, and long-term FU strategy for consideration of the disease status. These evidence-based recommendations are expected to avoid overtreatment and intensive FU of the majority of patients who will have a very good prognosis after the initial treatment of DTC patients, thereby ensuring that patients receive the most appropriate and effective treatment and FU options.

대한갑상선학회 갑상선분화암 진료권고안; Part III. 진행성 갑상선분화암의 치료 - 제5장 진행성 갑상선분화암 전이 병소의 부위별 치료 원칙 2024

정경연 대한갑상선학회 2024 International Journal of Thyroidology Vol.17 No.1

Only a small percentage of patients (2-5%) with differentiated thyroid cancer (DTC) exhibit distant metastasis at the initial diagnosis or during the disease course. The most common metastatic sites of DTC are the lungs, followed by the bones. Radioactive iodine (RAI) therapy is considered the primary treatment for RAI-avid distant metastatic DTC. Depending on the characteristics of metastatic lesions, local treatment such as surgical resection, radiofrequency ablation, and external beam radiation therapy may be considered for some patients with metastatic DTC. Slowly growing and asymptomatic metastases can be monitored with follow-up while receiving thyroid-stimulating hormone (TSH) suppression therapy. In patients with a limited number of lung metastases and good performance status, surgical removal of the metastatic lesions may be considered. Systemic therapy should be considered for patients with progressive RAI refractory DTC. In this clinical guideline, we aim to outline the treatment principles for patients with lung, bone, and brain metastases of DTC.

증례 : 갑상선 미분화암으로 오인된 전이성 폐암

김혜진 ( Hai Jin Kim ),김철식 ( Chul Sik Kim ),박종숙 ( Jong Suk Park ),황도유 ( Doh Yu Whang ),안철우 ( Chul Woo Ahn ),김경래 ( Kyung Rae Kim ),홍순원 ( Soon Won Hong ) 대한내과학회 2006 대한내과학회지 Vol.71 No.3

본 증례는 임상적으로나 조직학적으로 두 질환간의 감별이 어렵고, 현재까지도 환자의 모든 방사선검사 결과는 갑상선암의 폐전이로 보고되고 있다. 단지 경부조직 및 폐렴부위에서 시행한 면역조직화학검사를 통해 두 질환을 감별할 수 있었다. 이러듯 갑상선 전이암과 갑상선 원발암의 감별이 어려운 경우는 비교적 드물게 발생되어, 국내에는 이에 대한 사례보고가 아직 없지만 외국에는 1사례가 보고되고 있다19). 이에 저자들은 44세의 갑상선 미분화암으로 오인된 폐선암의 갑상선 전이 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Anaplastic thyroid cancer is the most aggressive form of cancer found in humans. Usually it is easily diagnosed; however at times other diseases are mistaken for anaplastic thyroid cancer. We present a case of primary lung adenocarcinoma presenting with features that appeared as anaplastic thyroid cancer. The 43-year-old female patient was diagnosed with anaplastic thyroid cancer at a local clinic just before presenting to our hospital. At the clinic she had a neck node excisional biopsy and was informed of the diagnosis of anaplastic cancer. On admission to our hospital, very large bilateral thyroid masses, and lymphadenopathy involving multiple cervical lymph nodes was observed; therefore, we started chemoradiotherapy. The patient showed dramatic improvement and we began to think of other potential etiologies. A FDG-PET study showed increased uptake at the left lower lung area corresponding to a pneumonic consolidation; a TBLB was performed, and reported as poorly differentiated adenocarcinoma. We referred the patient to the oncology department. The patient died after two cycles of systemic chemotherapy.(Korean J Med 71:316-321, 2006)

미분화 갑상선 암에 대한 임상적 고찰

김현영(Hyun-Young Kim),정기욱(Ki-wook Chung),김활웅(Hwal-Woong Kim),윤여규(Yeo-Kyu Youn),오승근(Seung-Kun Oh) 대한외과학회 2001 Annals of Surgical Treatment and Research(ASRT) Vol.61 No.2