2017 Section 7 Green Book

Ward MC, Adelstein DJ, Bhateja P, et al. Severe late dysphagia and cause of death after concurrent chemoradiation for larynx cancer in patients eligible for RTOG 91-11. Oral Oncol . 2016; 57:21-26. EBM level 3................................................................................65-70 Summary : This paper reports on the results of a retrospective cohort study of all patients treated for larynx cancer at a single institution who would have met criteria for the 91-11 trial. Patients were carefully followed for the development of severe late dysphagia that developed after 5 years of follow up and therefore not reported in that trial. They identified that 26% of patients developed severe late dysphagia as a result of therapy after 5 years of follow up. Management of Thyroid Nodules and Thyroid Malignancy Ito Y, Miyauchi A, Inoue H, et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J Surg . 2010; 34(1):28-35. EBM level 2..................................................................................................................................71-78 Summary : This is a prospective case-controlled study comparing observation versus surgical intervention for patients with papillary thyroid microcarcinoma. The results show that observation is adequate for many, and that progression during observation does not adversely affect survival or salvage rates. Lang BH, Ng SH, Lau LL, et al. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid . 2013; 23(9):1087-1098. EBM level 1......................79-90 Summary : This is a meta-analysis of the locoregional recurrence and complications in patients who underwent prophylactic central neck dissection compared to those who did not. Evidence shows the benefit of the prophylactic central neck dissection in patients with N0 neck. Locoregional recurrence was reduced in patients undergoing central neck dissection. Lang BH, Wong IO, Wong KP, et al. Risk of second primary malignancy in differentiated thyroid carcinoma treated with radioactive iodine therapy. Surgery . 2012; 151(6):844-850. EBM level 2........................................................................................................................91-97 Summary : Retrospective study of all patients treated with radioactive iodine (RAI) for differentiated thyroid cancer (DTC) within a single healthcare system in China. The 895 patients identified for study were followed for a minimum of 2 years; 645 patients received RAI as part of their treatment, while 249 patients did not. Controlling for other factors, RAI-positive and RAI-negative patients were compared the subsequent developments of second primary malignancies (SPMs). A statistically significant deference in the incidence of SPMs was noted in the RAI group, while the RAI-negative group had baseline levels of SPM development (13.5% vs 3.1%; p = 0.015). This study is one of several that strongly suggest that RAI therapy can have significant long-term effects on patients receiving this therapy and indirectly argues that RAI should be given selectively.

IV.

Morris LG, Sikora AG, Tosteson TD, Davies L. The increasing incidence of thyroid cancer: the influence of access to care. Thyroid . 2013; 23(7):885-891. EBM level 1...............98-104

Summary : This study uses the SEER database and correlates the well-recognized increased incidence of papillary thyroid cancer (PTC) diagnosis in the U.S. to the availability of and access to healthcare among the more affluent population. The study, in conjunction with others, shows that the majority of the increased cases of PTC are from small, likely indolent, PTCs, and is driven by increased detection in an already existing pool of patients with subclinical disease.