Latest news with #cancercenters
Medscape
21-07-2025
- Health
- Medscape
Safe to Skip Postop Radioiodine in Low-Risk Thyroid Cancers?
TOPLINE: A recent phase 3 trial found that 5-year recurrence-free survival was similar among patients who did and did not receive postoperative radioiodine, indicating the treatment can be safely avoided in patients with low-risk differentiated thyroid cancer — specifically those with pT1, pT2, and N0 or Nx tumors who have no adverse features after total thyroidectomy. METHODOLOGY: Although now used less often, total thyroidectomy followed by radioiodine has traditionally been the standard of care for treating differentiated thyroid cancer. Observational studies and the ESTIMABL2 trial , published in 2022, suggested that patients with low-risk disease could safely skip radioiodine, but confirmatory evidence was still needed. The recent randomized, noninferiority, phase 3 IoN trial aimed to answer this question. The study involved patients at 33 cancer centers in the UK who underwent complete resection following total thyroidectomy and stage pT1, pT2, pT3, or pT3a disease. Researchers randomly assigned 504 patients (77% women) to receive (n = 253) or not receive (n = 251) postoperative radioiodine. Patients underwent neck ultrasound scans annually and serum thyroglobulin measurements every 6 months. The median follow-up was 6.7 years. The primary outcome was 5-year disease-free survival, defined as the absence of locoregional recurrent or residual structural disease, distant metastases, or death from thyroid cancer. Noninferiority was assessed with a margin of 5 percentage points. Overall, 47% of patients had pT1 tumors, 44% had pT2, and 9% had pT3 or pT3a; 91% of patients had N0 or Nx disease, and 9% had N1a disease. TAKEAWAY: Overall, 17 recurrences were reported — 8 in the no-radioiodine group and 9 in the radioiodine group. The 5-year recurrence-free rate was 97.9% in the no-radioiodine group vs 96.3% in the radioiodine group, with an absolute risk difference of 0.5 percentage points (P for noninferiority = .033), highlighting the noninferiority of omitting radioiodine. Higher recurrence rates were observed in patients with pT3 or pT3a tumors than in those with pT1 or pT2 tumors (9% vs 3%) and in patients with N1a tumors than in those with N0 or Nx tumors (13% vs 2%). Additionally, baseline postsurgical thyroglobulin levels ≥ 2 ng/mL were associated with a higher risk for recurrence (hazard ratio, 12.75; P < .0001). Adverse events were comparable between the no-radioiodine and radioiodine groups, with fatigue (25% vs 28%), lethargy (14% in both), and dry mouth (10% vs 9%) being the most common. No treatment-related deaths or deaths from thyroid cancer were reported. But a total of eight patients died — an equal number in both groups. In the no-radioiodine group, deaths were due to two new primary cancers, one myocardial infarction, and one liver failure. In the radioiodine group, one death was due to bowel cancer and three due to vascular or unknown causes. IN PRACTICE: IoN and ESTIMABL2 together 'offer strong and complementary evidence showing' that postoperative radioiodine can be avoided in patients with low-risk differentiated thyroid cancer — more specifically, pT1 or pT2 tumors with N0 nodal status and no other adverse features, the study authors concluded. Although the evidence for or against radioiodine in patients with pT3, pT3a, or N1a tumors was deemed 'insufficient,' the authors concluded that 'most patients worldwide with low-risk differentiated thyroid cancer' can now safely avoid radioiodine. SOURCE: This study, led by Ujjal Mallick, Freeman Hospital, Newcastle upon Tyne, England, was published online in The Lancet. LIMITATIONS: Patients had relatively few recurrences, and the findings may not be applicable to the youngest patients. Additionally, molecular data (eg, on BRAF and TERT mutations) were not routinely collected from patients. DISCLOSURES: This study was funded by Cancer Research UK. One author reported receiving honoraria from Esai and the British Medical Ultrasound Society for presenting treatment options for differentiated thyroid cancer. Another author reported receiving honoraria from Esai for presenting treatment options for differentiated thyroid cancer. All other authors declared having no competing interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Washington Post
06-07-2025
- Health
- Washington Post
End-of-life advice: How to bring your A-game as a patient
It can feel like every top cancer center has the same PR pitch: a promise of 'patient centered' care delivered with a 'team approach.' I'm grateful that medicine predicated on the infallibility of physicians and the passivity of patients has largely fallen out of favor. But the patient's role on this new 'patient-centered' team can be confusing. In this, the second in a series of stories on living with a terminal illness, I'll give you my take on what patients can do.
Associated Press
24-06-2025
- Health
- Associated Press
Trusted Oncology Guidelines Get a Digital Makeover: National Comprehensive Cancer Network Launches NCCN Guidelines Navigator
The new interactive guideline tool represents a major format change for gold-standard NCCN Guidelines. PLYMOUTH MEETING, Pa., June 24, 2025 /PRNewswire/ -- The National Comprehensive Cancer Network® (NCCN®)—an alliance of leading cancer centers—announces a new, interactive digital delivery format for the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). The NCCN Guidelines® are the recognized standard for clinical decision making and policy in cancer care and are the most thorough and frequently updated clinical practice guidelines available in any area of medicine. They assist in the decision-making process of individuals involved in cancer care and prevention—including physicians, nurses, pharmacists, payers, patients and their caregivers—with the ultimate goal of improving patient care and outcomes. The new NCCN Guidelines Navigator ™ presents the evidence-based, expert consensus-driven recommendations from the NCCN Guidelines in a virtual platform that allows users to search and navigate more easily. Access to the NCCN Guidelines Navigator™ is available with a free NCCN account for non-commercial use. Features of the NCCN Guidelines Navigator™ include: 'This is truly the future of cancer treatment guidance,' said Crystal S. Denlinger, MD, Chief Executive Officer, NCCN. 'Cancer prevention, screening, treatment, and supportive care that follows internationally-trusted guidelines has been shown time and again to improve outcomes for people with cancer. I'm proud that we've achieved our ambitious goal for increasing the accessibility and usability of the content from the NCCN Guidelines without compromising any quality.' The NCCN Guidelines Navigator™ recently began beta testing for colon and prostate cancers. That was followed by rectal cancer, which was published on June 16, 2025. NCCN will continue to publish NCCN Guidelines Navigator™ for additional cancer types until all 88 NCCN Guidelines are available in the new format. The original pdf format will also remain available for all NCCN Guidelines. Both forms will feature the most up-to-date information users rely upon for daily use in cancer care and prevention. People who access the NCCN Guidelines in any format, including via the NCCN Guidelines Navigator™, can earn CE/MOC credit through the new NCCN Guidelines in Practice ™—which was just announced earlier this month. NCCN also plans to continue to optimize this new tool, including adding artificial intelligence (AI) capabilities to make searching even more conversational and intuitive, plus increased integration with NCCN's other resource offerings. 'It has been 30 years since we first launched the NCCN Guidelines; since then, they have come to be used by millions of people worldwide every year, including more than 90% of U.S. and global physicians surveyed,' said Dr. Denlinger. 'Cancer care is becoming increasingly effective but also more complicated every year. The new NCCN Guidelines Navigator tool simplifies the evolving evidence from the latest research, leverages expertise to put it into context, and places it at the point-of-care for decision-making support and education. This new resource integrates everything we do to support people with cancer and their care providers by defining and advancing quality, effective, equitable, and accessible cancer care and prevention so all people can live better lives.' Visit for more information. About the National Comprehensive Cancer Network The National Comprehensive Cancer Network® (NCCN®) is marking 30 years as a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to defining and advancing quality, effective, equitable, and accessible cancer care and prevention so all people can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus-driven recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation ®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit for more information. Media Contact: Rachel Darwin 267-622-6624 [email protected] View original content to download multimedia: SOURCE National Comprehensive Cancer Network
Medscape
14-05-2025
- Health
- Medscape
Calculator Aids With Assessing SNL Metastasis Risk in Melanoma
The Melanoma Institute of Australia (MIA) previously developed a risk calculator for sentinel lymph node (SLN) metastasis risk to help clinicians and patients with primary cutaneous melanoma decide whether to proceed with a SLN biopsy (SLNB). A new study published in JAMA Dermatology provides a validation update on the tool based on a larger and more geographically diverse study population. Not only were the results with a six-factor model using a larger population similar to those from the original dataset but also the calculator showed improved precision with narrowed 95% CIs. Both the original study and the larger validation analysis compared the accuracy of the calculator with the SLNB results that were available for each patient. The full calculator requires the input of age at diagnosis, Breslow tumor thickness (mm) and melanoma subtype (acral, superficial spreading, nodular, pure desmoplastic, or lentigo maligna melanoma). Clinicians can also include tumor mitotic rate (x/mm2 or mitosis present/absent), ulceration (present/absent) and lymphovascular invasion (present/absent) when this information is available. The new analysis included data from the National Danish Melanoma Database (N = 8533), three cancer centers in the United Kingdom (N = 2663), two in the United States (N = 1844), one in New Zealand (N = 449), one in Sweden (N = 1215), and one in Brazil (N = 1027). When pooled with the original cohort, 15,732 patients were included in the validation. What Did the New Study Find? A decision-curve analysis revealed the differences in clinical decision-making using the six-factor model or one using only Breslow thickness and ulceration. In this context, a given threshold probability reflects the minimum level of risk at which a clinician/patient would choose to proceed with an SLNB. Using all six MIA parameters and a threshold of 8% resulted in a favorable balance of minimizing unnecessary biopsies, while maintaining confidence in detecting metastasis. This lower-threshold approach is better suited to patients with a more conservative risk tolerance, who are willing to undergo biopsy when they have a lower risk for metastasis rather than miss one. In contrast, a simpler predictive model using only Breslow thickness and ulceration resulted in a higher net benefit at a 14% threshold for patients with higher risk tolerance. Net benefit refers to the reduced number of unnecessary biopsies (a positive) at the risk of missing some true cases of metastasis (a negative). This may be preferable for patients who want to limit biopsy to a high risk for metastasis. For these patients, avoiding biopsy is a greater concern than missing a true positive. This simpler approach may also be valuable in settings where more detailed information, such as subtype or mitotic rate, is unavailable. 'These findings reinforce the tool's reliability in predicting the risk a melanoma has spread to the lymph nodes in diverse patient groups, providing clinicians worldwide with greater confidence in its use for everyday practice,' primary investigator Alexander Varey, MD, PhD, said in a press statement. In addition, with the larger sample size the 95% CIs shrank with a mean reduction of more than 75%. Thresholds — the probability that reflects the minimum level of risk at which a clinician or patient would choose to proceed with an SLNB — of 5% and 10% are generally considered to be clinically relevant. At the 5% threshold, this increased precision shifted clinical interpretation in more than half of the patients (58%) — who previously had lower CI bounds below 5% — now had lower bounds greater than 5% with the inclusion of more data. In clinical terms, this means having greater confidence that a patient's true risk exceeds the 5% threshold (which reflects a patient's preference for a more conservative approach) improving the reliability of biopsy decisions in patients near that risk cutoff. Similarly, among patients whose upper 95% confidence bounds previously exceeded 10%, roughly a quarter (24%) now had upper bounds that fell below 10%, which increases the certainty that these patients are not at high risk. In clinical terms this supports safer biopsy avoidance in that group. What Makes the Tool Useful in Clinical Practice? 'This calculator is helpful because you can get all of this information just from the pathology report. You don't have to do another assay or spend thousands of dollars on genetic profiling,' said Mark Faries, MD, a surgical oncologist at Cedars‑Sinai and The Angeles Clinic and Research Institute, Los Angeles. He is also the co-director of the Cutaneous Oncology Program at the Cedars-Sinai and heads surgical oncology at The Angeles Clinic. The tool also adds easy-to-understand information for patients to improve the discussion of their care. 'If a patient comes in newly diagnosed with a melanoma, you would be able to put these parameters into the calculator, and it'll give you a number to suggest the risk that they have involvement of their lymph node', said Faries. 'Based on that information, you — together with the patient — can decide whether or not they can just have an excision of the skin site, or if they also need to have a sentinel lymph, node biopsy done.' He added, 'you can use [this calculator] for every patient. Just having that number helps patients understand what they're looking at. Many times, patients come in with a very pessimistic outlook, based on people's general feeling about melanoma. So even if they have a fairly substantial risk of having something in the node that justifies doing the node biopsy, you can reassure them that actually the most likely outcome is that everything's going to be okay. Even from that sort of peace of mind standpoint, it's useful for every patient.' What Does the New Study Add? In this study, 'they've collected a very large additional number of patients from other centers around the world and have further validated the results of the initial analysis…this new work makes the estimates more precise,' said Faries. With the earlier version of the calculator, 'there was a pretty wide range, where the probability might've reasonably fallen for a prediction. Now with these larger numbers [of patients] it's a much smaller range. So you have more confidence that the number you're getting is correct.,' he said. Are There Any Caveats or Room for Improvement? 'There still is some room for improvement at the lowest risk end of the scale,' Faries noted. 'The reason for that is that the calculator was developed based on patients who had a sentinel lymph node biopsy done. So they've already been selected to some extent. Relatively speaking, the number of patients they have at the very bottom end of the risk scale is not very large because those people don't get the lymph biopsy done. So I think when we have somebody who we generally wouldn't recommend doing a sentinel node biopsy for, the calculator is a little bit less definitive. I think there's more work that could be done to help at that very bottom end.' Varey reported receiving personal fees from Novartis AG and Merck & Co., Inc. (MSD).
