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Glover A.R.,Kolling Institute of Medical Research | Ip J.C.Y.,Kolling Institute of Medical Research | Ting Zhao J.,Kolling Institute of Medical Research | Soon P.S.H.,Kolling Institute of Medical Research | And 5 more authors.
OncoTargets and Therapy | Year: 2013

Adrenal cortical carcinoma (ACC) is a rare cancer that poses a number of management challenges due to the limited number of effective systemic treatments. Complete surgical resection offers the best chance of long-term survival. However, despite complete resection, ACC is associated with high recurrence rates. This review will discuss the management of recurrent ACC in adults following complete surgical resection. Management should take place in a specialist center and treatment decisions must consider the individual tumor biology of each case of recurrence. Given the fact that ACC commonly recurs, management to prevent recurrence should be considered from initial diagnosis with the use of adjuvant mitotane. Close follow up with clinical examination and imaging is important for early detection of recurrent disease. Locoregional recurrence may be isolated, and repeat surgical resection should be considered along with mitotane. The use of radiotherapy in ACC remains controversial. Systemic recurrence most often involves liver, pulmonary, and bone metastasis and is usually managed with mitotane, with or without combination chemotherapy. There is a limited role for surgical resection in systemic recurrence in selected patients. In all patients with recurrent disease, control of excessive hormone production is an important part of management. Despite intensive management of recurrent ACC, treatment failure is common and the use of clinical trials and novel treatment is an important part of management. © 2013 Glover et al, publisher and licensee Dove Medical Press Ltd.

Testini M.,University of Bari | Gurrado A.,University of Bari | Avenia N.,University of Perugia | Bellantone R.,Catholic University of the Sacred Heart | And 15 more authors.
Annals of Surgical Oncology | Year: 2011

Purpose: To compare the outcome in patients with cervical goiters and cervicomediastinal goiters (CMGs) undergoing total thyroidectomy using the cervical or extracervical approach. Methods: This was a retrospective study conducted at six academic departments of general surgery and one endocrine-surgical unit in Italy. The study population consisted of 19,662 patients undergoing total thyroidectomy between 1999 and 2008, of whom 18,607 had cervical goiter (group A) and 1055 had CMG treated using a cervical approach (group B, n = 986) or manubriotomy (group C, n = 69). The main parameters of interest were symptoms, gender, age, operative time, duration of drain, length of hospital stay, malignancy and outcome. Results: A split-sternal approach was required in 6.5% of cases of CMG. Malignancy was significantly more frequent in group B (22.4%) and group C (36.2%) versus group A (10.4%; both P < .001), and in group C versus group B (P = .009). Overall morbidity was significantly higher in groups B + C (35%), B (34.4%) and C (53.5%) versus group A (23.7%; P < .001). Statistically significant increases for group B + C versus group A were observed for transient hypocalcemia, permanent hypocalcemia, transient recurrent laryngeal nerve (RLN) palsies, permanent RLN palsies, phrenic nerve palsy, seroma/hematoma, and complications classified as other. With the exception of transient bilateral RLN palsy, all of these significant differences between group B + C versus group A were also observed for group B versus group A. Conclusions: Symptoms, malignancy, overall morbidity, hypoparathyroidism, RLN palsy and hematoma are increased in cases of substernal goiter. © 2011 Society of Surgical Oncology.

Lee J.C.,Monash University | Lee J.C.,Endocrine surgery unit | Lee J.C.,Kolling Institute of Medical Research | Lee J.C.,University of Sydney | And 9 more authors.
Oncologist | Year: 2014

Papillary thyroid cancer (PTC) is the major contributor to the dramatically increasing incidence of thyroid cancer. Low-risk PTC shows the most rapid rate of increase because of changing trends in neck imaging and the use of fine needle aspiration to investigate thyroid nodules. The need for a paradigm shift in the management of these patients, to provide personalized treatment and surveillance plans, has led to the focus on molecular biomarker research. MicroRNAs(miRNAs) compose a class of molecules with promisingapplications for every stage of PTC management, including diagnosis, prognosis, treatment, and surveillance. Although most of the miRNA studies are currently preclinical, given the rapid progress of scientific discovery, clinical trials will not be far away.Thyroid clinicians will be expected to have good insights into the current status of PTC-related molecular translational research.This article focuses on the potential roles of miRNA in PTC management in the context of contemporary recommended clinical practice. © AlphaMed Press 2014.

Kentwell J.,Kolling Institute of Medical Research | Kentwell J.,University of Sydney | Gundara J.S.,Kolling Institute of Medical Research | Gundara J.S.,Endocrine Surgical Unit | And 4 more authors.
Oncologist | Year: 2014

Only recently has it been uncovered that the mammalian transcriptome includes a large number of noncoding RNAs (ncRNAs) that play a variety of important regulatory roles in gene expression and other biological processes. Among numerous kinds of ncRNAs, short noncoding RNAs, such as microRNAs, have been extensively investigated with regard to their biogenesis, function, and importance in carcinogenesis. Long noncoding RNAs (lncRNAs) have only recently been implicated in playing a key regulatory role in cancer biology. The deregulation of ncRNAs has been demonstrated to have important roles in the regulation and progression of cancer development. In this review, we describe the roles of both short noncoding RNAs (including microRNAs, small nuclear RNAs, and piwi-interacting RNAs) and lncRNAs in carcinogenesis and outline the possible underlying genetic mechanisms, with particular emphasis on clinical applications. The focus of our review includes studies from the literature on ncRNAs in traditional endocrine-related cancers, including thyroid, parathyroid, adrenal gland, and gastrointestinal neuroendocrine malignancies. The current and potential future applications of ncRNAs in clinical cancer research is also discussed, with emphasis on diagnosis and future treatment. © AlphaMed Press 2014.

Edafe O.,University of Sheffield | Wadsley J.,Weston Park Hospital | Harrison B.J.,Endocrine Surgical Unit | Balasubramanian S.P.,University of Sheffield | Balasubramanian S.P.,Endocrine Surgical Unit
Thyroid Research | Year: 2014

Background: Differentiated thyroid cancer (DTC) has excellent long term survival in most patients. Long-term treatment related morbidity is therefore important, but may not be well characterised. The aim of this study was to conduct an electronic survey of clinicians involved in the care of patients with DTC to determine their views on treatment related morbidity. Methods. A nine item questionnaire was developed, piloted locally and sent by email to members of three United Kingdom (UK) medical organisations (Thyroid Cancer Forum, British Association of Endocrine and Thyroid Surgeons, British Thyroid Association). Results: 125 responses were received. Less than 5% of respondents had a formal protocol to detect morbidity associated with TSH suppression. Over 50% agreed that morbidity from TSH suppression is not well defined. The majority of responders also agreed that the long-term morbidity of hypocalcaemia, significant voice change and TSH suppression in DTC are not well characterised. Physicians perceived treatment related morbidity to be a bigger problem than surgeons (P = 0.019). Conclusion: Clinicians treating thyroid cancer agree that long-term treatment related morbidity from DTC is not well characterised. A study of the prevalence and severity of treatment related morbidity and its impact on health of patients with DTC is warranted. © 2014 Edafe et al.; licensee BioMed Central Ltd.

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