Struma ovarii medical therapy: Difference between revisions

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{{Struma ovarii}}
{{Struma ovarii}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{ARK}}


==Overview==
==Overview==
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The mainstay of treatment for struma ovarii is surgical therapy. [[Chemotherapy]] doesn't seem to have role in the regular management of [[Papillary thyroid cancer|papillary]] and [[Follicular thyroid cancer|follicular]] [[thyroid cancer]]. It is reserved for patients with progressive disease which is usually not controlled by surgery, [[Iodine-131|I-131]], or other treatment modalities. Adjuvant treatment modalities such as [[radioiodine]] <nowiki/>therapy and [[External beam radiation therapy|external beam radiation]] are recommended.
*Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
*The majority of cases of [disease name] are self-limited and require only supportive care.
 
*[Disease name] is a medical emergency and requires prompt treatment.
 
*The mainstay of treatment for [disease name] is [therapy].
 
*The optimal therapy for [malignancy name] depends on the stage at diagnosis.
* [Therapy] is recommended among all patients who develop [disease name].
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
[[Chemotherapy]] doesn't seem to have role in the regular management of [[Papillary thyroid cancer|papillary]] and [[follicular thyroid cancer]]. It is reserved for patients with progressive disease which is usually not controlled by surgery,  [[Iodine-131|I-131]], or other treatment modalities. <ref name="pmid25474425">{{cite journal |vauthors=Luo JR, Xie CB, Li ZH |title=Treatment for malignant struma ovarii in the eyes of thyroid surgeons: a case report and study of Chinese cases reported in the literature |journal=Medicine (Baltimore) |volume=93 |issue=26 |pages=e147 |year=2014 |pmid=25474425 |pmc=4616397 |doi=10.1097/MD.0000000000000147 |url=}}</ref><ref name="pmid16728537">{{cite journal |vauthors=Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W |title=European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium |journal=Eur. J. Endocrinol. |volume=154 |issue=6 |pages=787–803 |year=2006 |pmid=16728537 |doi=10.1530/eje.1.02158 |url=}}</ref>
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Adjuvant treatment modalities===
===Adjuvant treatment modalities===


====Radioiodine Therapy====
====Radioiodine Therapy====
*First line of management to be considered  for malignant struma ovarii is thyroidectomy and treatment with radioiodine I(131). <ref name="pmid18560398">{{cite journal |vauthors=Yassa L, Sadow P, Marqusee E |title=Malignant struma ovarii |journal=Nat Clin Pract Endocrinol Metab |volume=4 |issue=8 |pages=469–72 |year=2008 |pmid=18560398 |doi=10.1038/ncpendmet0887 |url=}}</ref> <ref name="pmid12798728">{{cite journal |vauthors=DeSimone CP, Lele SM, Modesitt SC |title=Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy |journal=Gynecol. Oncol. |volume=89 |issue=3 |pages=543–8 |year=2003 |pmid=12798728 |doi= |url=}}</ref> <ref name="pmid3297279">{{cite journal |vauthors=Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H |title=Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration |journal=Cancer |volume=60 |issue=2 |pages=178–82 |year=1987 |pmid=3297279 |doi= |url=}}</ref>
*First line of management to be considered  for malignant struma ovarii is [[thyroidectomy]] and treatment with [[radioiodine]]  [[Iodine-131|I-131]]. <ref name="pmid18560398">{{cite journal |vauthors=Yassa L, Sadow P, Marqusee E |title=Malignant struma ovarii |journal=Nat Clin Pract Endocrinol Metab |volume=4 |issue=8 |pages=469–72 |year=2008 |pmid=18560398 |doi=10.1038/ncpendmet0887 |url=}}</ref><ref name="pmid12798728">{{cite journal |vauthors=DeSimone CP, Lele SM, Modesitt SC |title=Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy |journal=Gynecol. Oncol. |volume=89 |issue=3 |pages=543–8 |year=2003 |pmid=12798728 |doi= |url=}}</ref><ref name="pmid3297279">{{cite journal |vauthors=Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H |title=Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration |journal=Cancer |volume=60 |issue=2 |pages=178–82 |year=1987 |pmid=3297279 |doi= |url=}}</ref>
*Radioiodine therapy has good outcomes in residual disease or metastatic/recurrent disease.  <ref name="pmid3297279">{{cite journal |vauthors=Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H |title=Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration |journal=Cancer |volume=60 |issue=2 |pages=178–82 |year=1987 |pmid=3297279 |doi= |url=}}</ref>
*[[Radioiodine|Radioiodine therapy]] has good outcomes in residual disease or [[metastatic]]/recurrent disease.  <ref name="pmid3297279">{{cite journal |vauthors=Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H |title=Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration |journal=Cancer |volume=60 |issue=2 |pages=178–82 |year=1987 |pmid=3297279 |doi= |url=}}</ref>
*Iodine scans have been preferred in the detection of recurrent disease after termination of therapy. <ref name="pmid19471561">{{cite journal |vauthors=Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS |title=Clinical characteristics of struma ovarii |journal=J Gynecol Oncol |volume=19 |issue=2 |pages=135–8 |year=2008 |pmid=19471561 |pmc=2676458 |doi=10.3802/jgo.2008.19.2.135 |url=}}</ref>
*Iodine scans have been preferred in the detection of recurrent disease after termination of therapy. <ref name="pmid19471561">{{cite journal |vauthors=Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS |title=Clinical characteristics of struma ovarii |journal=J Gynecol Oncol |volume=19 |issue=2 |pages=135–8 |year=2008 |pmid=19471561 |pmc=2676458 |doi=10.3802/jgo.2008.19.2.135 |url=}}</ref>


====External beam radiation====
===Post I-131 therapy monitoring recommendations===
*External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. <ref name="pmid2379061">{{cite journal |vauthors=O'Connell ME, Fisher C, Harmer CL |title=Malignant struma ovarii: presentation and management |journal=Br J Radiol |volume=63 |issue=749 |pages=360–3 |year=1990 |pmid=2379061 |doi=10.1259/0007-1285-63-749-360 |url=}}</ref>  
Recommendations: <ref name="pmid27355004">{{cite journal |vauthors=Oudoux A, Leblanc E, Beaujot J, Gauthier-Kolesnikov H |title=Treatment and follow-up of malignant struma ovarii: Regarding two cases |journal=Gynecol Oncol Rep |volume=17 |issue= |pages=56–9 |year=2016 |pmid=27355004 |pmc=4913172 |doi=10.1016/j.gore.2016.05.014 |url=}}</ref>


*Post 6 months after the end of treatment:
:*Routine clinical examination
:*Measure serum [[thyroglobulin]]
:*Diagnostic  [[Iodine-131|I-131]] [[scintigraphy]] (after rhTSH stimulation or withdrawal)


===Disease Name===
*Every 6 months for 18 months and every year thereafter:
:*The mainstay follow-up of clinical examination and thyroglobulin measurements with [[TSH]] suppression (thyroglobulin must be < 1 ng/ml).
:*Additional imaging such as  [[Iodine-131|I-131]] [[scintigraphy]], 18-[[FDG-PET]], [[ultrasonography]], [[CT-scans|CT]] and/or [[MRI]] must be performed in the case of abnormal results.
:*Pelvic locations help explain complementary imaging, adapted to the initial stage of the disease.


* '''1 Stage 1 - Name of stage'''
====External beam radiation====
** 1.1 '''Specific Organ system involved 1'''
[[External beam radiation therapy|External beam radiation]] has been beneficial for patients with multiple [[metastatic]] lesion and who do absorb [[radioiodine]] poorly. <ref name="pmid2379061">{{cite journal |vauthors=O'Connell ME, Fisher C, Harmer CL |title=Malignant struma ovarii: presentation and management |journal=Br J Radiol |volume=63 |issue=749 |pages=360–3 |year=1990 |pmid=2379061 |doi=10.1259/0007-1285-63-749-360 |url=}}</ref>
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 2.1 '''Specific Organ system involved 2'''
*** 2.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 2.1.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 00:51, 16 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]

Overview

The mainstay of treatment for struma ovarii is surgical therapy. Chemotherapy doesn't seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. Adjuvant treatment modalities such as radioiodine therapy and external beam radiation are recommended.

Medical Therapy

Chemotherapy doesn't seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. [1][2]

Adjuvant treatment modalities

Radioiodine Therapy

Post I-131 therapy monitoring recommendations

Recommendations: [7]

  • Post 6 months after the end of treatment:
  • Every 6 months for 18 months and every year thereafter:
  • The mainstay follow-up of clinical examination and thyroglobulin measurements with TSH suppression (thyroglobulin must be < 1 ng/ml).
  • Additional imaging such as I-131 scintigraphy, 18-FDG-PET, ultrasonography, CT and/or MRI must be performed in the case of abnormal results.
  • Pelvic locations help explain complementary imaging, adapted to the initial stage of the disease.

External beam radiation

External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. [8]

References

  1. ↑ Luo JR, Xie CB, Li ZH (2014). "Treatment for malignant struma ovarii in the eyes of thyroid surgeons: a case report and study of Chinese cases reported in the literature". Medicine (Baltimore). 93 (26): e147. doi:10.1097/MD.0000000000000147. PMC 4616397. PMID 25474425.
  2. ↑ Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W (2006). "European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium". Eur. J. Endocrinol. 154 (6): 787–803. doi:10.1530/eje.1.02158. PMID 16728537.
  3. ↑ Yassa L, Sadow P, Marqusee E (2008). "Malignant struma ovarii". Nat Clin Pract Endocrinol Metab. 4 (8): 469–72. doi:10.1038/ncpendmet0887. PMID 18560398.
  4. ↑ DeSimone CP, Lele SM, Modesitt SC (2003). "Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy". Gynecol. Oncol. 89 (3): 543–8. PMID 12798728.
  5. ↑ 5.0 5.1 Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H (1987). "Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration". Cancer. 60 (2): 178–82. PMID 3297279.
  6. ↑ Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS (2008). "Clinical characteristics of struma ovarii". J Gynecol Oncol. 19 (2): 135–8. doi:10.3802/jgo.2008.19.2.135. PMC 2676458. PMID 19471561.
  7. ↑ Oudoux A, Leblanc E, Beaujot J, Gauthier-Kolesnikov H (2016). "Treatment and follow-up of malignant struma ovarii: Regarding two cases". Gynecol Oncol Rep. 17: 56–9. doi:10.1016/j.gore.2016.05.014. PMC 4913172. PMID 27355004.
  8. ↑ O'Connell ME, Fisher C, Harmer CL (1990). "Malignant struma ovarii: presentation and management". Br J Radiol. 63 (749): 360–3. doi:10.1259/0007-1285-63-749-360. PMID 2379061.

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