Struma ovarii medical therapy: Difference between revisions

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


==Overview==
==Overview==
*The mainstay of treatment for Struma ovarii is surgical therapy.
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.


==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].
 
*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, I131, 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>


===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>


===Post I131 therapy monitoring recommendations===
===Post I-131 therapy monitoring recommendations===
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>
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:
*Post 6 months after the end of treatment:
:*Routine clinical examination
:*Routine clinical examination
:*Measure serum thyroglobulin
:*Measure serum [[thyroglobulin]]
:*Diagnostic I131 scintigraphy (after rhTSH stimulation or withdrawal).
:*Diagnostic [[Iodine-131|I-131]] [[scintigraphy]] (after rhTSH stimulation or withdrawal)


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


====External beam radiation====
====External beam radiation====
*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>
[[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>


==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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