De-escalate if possible, intensify when needed

De-escalate if possible, intensify when needed

This thesis of Pascal Jonker explores the full spectrum of thyroid cancer management, emphasizing reduced overtreatment for low-risk cases and evaluating intensive treatment outcomes for aggressive cancers. When research facilities closed amid the pandemic, the researcher utilized this time to study increased surgical risks for SARS-CoV-2 positive patients.

With a high survival rate in papillary thyroid cancer (PTC), less aggressive treatments may often be sufficient. This thesis concludes that active surveillance for low-risk cases and advanced imaging techniques like molecular fluorescence-guided imaging (MFGI) and spectroscopy show potential to improve staging accuracy and reduce unnecessary surgeries. Additionally, early postoperative thyroglobulin levels could better predict recurrence risk, supporting individualized follow-up plans.

During the pandemic, a nationwide study confirmed heightened mortality and morbidity risks for COVID-19-positive surgical patients. These findings supported safe perioperative care for SARS-CoV-2 positive patients during the pandemic.

For aggressive thyroid cancers, such as poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), this thesis evaluates the benefits and risks of radiotherapy and multimodal treatment strategies, while prioritizing promising new therapeutic targets.

Adjuvant intensity-modulated radiotherapy (IMRT) reduces local PDTC recurrence in patients with positive resection margins but carries a higher complication risk. Multimodal treatment (MMT) improves control and survival in patients with ATC, though with increased morbidity. Targets like MTOR and MET are identified as promising for systemic treatments in patients with ATC.

Dissertation: https://hdl.handle.net/11370/41546290-bc0d-4a46-a5cf-8a07e376e414