What is the diagnosis and treatment for Papillary Thyroid Carcinoma (PTC)?

From the Guidelines

Papillary thyroid carcinoma (PTC) should be managed with active surveillance as the first-line approach for low-risk patients, while surgery and radioactive iodine therapy may be recommended for higher-risk patients or those with larger tumors or lymph node involvement, as supported by the most recent evidence from 2019 1. The diagnosis of PTC typically involves careful exploration of the neck by ultrasound to assess the status of lymph node chains, and the initial treatment may include total or near-total thyroidectomy, depending on the tumor size and spread, as well as the patient's overall health and risk factors 1. Some key points to consider in the management of PTC include:

• Active surveillance is a viable option for low-risk patients with small tumors (≤10 mm) and no high-risk features, such as clinical node metastasis, distant metastasis, or significant extrathyroidal extension 1
• Surgery, including total or near-total thyroidectomy, may be recommended for patients with larger tumors or those with lymph node involvement, as well as for patients who have undergone active surveillance and show signs of progression 1
• Radioactive iodine therapy (typically 30-100 mCi of I-131) may be recommended for patients with higher-risk disease or those who have undergone surgery, to destroy any remaining cancer cells and reduce the risk of recurrence 1
• Lifelong thyroid hormone replacement therapy, usually with levothyroxine, is necessary for patients who have undergone thyroidectomy, to suppress TSH and prevent recurrence 1
• Regular monitoring, including periodic blood tests for thyroid function and thyroglobulin levels, as well as neck ultrasounds, is essential for detecting any signs of recurrence or progression 1

From the FDA Drug Label

The histological diagnoses were papillary carcinoma in 57%, follicular carcinoma (including Hürthle cell) in 25%, and poorly differentiated carcinoma in 10%, and other in 8% of the study population A statistically significant prolongation of PFS was demonstrated for sorafenib tablets -treated patients compared to those receiving placebo (Figure 3); Table 12: Efficacy Results from DECISION in Differentiated Thyroid Carcinoma Sorafenib Tablets N = 207 Placebo N = 210 Progression-free Survival1 Number of Deaths or Progression 113 (55%) 136 (65%) Median PFS in Months (95% CI) 10.8 (9.1,12.9) 5.8 ( 5. 3,7.8) Hazard Ratio (95% CI) 0.59 (0.46,0.76) P-value 2 < 0.001

The diagnosis of Papillary Thyroid Carcinoma (PTC) is based on histological diagnosis. The treatment for PTC includes sorafenib tablets, which have been shown to prolong progression-free survival (PFS) in patients with locally recurrent or metastatic, progressive differentiated thyroid carcinoma (DTC) refractory to radioactive iodine (RAI) treatment 2. Key points about the treatment include:

• Sorafenib tablets were administered at a dose of 400 mg twice daily
• A statistically significant prolongation of PFS was demonstrated for sorafenib tablets-treated patients compared to those receiving placebo
• The median PFS was 10.8 months for sorafenib tablets-treated patients and 5.8 months for placebo-treated patients

From the Research

Diagnosis of Papillary Thyroid Carcinoma (PTC)

• The diagnosis of PTC involves various methods, including preoperative neck ultrasound to detect nonpalpable cervical lymph node metastases 3
• Fine-needle aspiration cytology (FNAC) is also used for diagnosis, as seen in a prospective study of 300 patients with PTC 4
• The diagnosis is often confirmed by postoperative histopathology 4

Treatment of Papillary Thyroid Carcinoma (PTC)

• The first-line treatment for PTC is surgical excision, with total thyroidectomy being the preferred method for many patients 5, 3, 6, 7
• Total thyroidectomy has been shown to be superior for overall survival in select patient populations and reduces local recurrence 5
• Adjuvant therapy options include radioactive iodine ablation, thyroid-stimulating hormone (TSH) suppression with thyroxine, external beam radiation, and chemotherapy 5, 3
• The treatment approach may vary depending on patient factors, disease factors, and the decisions of the patient and treatment team 5

Surgical Options for PTC

• Total thyroidectomy is often recommended for patients with PTC, especially those with high-risk disease or large tumors 5, 3, 6, 7
• Hemithyroidectomy may be considered for patients with low-risk, small, unilateral PTC, as seen in a prospective study of 300 patients 4
• The choice of surgical procedure depends on various factors, including tumor size, location, and patient preferences 4, 6

Outcomes and Prognosis

• The overall survival rate for PTC is excellent, with more than 90% of patients surviving 5
• Recurrence rates vary, but can be as high as 20% 7
• Patients who undergo initial surgery at a comprehensive cancer center may have better oncologic outcomes, including lower recurrence rates and fewer positive surgical margins 7