Struma ovarii medical therapy: Difference between revisions

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====External beam radiation====
====External beam radiation====
*External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. <ref name="pmid2379061">{{cite journal |vauthors=O'Connell ME, Fisher C, Harmer CL |title=Malignant struma ovarii: presentation and management |journal=Br J Radiol |volume=63 |issue=749 |pages=360–3 |year=1990 |pmid=2379061 |doi=10.1259/0007-1285-63-749-360 |url=}}</ref>
*External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. <ref name="pmid2379061">{{cite journal |vauthors=O'Connell ME, Fisher C, Harmer CL |title=Malignant struma ovarii: presentation and management |journal=Br J Radiol |volume=63 |issue=749 |pages=360–3 |year=1990 |pmid=2379061 |doi=10.1259/0007-1285-63-749-360 |url=}}</ref>
===Disease Name===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 2.1 '''Specific Organ system involved 2'''
*** 2.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 2.1.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Revision as of 21:37, 20 August 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

  • The mainstay of treatment for Struma ovarii is surgical therapy.

Medical Therapy

  • Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
  • Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
  • Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
  • Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
  • 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, I131, 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 I131 therapy monitoring recommendations

Recommendations: [7]

  • Post 6 months after the end of treatment:
  • Routine clinical examination
  • Measure serum thyroglobulin
  • Diagnostic I131 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 131I scintigraphy, 18FDG 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.
  • Pelvic MRIs after therapy only advised for patient with the metastatic disease.

External beam radiation

  • External beam radiation has been beneficial for patients with multiple metastatic lesion and who do absorb radioiodine poorly. [8]

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.

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