Active Surveillance as First-Line Management of Low-Risk Thyroid Carcinoma

Submitted by onc_editor on Thu, 12/21/2017 - 18:30

Close and continuous monitoring is an acceptable approach to patient management of papillary microcarcinoma of the thyroid, according to a recent study published in Thyroid (online September 22, 2017; doi:10.1089/thy.2017.0227).

Rapid increases in the incidence of thyroid carcinoma have been documented, with stable mortality rates in many countries. Common belief is that these increases are due to the increased detection of small papillary thyroid carcinomas, especially papillary microcarcinomas. While the conventional treatment strategy for papillary microcarcinomas is immediate resection, active surveillance has yet to be studied extensively.

Yoshiharu Murata, Nagoya University (Japan), and colleagues conducted a study to determine the effectiveness of active surveillance as a first-line management option in papillary microcarcinomas of the thyroid. Multiple hospitals engaged in active surveillance practice for patients with low-risk papillary microcarcinomas based on extremely higher incidences of both latent thyroid carcinomas  and small papillary thyroid carcinomas compared with the prevalence of clinical thyroid carcinomas.

After 10 years of observations in the first hospital (total number of patients = 1235), only 8% showed carcinoma size enlargement by at least 3 mm and only 3.8% showed early signs of node metastasis. Papillary microcarcinomas were least likely to grow in patients aged 60 years or older.

Furthermore, in comparison to an active surveillance management approach, patients who underwent immediate surgery had substantially higher risks of unfavorable events, as well as four times the total cost of papillary microcarcinoma treatment.

"The seminal observations by the groups from Kuma Hospital and the Cancer Institute Hospital in Tokyo from Japan indicate that the vast majority of papillary thyroid microcarcinomas have an indolent behavior and that active surveillance may be an alternative approach in many patients," commented Peter A Kopp, MD, Editor-in-Chief, Thyroid, and professor of medicine, Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, (Chicago, IL), in a press release (December 14, 2017). "Similar prospective studies are now underway in other parts of the world.

“Ultimately, the goal is to avoid unnecessary treatment,” Dr Kopp continued. “The challenge that lies ahead of us is to identify the small group of patients with papillary thyroid microcarcinomas that require active intervention."—Zachary Bessette