Treatment of Thyroid Tumor: Japanese Clinical Guidelines

278 Pages·2013·2.24 MB·English

by  Akira Yoshida (auth.)

Treatment of Thyroid Tumor

Hiroshi Takami
Editor-in-Chief
Yasuhiro Ito Hitoshi Noguchi
●
Akira Yoshida Takahiro Okamoto
●
Editors
Treatment of Thyroid Tumor
Japanese Clinical Guidelines
Editor-in-Chief
Hiroshi Takami
Ito Hospital
4-3-6 Jinguumae
Shibuya-ku, Tokyo, Japan
Editors
Yasuhiro Ito Hitoshi Noguchi
Department of Surgery Noguchi Thyroid Clinic and Hospital
Kuma Hospital Foundation
8-2-35 Shimoyamate-dori 6-33 Noguchinaka-machi
Chuo-ku, Kobe, Japan Beppu, Japan
Akira Yoshida Takahiro Okamoto
Department of Breast and Endocrine Department of Endocrine Surgery
Surgery, Kanagawa Cancer Center Tokyo Women’s Medical University
1-1-2 Nakao, Asahi-ku 8-1 Kawada-cho, Shinjuku-ku
Yokohama, Japan Tokyo, Japan
This English translation is based on the Japanese original
KOJYOSEN SHUYO SHINRYO GUIDELINE 2010
© Japan Association of Endocrine Surgeons, Japanese Society of Thyroid Surgery 2010
Originally published in Japan in 2010 and all rights reserved by KANEHARA & CO., LTD.
ISBN 978-4-431-54048-9 ISBN 978-4-431-54049-6 (eBook)
DOI 10.1007/978-4-431-54049-6
Springer Tokyo Heidelberg New York Dordrecht London
Library of Congress Control Number: 2012942082
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Foreword
Creating clinical guidelines is a modern trend. It is clearly bene fi cial to collect
published studies pertaining to a given theme, evaluate their credibility, and then
present recommended treatment options in the form of evidence-based guidelines.
Thus, a Japanese “Clinical Guideline for the Treatment of Thyroid Tumor” was
desired by many clinicians. On the other hand, there were counter-arguments and
lively debates on the wisdom of creating such a guideline in light of Japan’s restric-
tions on the use of radioisotopes and the fact that this is a relatively common disease
with wide discrepancies in preferred treatment, even among specialists.
Eventually, however, the consensus was in favor of creating an evidence-based
Japanese guideline, and a joint effort was made by the Japanese Society of
Endocrine Surgery and the Japanese Society of Thyroid Surgery. The editing
committee was chaired by Dr. Akira Yoshida and co-chaired by Prof. Takahiro
Okamoto. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare
served as committee advisor. The four of us met on a summer evening 2 years ago
and had an intense discussion, after which a committee of 31 members was cho-
sen and, with their concerted efforts and diligence, a guideline was completed
over a span of 2 years. I give my sincere thanks to all the committee members, as
well as to the Japan Medical Library Association, for their comprehensive search
for documents.
Though guidelines can be classi fi ed into evidence-based and consensus-based
guidelines, this edition is a blend of the two. An evidence-based guideline can be
more accurate and exhaustive, but where evidence was absent or insuf fi cient, the
consensus of the committee was adopted.
It would be my greatest pleasure if this guideline were to be utilized by numerous
clinicians to improve the quality of care and treatment outcome. It is also necessary
to receive feedback from the fi eld and re fl ect this in subsequent editions. Periodic
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vi Foreword
revisions will be necessary. Abridged handbooks, online editions, and foreign
language information exchange must follow. Lastly, I would like to thank
Ms. Hitomi Sasaki of Kanehara Publishing for her devoted assistance.
October 2010 Hiroshi Takami
President and Director of the Japan
Association of Endocrine Surgeons
President and Director of the Japanese
Society of Thyroid Surgery
Preface
There are several thyroid tumor treatment guidelines in the West that have estab-
lished positions in clinical practice and gone through several editions. However, in
Japan, where radioisotope facilities are of limited availability, treatment plans for
differentiated thyroid cancer differ from those of foreign countries, and overseas
clinical guidelines cannot be adopted without changes. Also, although thyroid tumor
is a common disease in endocrine practice, its management can differ even among
specialists. For these reasons, the need to develop an original guideline for Japan
became widely recognized. The environment surrounding thyroid surgery was also
evolving with the establishment of independent accreditation for endocrine and thy-
roid surgeons, creating an urgent need for a guideline to complement the certifi cation
apparatus. Under these circumstances, an editing committee for the “Clinical
Guideline for the Treatment of Thyroid Tumor” was established in October 2008,
and it began as a working group. The objective of this group was to create an evi-
dence-based “Japanese” guideline and make it public. The editing committee was
composed primarily of surgeons and otorhinolaryngologists of the Japanese Society
of Endocrine Surgery and the Japanese Society of Thyroid Surgery but also included
a broad spectrum of specialists in nuclear medicine, pathology, and nonsurgical med-
icine in the fi eld. Prof. Masahiro Yoshida of the Japan Council for Quality Healthcare
joined us as an advisor and provided a great deal of valuable input. In the year and a
half after the committee was organized, the members met seven times to prepare a
draft. The timeline is outlined below.
1st Editorial Meeting. October 15, 2008. The general structure was discussed
and each team started proposing clinical questions.
2nd Editorial Meeting. January 24, 2009. Clinical questions and columns (important
issues that were diffi cult to pose as clinical questions) were chosen.
A search of documents pertaining to the clinical questions was commissioned to the
Japan Medical Library Association. The resulting documents were distributed to
each team. Each team evaluated the documents and composed a structured
abstract.
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viii Preface
3rd Editorial Meeting, June 27, 2009. Progress in the structured abstracts was
reported by each team. Various issues in the creation of a guideline were dis-
cussed. A summary and commentary for the clinical questions were created
based on the structured abstracts.
4th Editorial Meeting, September 26, 2009. Evaluation of the recommendations
and commentary (about half of the total). Discussion of issues in need of
consensus.
5th Editorial Meeting, December 12, 2009. Evaluation of the recommendations
and commentary presented after the 4th meeting. More discussion of issues in
need of consensus.
6th Editorial Meeting, February 13, 2010. Recommendation ratings to be divided
into six grades. Evaluation of the recommendation ratings of each clinical ques-
tion. Discussion of diagnostic and treatment algorithms.
7th Editorial Meeting, April 11, 2010. Evaluation of remaining clinical ques-
tions. Approval of commentary. Approval of diagnostic and treatment algorithms.
Draft completed.
Where evidence was insuffi cient, a consensus of the committee was used and an
effort was made to make the guideline as complete and comprehensive as possible.
Still, there are sections where the consensus was not fully accepted among the mem-
bers and further revisions will be required in the future.
That the fi rst edition guideline was completed in such a short period owes much
to the selfl ess devotion of the committee members who strongly recognized the
need for a guideline. We offer our sincere gratitude to the committee members.
Editorial Committee of the Clinical Guideline for the Treatment of Thyroid Tumor
Yokohama, Japan A kira Yoshida
Tokyo, Japan Takahiro Okamoto
October 2010
Preface to the English Version
This is the English version of the 1st edition of “Guidelines for Management of
Thyroid Tumor” established by the Japanese Society of Thyroid Surgery and the
Japanese Society of Endocrine Surgeons. There are some leading guidelines for
thyroid tumor in Western countries. In Japan, however, the circumstances surround-
ing the management and treatment of thyroid tumor differ signifi cantly from those
of Western countries because the use of radioactive iodine (RAI) is limited by legal
restrictions. This causes differences in therapeutic strategies for thyroid tumor, par-
ticularly for well-differentiated thyroid carcinoma, between Western countries and
Japan. However, it is also notable that treatment results for thyroid carcinoma in
Japan have generally been excellent in spite of such conditions.
In recent years, therapeutic experience and outcome data of thyroid tumor in
Japan have been accumulated and it is time not only to establish independent guide-
lines but also to transmit them to the rest of the world by publishing an English
version. As indicated above, treatment strategies for thyroid tumor in Japan differ
substantially from those in Western guidelines, and they defi nitely have their own
advantages and disadvantages. We are willing to suggest our management and treat-
ment of thyroid tumor as alternatives for conventional approaches by introducing
them in the guidelines. Also, we think that any disadvantages can be offset by par-
tially assimilating the advantages of Western guidelines over time. Ultimately, we
hope that the strategies for the management and treatment of thyroid tumor in
Western countries and Japan will fi nd an optimal compromise, leading to the best
possible treatment for patients all over the world in the not-so-distant future.
Kobe, Japan Yasuhiro Ito
Beppu, Japan H itoshi Noguchi
November 2010
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