Gabriele Materazzi

New Therapies for Dedifferentiated Papillary Thyroid Cancer

The number of thyroid cancers is increasing. Standard treatment usually includes primary surgery, thyroid-stimulating hormone suppressive therapy, and ablation of the thyroid remnant with radioactive iodine (RAI). Despite the generally good prognosis of thyroid carcinoma, about 5% of patients will develop metastatic disease, which fails to respond to RAI, exhibiting a more aggressive behavior. The lack of specific, effective and well-tolerated drugs, the scarcity of data about the association of multi-targeting drugs, and the limited role of radioiodine for dedifferentiated thyroid cancer, call for further efforts in the field of new drugs development. Rearranged during transfection (RET)/papillary thyroid carcinoma gene rearrangements, BRAF (B-RAF proto-oncogene, serine/threonine kinase) gene mutations, RAS (rat sarcoma) mutations, and vascular endothelial growth factor receptor 2 angiogenesis pathways are some of the known pathways playing a crucial role in the development of thyroid cancer. Targeted novel compounds have been demonstrated to induce clinical responses and stabilization of disease. Sorafenib has been approved for differentiated thyroid cancer refractory to RAI.

Thyroid and Parathyroid (MIVAT and MIVAP)

The first endoscopic procedure in the cervical area was performed by M. Gagner who operated on a patient presenting with a primary hyperparathyroidism (PHPT) caused by a hyperplasia of four glands. PHPT seemed immediately to be an ideal disease to be approached endoscopically for several reasons: (1) the tumor giving rise to the hyperfunction is almost always benign (2) it rarely exceeds 2–3 of cm size (3) there is no need for any surgical reconstruction after the small mass removal. Not much later, also thyroid gland started to be approached endoscopically, although thyroid diseases more often present with a pathologic pattern which makes difficult to operate on them via an endoscopic access. In fact large goiters and invasive tumors are still common indications for thyroid surgery and the size of the mass to remove from the neck strongly limits the prospects of endoscopic thyroidectomy.

Minimally Invasive Video-Assisted Parathyroidectomy; A Detailed Illustration and Highlighting an Additional Potential Advantage Over Other Targeted Parathyroid Surgeries

Targeted parathyroid surgery also referred to as minimally invasive parathyroidectomy has replaced full neck exploration as the preferred surgical approach to primary hyperparathyroidism. This is attributed to the ability to accurately localize enlarged parathyroid glands preoperatively and obtain objective evidence of adequate resection intraoperatively. The two most widely used minimally invasive parathyroid surgeries are the non-endoscopic miniincision parathyroidectomy and the minimally invasive video-assisted parathyroidectomy. The aim of this article is to provide a detailed illustration of the latter supplemented with an animated video of the procedure, and to highlight a potential advantage it offers over other targeted parathyroid procedures; the ability to perform a full neck exploration and/or a concomitant thyroid surgery without the need to convert to a standard cervicotomy.