Head & Neck/Thyroid Cancers

Lenvatinib was associated with significant improvements in progression-free survival among patients with radioiodine-refractory thyroid cancer when compared with placebo, according to research published in the New England Journal of Medicine.

In the randomized, multicenter study, 261 patients received lenvatinib (at a daily dose of 24 mg per day in 28-day cycles) and 131 patients received a placebo. The median progression-free survival was 18.3 months in the lenvatinib group and 3.6 months in the placebo group, the investigators wrote, although adverse effects occurred in more than 40% of patients in the lenvatinib group.

Lenvatinib is an oral inhibitor of vascular endothelial growth factor receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor alpha, RET, and KIT.

Read more at N. Engl. J. Med. 2015 (doi:10.1056/NEJMoa1406470).

Lenvatinib was associated with significant improvements in progression-free survival among patients with radioiodine-refractory thyroid cancer when compared with placebo, according to research published in the New England Journal of Medicine.

In the randomized, multicenter study, 261 patients received lenvatinib (at a daily dose of 24 mg per day in 28-day cycles) and 131 patients received a placebo. The median progression-free survival was 18.3 months in the lenvatinib group and 3.6 months in the placebo group, the investigators wrote, although adverse effects occurred in more than 40% of patients in the lenvatinib group.

Lenvatinib is an oral inhibitor of vascular endothelial growth factor receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor alpha, RET, and KIT.

Read more at N. Engl. J. Med. 2015 (doi:10.1056/NEJMoa1406470).

Lenvatinib was associated with significant improvements in progression-free survival among patients with radioiodine-refractory thyroid cancer when compared with placebo, according to research published in the New England Journal of Medicine.

In the randomized, multicenter study, 261 patients received lenvatinib (at a daily dose of 24 mg per day in 28-day cycles) and 131 patients received a placebo. The median progression-free survival was 18.3 months in the lenvatinib group and 3.6 months in the placebo group, the investigators wrote, although adverse effects occurred in more than 40% of patients in the lenvatinib group.

Lenvatinib is an oral inhibitor of vascular endothelial growth factor receptors 1, 2, and 3, fibroblast growth factor receptors 1 through 4, platelet-derived growth factor receptor alpha, RET, and KIT.

Read more at N. Engl. J. Med. 2015 (doi:10.1056/NEJMoa1406470).

The Food and Drug Administration has approved the kinase inhibitor lenvatinib (Lenvima) for the treatment of differentiated thyroid cancer, the agency announced Feb. 13. The drug is approved for use in patients in whom disease progressed despite receiving radioactive iodine therapy.

A trial of 392 patients with progressive, radioactive iodine–refractory differentiated thyroid cancer (DTC) found a median progression-free survival time of 18.3 months in participants treated with Lenvima, compared with a median of 3.6 months in those who received a placebo, the FDA said in a statement. In addition, 65% of lenvatinib-treated patients saw a reduction in tumor size, compared with just 2% of patients who received placebo.

DTC is the most common type of thyroid cancer. The National Cancer Institute has estimated that nearly 63,000 Americans were diagnosed with thyroid cancer, and nearly 1,900 died from the disease in 2014, the FDA said.

Lenvatinib was approved early upon expedited review under the FDA’s priority review program, which allows for the accelerated evaluation of promising drugs that would significantly benefit patients with serious illness.

Common side effects from the drug included hypertension, fatigue, diarrhea, joint and muscle pain, decreased appetite, weight loss, and nausea, among others.

Lenvatinib is marketed by Eisai, based in Woodcliff Lake, N.J.

[email protected]

The Food and Drug Administration has approved the kinase inhibitor lenvatinib (Lenvima) for the treatment of differentiated thyroid cancer, the agency announced Feb. 13. The drug is approved for use in patients in whom disease progressed despite receiving radioactive iodine therapy.

A trial of 392 patients with progressive, radioactive iodine–refractory differentiated thyroid cancer (DTC) found a median progression-free survival time of 18.3 months in participants treated with Lenvima, compared with a median of 3.6 months in those who received a placebo, the FDA said in a statement. In addition, 65% of lenvatinib-treated patients saw a reduction in tumor size, compared with just 2% of patients who received placebo.

DTC is the most common type of thyroid cancer. The National Cancer Institute has estimated that nearly 63,000 Americans were diagnosed with thyroid cancer, and nearly 1,900 died from the disease in 2014, the FDA said.

Lenvatinib was approved early upon expedited review under the FDA’s priority review program, which allows for the accelerated evaluation of promising drugs that would significantly benefit patients with serious illness.

Common side effects from the drug included hypertension, fatigue, diarrhea, joint and muscle pain, decreased appetite, weight loss, and nausea, among others.

Lenvatinib is marketed by Eisai, based in Woodcliff Lake, N.J.

[email protected]

The Food and Drug Administration has approved the kinase inhibitor lenvatinib (Lenvima) for the treatment of differentiated thyroid cancer, the agency announced Feb. 13. The drug is approved for use in patients in whom disease progressed despite receiving radioactive iodine therapy.

A trial of 392 patients with progressive, radioactive iodine–refractory differentiated thyroid cancer (DTC) found a median progression-free survival time of 18.3 months in participants treated with Lenvima, compared with a median of 3.6 months in those who received a placebo, the FDA said in a statement. In addition, 65% of lenvatinib-treated patients saw a reduction in tumor size, compared with just 2% of patients who received placebo.

DTC is the most common type of thyroid cancer. The National Cancer Institute has estimated that nearly 63,000 Americans were diagnosed with thyroid cancer, and nearly 1,900 died from the disease in 2014, the FDA said.

Lenvatinib was approved early upon expedited review under the FDA’s priority review program, which allows for the accelerated evaluation of promising drugs that would significantly benefit patients with serious illness.

Common side effects from the drug included hypertension, fatigue, diarrhea, joint and muscle pain, decreased appetite, weight loss, and nausea, among others.

Lenvatinib is marketed by Eisai, based in Woodcliff Lake, N.J.

[email protected]

A 74-year-old woman presented with a 2-day history of exertional dyspnea and palpitations. Her past medical history was significant for metastatic papillary thyroid carcinoma treated with total thyroidectomy and radioactive iodine ablation with levothyroxine for chronic suppressive therapy.

On examination, the patient was afebrile with an oxygen saturation of 98% on room air, heart rate of 92 beats/min, and blood pressure of 100/54 mm Hg. There was trace bilateral lower extremity edema, and her cardiopulmonary examination was unremarkable. The laboratory studies showed a white blood cell count of 24,300/µL (3,400-9,800); platelets 86,000/µL (142,000-362,000); thyroid stimulating hormone 0.009 mlU/L (0.4-4.1); free T4 2.07 ng/dL (0.8-2.0); thyroglobulin antibody titer < 1:10 (< 1:160); thyroid microsomal antibody titer < 1:100 (< 1:1600); and thyroglobulin 17.9 ng/mL (2.0-35.0). Her initial troponin T was undetectable.

An electrocardiogram showed a first-degree atrioventricular block and subsequently a new intermittent third-degree atrioventricular block. A computed tomography angiogram (Figure 1) and cardiac magnetic resonance imaging (Figure 2) revealed a 2.6-cm soft tissue mass in the right ventricular outflow tract along with multiple pulmonary emboli and previously diagnosed pulmonary metastases. A positron emission tomography (PET) scan (not shown) revealed a 3.5-cm PET-avid lesion within the right ventricular outflow tract.

• What is your diagnosis?
• How would you treat this patient? 

[Click through to the next page to see the answer.]

Our Treatment

Diagnosis and Discussion

This patient experienced complete heart block due to a cardiac tumor from papillary thyroid carcinoma metastasis. Complete heart block is not an unprecedented symptom of metastatic disease, but to our knowledge this is the first reported case of heart block secondary to metastatic papillary thyroid cancer.¹ In general, metastatic cardiac tumors, usually associated with cancers of the breast and lung, melanoma, and lymphoma, are more common than are primary cardiac tumors and are often asymptomatic and discovered mostly postmortem.^2,3 The frequency of thyroid metastasis to the heart has been reported to be as low as 0% to 2%, and a review of the literature demonstrated only 13 total cases in the past 30 years.

Theoretical mechanisms for invasion into the heart include lymphatic spread, hematogenous dissemination, or direct right ventricular invasion from the thoracic duct. It has been suggested that the lower blood flow to the myocardium (240 mL/min) relative to bone (600 mL/min) or the brain (750 mL/min) is the reason for a lower likelihood of cardiac involvement in metastatic disease.³ Given the findings in this case, evidence of cardiac conduction abnormalities in the setting of papillary thyroid cancer should raise suspicion for cardiac metastatic disease.

Case Outcome

In this patient, a permanent pacemaker was implanted for high-grade atrioventricular block, with resolution of the palpitations. The pulmonary emboli were concomitantly treated with enoxaparin, and the patient was discharged to a rehabilitation facility. Her prognosis was extremely poor given that survival with cardiac metastasis from any type of cancer is limited to a few weeks to months.³ She was to be reevaluated for experimental chemotherapy after reconditioning. However, not long after discharge she was readmitted in respiratory failure and died.

Acknowledgments
We would like to thank Dr. Kevin Steel, Lt Col, USAF, MC, imaging cardiologist at the Brooke Army Medical Center for his time and effort in accessing and preparing the CT and MRI images for this article.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect the official policy or position of Federal Practitioner, Frontline Medical Communications Inc., Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense, the U.S. Government, or any other of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

A 74-year-old woman presented with a 2-day history of exertional dyspnea and palpitations. Her past medical history was significant for metastatic papillary thyroid carcinoma treated with total thyroidectomy and radioactive iodine ablation with levothyroxine for chronic suppressive therapy.

On examination, the patient was afebrile with an oxygen saturation of 98% on room air, heart rate of 92 beats/min, and blood pressure of 100/54 mm Hg. There was trace bilateral lower extremity edema, and her cardiopulmonary examination was unremarkable. The laboratory studies showed a white blood cell count of 24,300/µL (3,400-9,800); platelets 86,000/µL (142,000-362,000); thyroid stimulating hormone 0.009 mlU/L (0.4-4.1); free T4 2.07 ng/dL (0.8-2.0); thyroglobulin antibody titer < 1:10 (< 1:160); thyroid microsomal antibody titer < 1:100 (< 1:1600); and thyroglobulin 17.9 ng/mL (2.0-35.0). Her initial troponin T was undetectable.

An electrocardiogram showed a first-degree atrioventricular block and subsequently a new intermittent third-degree atrioventricular block. A computed tomography angiogram (Figure 1) and cardiac magnetic resonance imaging (Figure 2) revealed a 2.6-cm soft tissue mass in the right ventricular outflow tract along with multiple pulmonary emboli and previously diagnosed pulmonary metastases. A positron emission tomography (PET) scan (not shown) revealed a 3.5-cm PET-avid lesion within the right ventricular outflow tract.

• What is your diagnosis?
• How would you treat this patient? 

[Click through to the next page to see the answer.]

Our Treatment

Diagnosis and Discussion

This patient experienced complete heart block due to a cardiac tumor from papillary thyroid carcinoma metastasis. Complete heart block is not an unprecedented symptom of metastatic disease, but to our knowledge this is the first reported case of heart block secondary to metastatic papillary thyroid cancer.¹ In general, metastatic cardiac tumors, usually associated with cancers of the breast and lung, melanoma, and lymphoma, are more common than are primary cardiac tumors and are often asymptomatic and discovered mostly postmortem.^2,3 The frequency of thyroid metastasis to the heart has been reported to be as low as 0% to 2%, and a review of the literature demonstrated only 13 total cases in the past 30 years.

Theoretical mechanisms for invasion into the heart include lymphatic spread, hematogenous dissemination, or direct right ventricular invasion from the thoracic duct. It has been suggested that the lower blood flow to the myocardium (240 mL/min) relative to bone (600 mL/min) or the brain (750 mL/min) is the reason for a lower likelihood of cardiac involvement in metastatic disease.³ Given the findings in this case, evidence of cardiac conduction abnormalities in the setting of papillary thyroid cancer should raise suspicion for cardiac metastatic disease.

Case Outcome

In this patient, a permanent pacemaker was implanted for high-grade atrioventricular block, with resolution of the palpitations. The pulmonary emboli were concomitantly treated with enoxaparin, and the patient was discharged to a rehabilitation facility. Her prognosis was extremely poor given that survival with cardiac metastasis from any type of cancer is limited to a few weeks to months.³ She was to be reevaluated for experimental chemotherapy after reconditioning. However, not long after discharge she was readmitted in respiratory failure and died.

Acknowledgments
We would like to thank Dr. Kevin Steel, Lt Col, USAF, MC, imaging cardiologist at the Brooke Army Medical Center for his time and effort in accessing and preparing the CT and MRI images for this article.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect the official policy or position of Federal Practitioner, Frontline Medical Communications Inc., Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense, the U.S. Government, or any other of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

A 74-year-old woman presented with a 2-day history of exertional dyspnea and palpitations. Her past medical history was significant for metastatic papillary thyroid carcinoma treated with total thyroidectomy and radioactive iodine ablation with levothyroxine for chronic suppressive therapy.

On examination, the patient was afebrile with an oxygen saturation of 98% on room air, heart rate of 92 beats/min, and blood pressure of 100/54 mm Hg. There was trace bilateral lower extremity edema, and her cardiopulmonary examination was unremarkable. The laboratory studies showed a white blood cell count of 24,300/µL (3,400-9,800); platelets 86,000/µL (142,000-362,000); thyroid stimulating hormone 0.009 mlU/L (0.4-4.1); free T4 2.07 ng/dL (0.8-2.0); thyroglobulin antibody titer < 1:10 (< 1:160); thyroid microsomal antibody titer < 1:100 (< 1:1600); and thyroglobulin 17.9 ng/mL (2.0-35.0). Her initial troponin T was undetectable.

An electrocardiogram showed a first-degree atrioventricular block and subsequently a new intermittent third-degree atrioventricular block. A computed tomography angiogram (Figure 1) and cardiac magnetic resonance imaging (Figure 2) revealed a 2.6-cm soft tissue mass in the right ventricular outflow tract along with multiple pulmonary emboli and previously diagnosed pulmonary metastases. A positron emission tomography (PET) scan (not shown) revealed a 3.5-cm PET-avid lesion within the right ventricular outflow tract.

• What is your diagnosis?
• How would you treat this patient? 

[Click through to the next page to see the answer.]

Our Treatment

Diagnosis and Discussion

This patient experienced complete heart block due to a cardiac tumor from papillary thyroid carcinoma metastasis. Complete heart block is not an unprecedented symptom of metastatic disease, but to our knowledge this is the first reported case of heart block secondary to metastatic papillary thyroid cancer.¹ In general, metastatic cardiac tumors, usually associated with cancers of the breast and lung, melanoma, and lymphoma, are more common than are primary cardiac tumors and are often asymptomatic and discovered mostly postmortem.^2,3 The frequency of thyroid metastasis to the heart has been reported to be as low as 0% to 2%, and a review of the literature demonstrated only 13 total cases in the past 30 years.

Theoretical mechanisms for invasion into the heart include lymphatic spread, hematogenous dissemination, or direct right ventricular invasion from the thoracic duct. It has been suggested that the lower blood flow to the myocardium (240 mL/min) relative to bone (600 mL/min) or the brain (750 mL/min) is the reason for a lower likelihood of cardiac involvement in metastatic disease.³ Given the findings in this case, evidence of cardiac conduction abnormalities in the setting of papillary thyroid cancer should raise suspicion for cardiac metastatic disease.

Case Outcome

In this patient, a permanent pacemaker was implanted for high-grade atrioventricular block, with resolution of the palpitations. The pulmonary emboli were concomitantly treated with enoxaparin, and the patient was discharged to a rehabilitation facility. Her prognosis was extremely poor given that survival with cardiac metastasis from any type of cancer is limited to a few weeks to months.³ She was to be reevaluated for experimental chemotherapy after reconditioning. However, not long after discharge she was readmitted in respiratory failure and died.

Acknowledgments
We would like to thank Dr. Kevin Steel, Lt Col, USAF, MC, imaging cardiologist at the Brooke Army Medical Center for his time and effort in accessing and preparing the CT and MRI images for this article.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect the official policy or position of Federal Practitioner, Frontline Medical Communications Inc., Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, Department of Defense, the U.S. Government, or any other of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Sunitinib elicited an “exceptional” treatment response from refractory thymic carcinoma in an open-label phase II clinical trial involving 40 patients, investigators reported online in Lancet Oncology.

The oral tyrosine kinase inhibitor produced a 26% rate of complete or partial response for thymic epithelial tumors overall and a 91% response rate in the subset of patients with thymic carcinoma. That response was rapid and durable with continued administration of the agent. This is particularly important because most of the study participants had failed on two or more previous treatments including platinum-based chemotherapy, and no other standard treatments are available for patients who have this aggressive cancer. “Our trial is the first to show robust and durable clinical activity of a targeted agent in previously treated patients with thymic carcinoma,” said Dr. Anish Thomas of the Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Md., and his associates.

The trial, performed at two U.S. cancer centers during an 18-month period, involved 24 patients with thymic carcinoma and 16 with advanced thymoma whose disease had progressed despite at least one line of platinum-based chemotherapy. All the participants were given oral sunitinib once daily in 6-week cycles until further progression or unacceptable adverse events occurred. A total of 21 of the 23 assessable patients with thymic carcinoma (91%) achieved disease control (partial response or stable disease), as did 13 of the 16 patients who had thymoma (81%), and the median duration of response was 16.4 months. Median progression-free survival was 7.2 months for thymic carcinoma and 8.5 months for thymoma, and 1-year estimated survival was 78% and 86%, respectively.

Sunitinib was generally well tolerated, though many patients required dose reductions. “Considering concurrent cardiac risk factors in patients with thymic epithelial tumors – e.g., previous exposure to anthracyclines, radiation, and high rates of subclinical cardiac tumor involvement – careful monitoring of cardiac function is needed,” Dr. Thomas and his associates said (Lancet Oncol. 2015 Jan. 13 [doi:10.1016/S1470-2045(14)71181-7]).

They noted that these exploratory findings should be viewed with caution and must be confirmed in larger cohorts. At least one such trial (NCT01621568) is currently underway.

Sunitinib elicited an “exceptional” treatment response from refractory thymic carcinoma in an open-label phase II clinical trial involving 40 patients, investigators reported online in Lancet Oncology.

The oral tyrosine kinase inhibitor produced a 26% rate of complete or partial response for thymic epithelial tumors overall and a 91% response rate in the subset of patients with thymic carcinoma. That response was rapid and durable with continued administration of the agent. This is particularly important because most of the study participants had failed on two or more previous treatments including platinum-based chemotherapy, and no other standard treatments are available for patients who have this aggressive cancer. “Our trial is the first to show robust and durable clinical activity of a targeted agent in previously treated patients with thymic carcinoma,” said Dr. Anish Thomas of the Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Md., and his associates.

The trial, performed at two U.S. cancer centers during an 18-month period, involved 24 patients with thymic carcinoma and 16 with advanced thymoma whose disease had progressed despite at least one line of platinum-based chemotherapy. All the participants were given oral sunitinib once daily in 6-week cycles until further progression or unacceptable adverse events occurred. A total of 21 of the 23 assessable patients with thymic carcinoma (91%) achieved disease control (partial response or stable disease), as did 13 of the 16 patients who had thymoma (81%), and the median duration of response was 16.4 months. Median progression-free survival was 7.2 months for thymic carcinoma and 8.5 months for thymoma, and 1-year estimated survival was 78% and 86%, respectively.

Sunitinib was generally well tolerated, though many patients required dose reductions. “Considering concurrent cardiac risk factors in patients with thymic epithelial tumors – e.g., previous exposure to anthracyclines, radiation, and high rates of subclinical cardiac tumor involvement – careful monitoring of cardiac function is needed,” Dr. Thomas and his associates said (Lancet Oncol. 2015 Jan. 13 [doi:10.1016/S1470-2045(14)71181-7]).

They noted that these exploratory findings should be viewed with caution and must be confirmed in larger cohorts. At least one such trial (NCT01621568) is currently underway.

Sunitinib elicited an “exceptional” treatment response from refractory thymic carcinoma in an open-label phase II clinical trial involving 40 patients, investigators reported online in Lancet Oncology.

The oral tyrosine kinase inhibitor produced a 26% rate of complete or partial response for thymic epithelial tumors overall and a 91% response rate in the subset of patients with thymic carcinoma. That response was rapid and durable with continued administration of the agent. This is particularly important because most of the study participants had failed on two or more previous treatments including platinum-based chemotherapy, and no other standard treatments are available for patients who have this aggressive cancer. “Our trial is the first to show robust and durable clinical activity of a targeted agent in previously treated patients with thymic carcinoma,” said Dr. Anish Thomas of the Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, Bethesda, Md., and his associates.

The trial, performed at two U.S. cancer centers during an 18-month period, involved 24 patients with thymic carcinoma and 16 with advanced thymoma whose disease had progressed despite at least one line of platinum-based chemotherapy. All the participants were given oral sunitinib once daily in 6-week cycles until further progression or unacceptable adverse events occurred. A total of 21 of the 23 assessable patients with thymic carcinoma (91%) achieved disease control (partial response or stable disease), as did 13 of the 16 patients who had thymoma (81%), and the median duration of response was 16.4 months. Median progression-free survival was 7.2 months for thymic carcinoma and 8.5 months for thymoma, and 1-year estimated survival was 78% and 86%, respectively.

Sunitinib was generally well tolerated, though many patients required dose reductions. “Considering concurrent cardiac risk factors in patients with thymic epithelial tumors – e.g., previous exposure to anthracyclines, radiation, and high rates of subclinical cardiac tumor involvement – careful monitoring of cardiac function is needed,” Dr. Thomas and his associates said (Lancet Oncol. 2015 Jan. 13 [doi:10.1016/S1470-2045(14)71181-7]).

They noted that these exploratory findings should be viewed with caution and must be confirmed in larger cohorts. At least one such trial (NCT01621568) is currently underway.

Diagnosis of low-risk thyroid cancer has increased, yet researchers have unexpectedly found an increase in the use of postdiagnosis imaging among patients with all stages of disease, according to a report published online in Cancer.

“Greater imaging use clearly contributes to increased costs. Specific to thyroid cancer, increased imaging may identify low-volume recurrent disease that is unlikely to be clinically significant, leading to heightened patient anxiety and potentially unnecessary interventions,” Dr. Jaime L. Wiebel and associates at the University of Michigan wrote.

Investigators analyzed the records of 23,669 patients diagnosed with differentiated thyroid cancer from 1991-2009 in the Surveillance, Epidemiology, and End Results-Medicare database, and identified the percentage of patients who underwent a neck ultrasound, I-131 scan, or PET scan during the first 3 years after diagnosis.

“Using the SEER-Medicare database, we unexpectedly found that there was a significant increase in the use of surveillance imaging studies over the past 20 years across all stages of disease,” Dr. Wiebel and her associates wrote.

Patients diagnosed after 2000 were more likely to have localized disease (P < .001) and tumors measuring less than 1 cm (P < .001), compared with those diagnosed between 1991 and 2000, and were more likely to undergo neck ultrasound (odds ratio, 2.15; 95% confidence interval, 2.02 to 2.28) and I-131 scan (odds ratio, 1.44; 95% confidence interval, 1.35 to 1.54).

Compared with 1996 through 2004, PET scan use from 2005 to 2009 increased 32.4-fold (P = .001) in patients with localized disease, 13.1-fold (P < .001) in patients with regional disease, and 33.4-fold (P < .001) in patients with distant differentiated thyroid cancer, Dr. Wiebel and her associates reported (Cancer 2015 Jan. 6 [doi: 10.1002/cncr.29210]).

“We demonstrated the increased use of imaging over time despite the diagnosis of smaller, more limited, low-risk thyroid cancer. Although many of the themes presented in the current study are true for other malignancies, the overuse of imaging is highlighted by the increased use in patients with this relatively indolent malignancy,” the researchers wrote.

[email protected]

On Twitter @nikolaideslaura

Diagnosis of low-risk thyroid cancer has increased, yet researchers have unexpectedly found an increase in the use of postdiagnosis imaging among patients with all stages of disease, according to a report published online in Cancer.

“Greater imaging use clearly contributes to increased costs. Specific to thyroid cancer, increased imaging may identify low-volume recurrent disease that is unlikely to be clinically significant, leading to heightened patient anxiety and potentially unnecessary interventions,” Dr. Jaime L. Wiebel and associates at the University of Michigan wrote.

Investigators analyzed the records of 23,669 patients diagnosed with differentiated thyroid cancer from 1991-2009 in the Surveillance, Epidemiology, and End Results-Medicare database, and identified the percentage of patients who underwent a neck ultrasound, I-131 scan, or PET scan during the first 3 years after diagnosis.

“Using the SEER-Medicare database, we unexpectedly found that there was a significant increase in the use of surveillance imaging studies over the past 20 years across all stages of disease,” Dr. Wiebel and her associates wrote.

Patients diagnosed after 2000 were more likely to have localized disease (P < .001) and tumors measuring less than 1 cm (P < .001), compared with those diagnosed between 1991 and 2000, and were more likely to undergo neck ultrasound (odds ratio, 2.15; 95% confidence interval, 2.02 to 2.28) and I-131 scan (odds ratio, 1.44; 95% confidence interval, 1.35 to 1.54).

Compared with 1996 through 2004, PET scan use from 2005 to 2009 increased 32.4-fold (P = .001) in patients with localized disease, 13.1-fold (P < .001) in patients with regional disease, and 33.4-fold (P < .001) in patients with distant differentiated thyroid cancer, Dr. Wiebel and her associates reported (Cancer 2015 Jan. 6 [doi: 10.1002/cncr.29210]).

“We demonstrated the increased use of imaging over time despite the diagnosis of smaller, more limited, low-risk thyroid cancer. Although many of the themes presented in the current study are true for other malignancies, the overuse of imaging is highlighted by the increased use in patients with this relatively indolent malignancy,” the researchers wrote.

[email protected]

On Twitter @nikolaideslaura

Diagnosis of low-risk thyroid cancer has increased, yet researchers have unexpectedly found an increase in the use of postdiagnosis imaging among patients with all stages of disease, according to a report published online in Cancer.

“Greater imaging use clearly contributes to increased costs. Specific to thyroid cancer, increased imaging may identify low-volume recurrent disease that is unlikely to be clinically significant, leading to heightened patient anxiety and potentially unnecessary interventions,” Dr. Jaime L. Wiebel and associates at the University of Michigan wrote.

Investigators analyzed the records of 23,669 patients diagnosed with differentiated thyroid cancer from 1991-2009 in the Surveillance, Epidemiology, and End Results-Medicare database, and identified the percentage of patients who underwent a neck ultrasound, I-131 scan, or PET scan during the first 3 years after diagnosis.

“Using the SEER-Medicare database, we unexpectedly found that there was a significant increase in the use of surveillance imaging studies over the past 20 years across all stages of disease,” Dr. Wiebel and her associates wrote.

Patients diagnosed after 2000 were more likely to have localized disease (P < .001) and tumors measuring less than 1 cm (P < .001), compared with those diagnosed between 1991 and 2000, and were more likely to undergo neck ultrasound (odds ratio, 2.15; 95% confidence interval, 2.02 to 2.28) and I-131 scan (odds ratio, 1.44; 95% confidence interval, 1.35 to 1.54).

Compared with 1996 through 2004, PET scan use from 2005 to 2009 increased 32.4-fold (P = .001) in patients with localized disease, 13.1-fold (P < .001) in patients with regional disease, and 33.4-fold (P < .001) in patients with distant differentiated thyroid cancer, Dr. Wiebel and her associates reported (Cancer 2015 Jan. 6 [doi: 10.1002/cncr.29210]).

“We demonstrated the increased use of imaging over time despite the diagnosis of smaller, more limited, low-risk thyroid cancer. Although many of the themes presented in the current study are true for other malignancies, the overuse of imaging is highlighted by the increased use in patients with this relatively indolent malignancy,” the researchers wrote.

[email protected]

On Twitter @nikolaideslaura