Watch and Wait: Examining Rates of Tumor Growth in Active Thyroid Surveillance

HealthDay News — Among patients with low-risk papillary thyroid cancer (PTC), the rates of tumor growth during active surveillance are low, according to a study published online in JAMA Otolaryngology-Head & Neck Surgery.

R. Michael Tuttle, MD, from the Memorial Sloan Kettering Cancer Center in New York City, and colleagues describe the kinetics of PTC tumor growth during active surveillance in a cohort of 291 patients undergoing active surveillance for low-risk PTC.

The researchers found that growth in tumor diameter of 3 mm or more occurred in 3.8% of patients, with a cumulative incidence of 2.5% and 12.1% at 2 and 5 years, respectively. During active surveillance, no regional or distant metastases developed. Three-dimensional measurements of tumor volume allowed for earlier identification of growth in all cases (median, 8.2 months before increase in tumor diameter). Younger age at diagnosis (hazard ratio [HR] per year, 0.92) and risk category at presentation (HR for inappropriate, 55.17) correlated independently with the likelihood of tumor growth. Kinetics demonstrated a classic exponential growth pattern among tumors experiencing volume growth, with a median doubling time of 2.2 years.

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“Serial measurement of tumor volumes may facilitate early identification of tumors that will continue to grow and thereby inform the timing of surveillance imaging and therapeutic interventions,” the authors write.

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Tuttle RM, Fagin JA, Minkowitz G, et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance [published online August 31, 2017]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2017.1442