TY - JOUR
T1 - Controversies in primary treatment of low-risk papillary thyroid cancer
AU - McLeod, Donald S.A.
AU - Sawka, Anna M.
AU - Cooper, David S.
N1 - Funding Information:
DSAM was supported by a Royal Australasian College of Physicians IMS Travelling Fellowship and a Cancer Council Queensland PhD scholarship. AMS holds a Cancer Care Ontario Research Chair in Health Services Research, and has received funding from the Cancer Care Ontario Infrastructure Funding Programme to support literature-review associated expenses.
PY - 2013/3
Y1 - 2013/3
N2 - In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.
AB - In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.
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U2 - 10.1016/S0140-6736(12)62205-3
DO - 10.1016/S0140-6736(12)62205-3
M3 - Review article
C2 - 23668555
AN - SCOPUS:84875286337
SN - 0140-6736
VL - 381
SP - 1046
EP - 1057
JO - The Lancet
JF - The Lancet
IS - 9871
ER -