Struma ovarii medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
The mainstay of treatment for struma ovarii is surgical therapy. Chemotherapy doesn't seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. Adjuvant treatment modalities such as radioiodine therapy and external beam radiation are recommended.
Medical Therapy
Chemotherapy doesn't seem to have role in the regular management of papillary and follicular thyroid cancer. It is reserved for patients with progressive disease which is usually not controlled by surgery, I-131, or other treatment modalities. [1][2]
Adjuvant treatment modalities
Radioiodine Therapy
- First line of management to be considered for malignant struma ovarii is thyroidectomy and treatment with radioiodine I-131. [3][4][5]
- Radioiodine therapy has good outcomes in residual disease or metastatic/recurrent disease. [5]
- Iodine scans have been preferred in the detection of recurrent disease after termination of therapy. [6]
Post I-131 therapy monitoring recommendations
Recommendations: [7]
- Post 6 months after the end of treatment:
- Routine clinical examination
- Measure serum thyroglobulin
- Diagnostic I-131 scintigraphy (after rhTSH stimulation or withdrawal)
- Every 6 months for 18 months and every year thereafter:
- The mainstay follow-up of clinical examination and thyroglobulin measurements with TSH suppression (thyroglobulin must be < 1 ng/ml).
- Additional imaging such as I-131 scintigraphy, 18-FDG-PET, ultrasonography, CT and/or MRI must be performed in the case of abnormal results.
- Pelvic locations help explain complementary imaging, adapted to the initial stage of the disease.
External beam radiation
External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. [8]
References
- ↑ Luo JR, Xie CB, Li ZH (2014). "Treatment for malignant struma ovarii in the eyes of thyroid surgeons: a case report and study of Chinese cases reported in the literature". Medicine (Baltimore). 93 (26): e147. doi:10.1097/MD.0000000000000147. PMC 4616397. PMID 25474425.
- ↑ Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W (2006). "European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium". Eur. J. Endocrinol. 154 (6): 787–803. doi:10.1530/eje.1.02158. PMID 16728537.
- ↑ Yassa L, Sadow P, Marqusee E (2008). "Malignant struma ovarii". Nat Clin Pract Endocrinol Metab. 4 (8): 469–72. doi:10.1038/ncpendmet0887. PMID 18560398.
- ↑ DeSimone CP, Lele SM, Modesitt SC (2003). "Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy". Gynecol. Oncol. 89 (3): 543–8. PMID 12798728.
- ↑ 5.0 5.1 Willemse PH, Oosterhuis JW, Aalders JG, Piers DA, Sleijfer DT, Vermey A, Doorenbos H (1987). "Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration". Cancer. 60 (2): 178–82. PMID 3297279.
- ↑ Yoo SC, Chang KH, Lyu MO, Chang SJ, Ryu HS, Kim HS (2008). "Clinical characteristics of struma ovarii". J Gynecol Oncol. 19 (2): 135–8. doi:10.3802/jgo.2008.19.2.135. PMC 2676458. PMID 19471561.
- ↑ Oudoux A, Leblanc E, Beaujot J, Gauthier-Kolesnikov H (2016). "Treatment and follow-up of malignant struma ovarii: Regarding two cases". Gynecol Oncol Rep. 17: 56–9. doi:10.1016/j.gore.2016.05.014. PMC 4913172. PMID 27355004.
- ↑ O'Connell ME, Fisher C, Harmer CL (1990). "Malignant struma ovarii: presentation and management". Br J Radiol. 63 (749): 360–3. doi:10.1259/0007-1285-63-749-360. PMID 2379061.