Hartl Dana M, Hadoux Julien, Garcia Camilo, Ghuzlan Abir Al, Guerlain Joanne, Breuskin Ingrid, Baudin Eric, Lamartina Livia
Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de chirurgie, service de cancérologie cervico-faciale, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
Gustave-Roussy Cancer Campus and Université Paris-Saclay, département de médecine nucléaire et d'oncologie endocrinienne, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
Bull Cancer. 2021 Dec;108(12):1132-1144. doi: 10.1016/j.bulcan.2021.07.008. Epub 2021 Oct 11.
Thyroid cancer runs the gamut from indolent micropapillary carcinoma to highly aggressive metastatic disease. Today, using prognostic algorithms, treatment and follow-up can be tailored to each patient in order to decrease overtreatment and over-medicalization of indolent disease. Active surveillance of papillary thyroid carcinoma less than 1cm avoids surgery and thyroid hormone replacement in a large proportion of patient whose tumors remain stable for years. Total thyroidectomy, once a dogma in the treatment of all thyroid cancer, is being supplanted by thyroid lobectomy for low-risk cancers, thereby decreasing the surgical risks involved and improving patients' quality of life. Indications for prophylactic central neck dissection, once mandatory, are now being adapted to the risk of cancer recurrence. Radioactive iodine therapy, also previously mandatory for all, is now only employed according to risk factors and expected outcomes. Follow-up is also being tailored to risk factors for recurrence, with less frequent visits and less use of ultrasound and scintigraphy. For more advanced disease, molecular therapies tailored to somatic mutations are opening opportunities for redifferentiation of aggressive tumors which become amenable to radioactive iodine therapy which carries fewer side effects than other systemic therapies. These advances in the management of thyroid cancer with a personalized approach and de-escalation of treatment and follow-up are improving the way we treat thyroid cancer, avoiding overtreatment and improving patients' quality of life.
甲状腺癌涵盖了从惰性微小乳头状癌到高度侵袭性转移性疾病的各种类型。如今，通过使用预后算法，可以根据每位患者的情况量身定制治疗和随访方案，以减少对惰性疾病的过度治疗和过度医疗。对直径小于1厘米的乳头状甲状腺癌进行主动监测，可使很大一部分肿瘤多年保持稳定的患者避免手术和甲状腺激素替代治疗。甲状腺全切除术曾是所有甲状腺癌治疗的教条，现在正被甲状腺叶切除术所取代，用于治疗低风险癌症，从而降低手术风险并提高患者的生活质量。预防性中央区颈淋巴结清扫术的指征，曾经是强制性的，现在正根据癌症复发风险进行调整。放射性碘治疗，以前也是对所有患者都强制使用，现在仅根据风险因素和预期结果使用。随访也根据复发风险因素进行调整，减少就诊频率，减少超声和闪烁扫描的使用。对于更晚期的疾病，针对体细胞突变的分子疗法为侵袭性肿瘤的再分化开辟了机会，使这些肿瘤能够接受放射性碘治疗，而放射性碘治疗的副作用比其他全身疗法更少。甲状腺癌管理中这些采用个性化方法以及治疗和随访降级的进展，正在改善我们治疗甲状腺癌的方式，避免过度治疗并提高患者的生活质量。
