Background: Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. Methods: From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). Results: We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm3 (range: 0.003-38.18 cm3), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452, p = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904; p = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945; p = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. Conclusion: The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.

• Klíčová slova
• brain metastases, local control, stereotactic radiosurgery, survival, thyroid cancer,
• MeSH
• analýza přežití MeSH
• doba přežití bez progrese choroby MeSH
• dospělí MeSH
• folikulární adenokarcinom sekundární   chirurgie   MeSH
• Karnofského skóre MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory mozku sekundární   chirurgie   MeSH
• nádory štítné žlázy patologie   MeSH
• následné studie MeSH
• papilární karcinom sekundární   chirurgie   MeSH
• radiochirurgie škodlivé účinky   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: It is well known that patient characteristics and survival outcomes in randomized trials may not necessarily be similar to those in real-life clinical practice. The aim of the present study was to analyse second line treatment strategies in the real-world practice and to estimate the outcomes of patients treated with second-line targeted therapy for metastatic renal cell carcinoma (mRCC). METHODS: This is a retrospective, registry-based study using data from the national registry of targeted therapies for mRCC. The RENIS registry contains data on 3049 patients who started the therapy with at least one targeted agent before 31 December, 2014. Of these patients, 1029 had a record of at least two different targeted therapies and sufficient data for analysis. Survival analysis was carried out using the Kaplan-Meier method. Statistical significance of differences in survival between subgroups was assessed using the log-rank test. RESULTS: The median overall survival from the start of second-line treatment was 17.0 months (95% confidence interval [CI] 14.5-19.5 months), 17.1 months (95% CI 14.5-19.8), and 15.4 months (95% CI 11.0-19.7) for second-line everolimus, sorafenib, and sunitinib, respectively. Patients receiving second-line everolimus were older at the start of second-line treatment, more likely to have metachronous disease, and less likely to be previously treated with cytokines or to continue to third-line treatment than patients treated with second-line sunitinib or sorafenib. Progression-free survival (PFS) correlated with PFS on first-line treatment only for everolimus. CONCLUSIONS: In this retrospective study, no significant differences in survival were observed between the cohorts treated with different second-line agents including everolimus, sorafenib, and sunitinib.

• Klíčová slova
• Everolimus, Pazopanib, Renal cell carcinoma, Sorafenib, Sunitinib, Therapy,
• MeSH
• cílená molekulární terapie * MeSH
• dospělí MeSH
• karcinom z renálních buněk farmakoterapie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• míra přežití MeSH
• nádory ledvin farmakoterapie   sekundární   MeSH
• následné studie MeSH
• papilární karcinom farmakoterapie   sekundární   MeSH
• prognóza MeSH
• protokoly protinádorové kombinované chemoterapie terapeutické užití   MeSH
• registrace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• záchranná terapie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The open-label, phase II RECORD-2 trial compared efficacy and safety of first-line everolimus plus bevacizumab (EVE/BEV) with interferon plus bevacizumab (IFN/BEV) in patients with metastatic renal cell carcinoma. PATIENTS AND METHODS: Previously untreated patients were randomized 1:1 to bevacizumab 10 mg/kg every 2 weeks with either everolimus 10 mg/day (EVE/BEV) or interferon (9 MIU 3 times/week, if tolerated) (IFN/BEV). Tumor assessments occurred every 12 weeks. The primary objective was the assessment of treatment effect on progression-free survival (PFS), based on an estimate of the chance of a subsequent phase III trial success (50% threshold for phase II success). RESULTS: Baseline characteristics were balanced between the EVE/BEV (n = 182) and IFN/BEV (n = 183) arms. The median PFS was 9.3 and 10.0 months in the EVE/BEV and IFN/BEV arms, respectively (P = 0.485). The predicted probability of phase III success was 5.05% (hazard ratio = 0.91; 95% confidence interval 0.69-1.19). The median duration of exposure was 8.5 and 8.3 months for EVE/BEV and IFN/BEV, respectively. The percentage of patients discontinuing because of adverse events (AEs) was 23.4% for EVE/BEV and 26.9% for IFN/BEV. Common grade 3/4 AEs included proteinuria (24.4%), stomatitis (10.6%), and anemia (10.6%) for EVE/BEV and fatigue (17.1%), asthenia (14.4%), and proteinuria (10.5%) for IFN/BEV. The median overall survival was 27.1 months in both arms. CONCLUSIONS: The efficacy of EVE/BEV and IFN/BEV appears similar. No new or unexpected safety findings were identified and, with the exception of proteinuria in about one-fourth of the population, EVE/BEV was generally well tolerated. CLINICAL TRIAL REGISTRY AND TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT00719264.

• Klíčová slova
• bevacizumab, combination targeted therapy, everolimus, first-line, metastatic renal cell carcinoma,
• MeSH
• bevacizumab aplikace a dávkování   MeSH
• dospělí MeSH
• everolimus aplikace a dávkování   MeSH
• interferon alfa aplikace a dávkování   MeSH
• karcinom z renálních buněk farmakoterapie   mortalita   sekundární   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• míra přežití MeSH
• mladý dospělý MeSH
• nádory ledvin farmakoterapie   mortalita   patologie   MeSH
• následné studie MeSH
• papilární karcinom farmakoterapie   mortalita   sekundární   MeSH
• prognóza MeSH
• protokoly protinádorové kombinované chemoterapie terapeutické užití   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Názvy látek
• bevacizumab MeSH
• everolimus MeSH
• IFNA2 protein, human MeSH Prohlížeč
• interferon alfa MeSH

Surgery remains the basic therapeutical method of the thyroid gland papillary carcinoma treatment. It is complemented by the adjacent thyro-eliminating therapy. A remarkable number of the thyroid gland carcinoma cases is still being diagnosed accidentally during the surgery for the thyroid gland benign disorders. The above mentioned patients, then, must undergo a reoperation, in order for the total thyroidectomy (TTE) and the lymphonodes dissection (LU) to be finished. The reoperations should be conducted in specialized clinics by sufficiently proficient teams. Our study reviews a case of a patient who underwent three surgeries on his thyroid gland.

• MeSH
• dospělí MeSH
• lidé MeSH
• lymfadenektomie MeSH
• lymfatické metastázy diagnostické zobrazování   MeSH
• lymfatické uzliny diagnostické zobrazování   MeSH
• nádory štítné žlázy diagnostické zobrazování   patologie   chirurgie   MeSH
• papilární karcinom diagnostické zobrazování   sekundární   chirurgie   MeSH
• radioisotopová scintigrafie MeSH
• radioizotopy jodu * MeSH
• reoperace MeSH
• reziduální nádor MeSH
• tyreoidektomie * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• radioizotopy jodu * MeSH

The authors present on the basis of case report the problematic of thyroid gland cancer where was manifest long-term (3 years) clinical only as the resistance on the right part of the neck in the trigonum submandibular. Histological examination confirmed the metastasis of thyroid gland papillocarcinoma. Total thyroidectomy was performed and the same type of cancer in both lobes was confirmed. The patient has been 2 years after surgery and radiotherapy (radioiodine) without recurrence.

• MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• krk MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• nádory štítné žlázy diagnóza   patologie   MeSH
• papilární karcinom sekundární   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The authors present their experience with surgical treatment for nodal metastases of thyroid carcinoma based on neck dissections. The specificity of the surgical approach to the lymph nodes was determined by the biologic behavior of each thyroid tumor. Using the available literature on metastases from thyroid tumors, an opinion is supported that surgery for differentiated carcinomas (papillary and follicular neoplasms) can be more conservative and can be safely limited to modified neck dissections. In contrast, a more extended type of selective neck dissection, and only rarely a comprehensive neck dissection, is needed for medullary carcinoma. Because of its rapid spread to distant sites local aggressivity, extirpation of individual lymph nodes or neck dissection is not justified in patients with anaplastic thyroid carcinoma.

• MeSH
• anaplazie MeSH
• dospělí MeSH
• folikulární adenokarcinom sekundární   chirurgie   MeSH
• karcinom sekundární   chirurgie   MeSH
• klinické protokoly MeSH
• krční disekce MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfadenektomie metody   MeSH
• lymfatické metastázy * MeSH
• medulární karcinom sekundární   chirurgie   MeSH
• mladiství MeSH
• nádory štítné žlázy chirurgie   MeSH
• papilární karcinom sekundární   chirurgie   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

We describe two cases of papillary carcinoma of the thyroid containing prominent nodular, fasciitis-like stroma. In one of the cases infiltration into the adjacent parathyroid gland and metastases to two cervical lymph nodes occurred. In the lymph nodes and the parathyroid gland the carcinoma grew without any fasciitis-like stroma. This unusual change in tumour stroma seems to be reactive in nature and confined only to the thyroid and adjacent soft tissues.

• MeSH
• dospělí MeSH
• invazivní růst nádoru MeSH
• lidé středního věku MeSH
• lidé MeSH
• lymfatické metastázy MeSH
• nádory štítné žlázy patologie   MeSH
• papilární karcinom patologie   sekundární   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH