Reese W. Randle

Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years.

Background. The impact of recent medical advances on disease presentation, extent of operation, and disease‐specific survival for patients with medullary thyroid cancer is unclear. Methods. We used the Surveillance, Epidemiology, and End Results registry to compare trends over 3 time periods, 1983–1992, 1993–2002, and 2003–2012. Results. There were 2,940 patients diagnosed with medullary thyroid cancer between 1983 and 2012. The incidence of medullary thyroid cancer increased during this time period from 0.14 to 0.21 per 100,000 population, and mean age at diagnosis increased from 49.8 to 53.8 (P < .001). The proportion of tumors ≤1 cm also increased from 11.4% in 1983–1992, 19.6% in 1993–2002, to 25.1% in 2003–2012 (P < .001), but stage at diagnosis remained constant (P = .57). In addition, the proportion of patients undergoing a total thyroidectomy and lymph node dissection increased from 58.2% to 76.5% during the study period (P < .001). In the most recent time interval, 5‐year, disease‐specific survival improved from 86% to 89% in all patients (P < .001) but especially for patients with regional (82% to 91%, P = .003) and distant (40% to 51%, P = .02) disease. Conclusion. These data demonstrate that the extent of operation is increasing for patients with medullary thyroid cancer. Disease‐specific survival is also improving, primarily in patients with regional and distant disease.

Significance of diabetes on morbidity and mortality following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

Patients with diabetes suffering from peritoneal surface disease represent a challenge to treat due to the effects of both processes on multiple organ systems. We sought to define the impact of diabetes on outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

Optimal extent of lymphadenectomy for gastric adenocarcinoma: A 7-institution study of the U.S. gastric cancer collaborative.

The optimal extent of lymphadenectomy in the treatment of gastric adenocarcinoma is debated. We compared gastrectomy outcomes following limited (D1) or extended (D2) lymphadenectomy.

Appendiceal goblet cell carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment commonly applied to peritoneal surface disease from low-grade mucinous tumors of the appendix. Some centers have extended this therapy to carcinomatosis from more aggressive malignancies. Therefore, we reviewed our experience with CRS/HIPEC for patients with goblet cell carcinomatosis. METHODS Patients with carcinomatosis from appendiceal primaries with goblet cell features were identified in a prospectively maintained database of 1198 CRS/HIPEC procedures performed between 1991 and 2014. Patient demographics, disease characteristics, morbidity, mortality, and survival were reviewed. RESULTS A total of 31 patients with carcinomatosis originating from appendiceal goblet cell tumors underwent CRS/HIPEC during the study period. Patients were generally young (mean age, 53 y) and otherwise healthy (84% without comorbidities) with good performance status (94% Eastern Cooperative Oncology Group 0 or 1). The mean number of visceral resections was 3.5, and complete cytoreduction of macroscopic disease was accomplished in 36%. Major 90-d morbidity and mortality rates were 38.7% and 9.7%, respectively. Median overall survival (OS) for all patients was 18.4 mo. Patients with negative nodes had better survival than those with positive nodes (median OS, 29.2 versus 10.2 mo), respectively (P = 0.002). Although complete cytoreduction was associated with longer median OS after CRS/HIPEC (R0/R1 28.6 versus R2 17.2 mo, P = 0.47), the observed difference did not reach statistical significance. CONCLUSIONS CRS/HIPEC may improve survival in patients with node negative goblet cell carcinomatosis when a complete cytoreduction is achieved. Patients with disease not amenable to complete cytoreduction should not be offered CRS/HIPEC.

Oncolytic vesicular stomatitis virus as a treatment for neuroendocrine tumors.

BACKGROUND Therapeutic goals for neuroendocrine tumors (NETs) not amenable to operative cure are limited to relieving symptoms and slowing progression. Many malignancies acquire defective antiviral responses as they undergo unregulated proliferation. Therefore, we explored the abilities of recombinant wild-type vesicular stomatitis virus and an attenuated matrix protein mutant (M51R-VSV) to exploit defective antiviral pathways in NETs. METHODS Viral infectivity and lethality were evaluated in a panel of human NET cell lines H727, UMC-11, and CNDT2.5. We evaluated β-interferon pathways in these cells to define the acquired defect. Murine xenografts were treated with a single intratumoral injection of M51R-VSV to study viral efficacy in vivo. RESULTS VSV infected >99% of cells within 24 hours and killed >95% within 72 hours. NET cells did not produce relevant amounts of β-interferon after infection, but exogenous β-interferon protected cells from oncolysis. Treatment with M51R-VSV resulted in suppressed tumor growth (mean value ± standard error of the mean) compared with mock-infected xenografts for H727 (87 ± 72% vs. 2,197 ± 335%; P < .001), UMC-11 (13 ± 59% vs. 1,471 ± 324%; P < .001), and CNDT2.5 (81 ± 121% vs. 1,576 ± 349%; P = .001). CONCLUSION VSV infects and kills human NETs by exploiting their inability to produce a type I antiviral response. Therefore, M51R-VSV is an excellent candidate for the treatment of advanced NETs.

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Background. Papillary thyroid carcinoma has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of reoperations performed for persistent, rather than truly recurrent, disease. Methods. We conducted a retrospective review of a prospectively maintained database. Patients with papillary thyroid carcinoma who underwent reoperation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and a negative ultrasonography within 1 year of operation. Results. A total of 69 patients underwent 92 reoperations. On initial pathology, mean tumor size was 2.6 cm, 51% were multifocal, and 42% had extrathyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at the initial operation, and 77% were treated with postoperative radioactive iodine. The median time to first reoperation was 21 months (range, 1–292), and 42% occurred within 1 year. Only 3 operations met criteria for true “recurrence,” while 71 operations were categorized as persistent disease. Conclusion. Many reoperations for papillary thyroid carcinoma are for management of persistent disease. More than half of the patients required reoperation within the first 2 years, which suggests strongly that improvements in the preoperative assessment and adequacy of initial operative therapy need to be made to improve the care of patients with thyroid cancer.

Clinical Presentation and Diagnosis of Follicular Thyroid Cancer

Follicular thyroid cancer (FTC) is a well-differentiated thyroid cancer which arises from thyroid follicular cells. FTC is increasing in incidence but remains much less common than papillary thyroid cancer. Patients generally present with indeterminate nodules because fine needle aspiration biopsy is inadequate to render a diagnosis. The diagnosis of FTC requires demonstration of capsular or vascular invasion which is generally not apparent until after the primary lesion has been resected. Surgery is the primary treatment. Adjuvant treatment strategies may include radioactive iodine and thyroid-stimulating hormone suppression. Prognosis is generally favorable with 5-year survival ranging between 71 and 94% and 10-year survival between 43 and 95%. Negative prognostic factors include older age, tumor size, vascular invasion, degree of invasion, metastatic disease, and incomplete resection.

Su1666 Clinical Outcomes for Neuroendocrine Tumors of the Duodenum and Ampulla of Vater: A Population-Based Study

Background Previous case series report that neuroendocrine tumors (NETs) of the ampulla of Vater have worse overall survival (OS) than NETs in the duodenum. We aimed to compare the OS of patients with ampullary NETs to patients with duodenal NETs.

Lymph Node Dissection Versus No Lymph Node Dissection for Parathyroid Cancer

Surgery is the primary treatment for parathyroid carcinoma, but no consensus statement exists regarding the optimal extent of the initial resection. Given the rare nature of the disease, the literature is almost entirely limited to retrospective reviews, but was used in an attempt to determine the impact a routine central neck dissection has on recurrence, survival, and complications in patients being treated for parathyroid carcinoma. Nodal metastases do seem to predict recurrence but not worse survival. However, no clear difference was observed in recurrence or survival based on whether or not a lymph node dissection was performed indicating that there is minimal value in a nodal dissection as a routine procedure in all patients. While the addition of a central neck dissection does not increase rates of vocal cord palsies or hematomas, it does carry a significant risk of permanent hypoparathyroidism. Therefore, because there is no definitive benefit in patients with parathyroid carcinoma, the added risk of a routine central node dissection is not justified for all patients.

Survival in patients with medullary thyroid cancer after less than the recommended initial operation

We aimed to evaluate the disease specific‐survival (DSS) of patients with Medullary Thyroid Cancer (MTC) confined to the central neck based on the extent of the initial operation.