David Viola

David Viola
Università di Pisa | UNIPI · Department of Clinical and Experimental Medicine

MD

About

85
Publications
9,079
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3,595
Citations
Additional affiliations
June 2012 - January 2013
Spanish National Research Council
Position
  • European Society Endocrine Scholar Program
October 2003 - present
Azienda Ospedaliero-Universitaria Pisana
Position
  • Assegnista di Ricerca
October 2003 - present
Università di Pisa
Position
  • Assegnista di Ricerca

Publications

Publications (85)
Article
Purpose: Selumetinib can increase radioactive iodine (RAI) avidity in RAI-refractory tumors. We investigated whether selumetinib plus adjuvant RAI improves complete remission (CR) rates in patients with differentiated thyroid cancer (DTC) at high risk of primary treatment failure versus RAI alone. Methods: ASTRA (NCT01843062) is an international...
Article
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Sommario La sopravvivenza del paziente con carcinoma tiroideo peggiora in presenza di metastasi a distanza. L’osso, dopo il polmone, rappresenta la sede di metastatizzazione più frequente e il suo interessamento può incidere negativamente anche sulla qualità di vita del paziente, causando dolore, fratture e/o compressione del midollo spinale. La ge...
Article
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Multiple Endocrine Neoplasia 2 (MEN2) is a hereditary cancer syndrome for developing medullary thyroid cancer (MTC) due to germline mutations of RET gene. Subjects harboring a germline RET mutation without any clinical signs of MTC are defined as gene carriers (GCs), for whom guidelines propose a prophylactic thyroid surgery. We evaluate if active...
Article
Context How lymph node metastasis (LNM)-associated mortality risk is affected by BRAF V600E in papillary thyroid cancer (PTC) remains undefined. Objective To study whether BRAF V600E affected LNM-associated mortality in PTC. Design, Setting, Participants We retrospectively analyzed the effect of LNM on PTC-specific mortality with respect to BRAF...
Article
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Osteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no...
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Purpose Recent diagnostic criteria updates of the tall cell variant of papillary thyroid carcinoma (TCPTC) by the World Health Organization (WHO) have determined the inclusion of tumours with 30-49% of tall cells. However, the impact of tall cell percentage on papillary thyroid carcinoma (PTC) patients’ prognosis is still debated. We aimed to evalu...
Article
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Differentiated thyroid cancers (DTC) are commonly and successfully treated with total thyroidectomy plus/minus radioiodine therapy (RAI). Medullary thyroid cancer (MTC) is only treated with surgery but only intrathyroidal tumors are cured. The worst prognosis is for anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC). Whenever a local...
Article
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Introduction: Tyrosine kinase inhibitors represent a better treatment in patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC). Lenvatinib is usually well-tolerated, but sometimes, it is associated with serious and even life-threatening side effects. The aim of this study was to evaluate the prevalence of and the potential...
Article
Background: Serum Ca19.9 positivity is a prognostic factor for mortality in patients with advanced medullary thyroid cancer (aMTC), independently from calcitonin doubling time (DT). However, it is unknown whether aMTC patients who become positive for Ca19.9 also have progressive disease (PD) according to response evaluation criteria in solid tumors...
Article
Objective: Prophylactic central compartment lymph node dissection (pCCND) results in a higher percentage of surgical-related complications. To date, no evidence of the impact of pCCND on the clinical outcome of papillary thyroid carcinoma (PTC) patients with synchronous ipsilateral cervical lymph node metastases has been reported. Methods: We evalu...
Article
Objective: At the present, recombinant TSH cannot be used for the treatment of metastatic differentiated thyroid cancer patients. Aim of this study was to evaluate if the type of TSH stimulation, recombinant or endogenous, had an impact on the outcome of these patients. Design and methods: We compared the outcome of two propensity score-matched gro...
Article
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PurposeTo compare the epidemiological, clinical, and pathological features of follicular (FVPTC) and classical (CVPTC) variants of papillary thyroid cancer and to correlate their outcomes according to different features.Methods Retrospective analysis of FVPTC and CVPTC patients selected at the moment of surgical treatment from 1999 to 2004, with a...
Article
Introduction Low risk Differentiated Thyroid Cancer (DTC) are currently rarely treated with radioiodine (131I) to ablate the postoperative remnant. Therefore, the interpretation of the serum thyroglobulin (Tg) values, should be reconsidered. The aim of our study was to evaluate the changes in Tg values during follow-up with regard to the changing v...
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Introduction: Medullary thyroid carcinoma (MTC) is a rare tumor, it originates from the C cells producing calcitonin (CT) and can occur as sporadic or associated to germline RET mutation. The initial treatment is represented by total thyroidectomy associated with central compartment lymph nodes dissection and possible extension to the laterocervica...
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Objective: Tyrosine kinase inhibitors (TKIs) are used for the treatment of metastatic differentiated (DTC), poorly differentiated (PDTC) and medullary (MTC) thyroid cancer. Several adverse events (AEs) have been reported in almost all patients (pts) treated with TKIs. One of the less known AE related to the use of these drugs is the primary adrenal...
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Background: Our previous retrospective study demonstrated that the absence of tumor capsule or, if present, its invasion were independent risk factors for the persistence of the disease (OR 6.75, CI 1.97-23.08 and OR 7.89, CI 1.78-34.94, respectively) in papillary thyroid cancer (PTC). This data was confirmed also analyzing separately the most freq...
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Introduction: Medullary thyroid cancer (MTC) arises from C cells secreting calcitonin. In familial MTC cases, a germline RET mutation is discovered in 98% of cases. Nowadays, an early diagnosis and radical surgery are the only curative approach. However, thyroidectomy in children is associated with a higher rate of surgical adverse events, compared...
Article
PurposeThe use of tyrosine kinase inhibitors (TKIs) in thyroid cancer patients is often limited by toxicities. Some have a long-term onset and potentially could impact patients’ survival. Among them, there is the nephrotoxicity, mainly represented by proteinuria. The aim of the study was to evaluate the prevalence of proteinuria in medullary thyroi...
Article
Vandetanib is an important option to treat advanced metastatic medullary thyroid cancer. The aims of this study were to evaluate the predictors of both a longer response to vandetanib and of their outcome. Medical records of 79 medullary thyroid cancer patients treated with vandetanib in our center were analysed. Twenty-five patients were treated f...
Article
Context The dramatic rise in the incidence of thyroid cancer over the last 30 years is largely attributable to the increasing diagnosis of papillary microcarcinomas (mPTCs). Current guidelines endorse an observational management approach in properly selected cases. Objective To evaluate the feasibility of active surveillance in mPTC in Italy, its...
Article
Objective: In intermediate risk DTC (IR-DTC) patients, selective use of radioiodine (131-I) for remnant ablation and/or as adjuvant therapy (RRA) is advocated. The recently suggested post-operative evaluation could delay the RRA. The aim of this study was to evaluate if a delayed RRA, can worsen the clinical outcome of IR-DTC patients. Patients and...
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Background: The tyrosine kinase inhibitors (TKIs) are indicated for the treatment of locally advanced or metastatic progressive thyroid carcinoma (CDT), refractory to radioactive iodine. The following report describes the efficacy of lenvatinib administered through a nose-gastric tube (SNG) in a patient affected with a poorly differentiated thyroi...
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Background: Pathogenic germline mutations affecting the RET proto-oncogene underlie the development of hereditary medullary thyroid carcinoma (MTC). The aims of this study were to evaluate the prevalence of germline RET mutations in a large series of MTC, collected over the last 25 years, and to reappraise their clinical significance. Methods: W...
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Sporadic Medullary Thyroid Carcinoma (sMTC) is a rare but aggressive thyroid tumor. RET and RAS genes are present in about 50%-80% of cases, but most of the remaining cases are still orphan of a genetic driver. We studied the largest series of sMTC by deep sequencing to define the mutational landscape. With this methodology we greatly reduced the n...
Article
Context The incidence of differentiated thyroid cancer (DTC) is increasing, yet the prognosis is favorable and long‐term survival is expected. Exogenous TSH suppression has been used for many years to prevent DTC recurrence and may be associated with increased risks of circulatory diseases. Design Risks of circulatory disease in patients treated f...
Article
Background Multiple Endocrine Neoplasia type 2B (MEN 2B) is a very rare syndrome characterized by a very peculiar phenotype with mucosal neuromas, marfanoid habitus and bumpy lips associated with medullary thyroid cancer (MTC) and pheocromocytoma (PHEO). Although the syndrome was first described 50 years ago, patients are still diagnosed too late w...
Article
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Background: Recently, there has been a trend to reduce the use of radioiodine remnant ablation (RRA) in patients with low-risk (LR) and intermediate-risk (IR) differentiated thyroid cancer (DTC). Objectives: The aim of this paper was to evaluate the diagnostic role of whole-body scan (ptWBS) performed after RRA in LR and IR DTC patients. Method...
Article
Medullary thyroid cancer (MTC) is rare but aggressive. It can be cured only if intrathyroid at diagnosis. MTC can be sporadic (75%) or familial (25%) and the 2 forms are distinguished by RET mutations analysis. Calcitonin is the specific serum marker; its doubling time is the most important prognostic factor for survival and progression; 30% of MTC...
Article
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Introduction: Papillary thyroid cancer (PTC) is the most common endocrine malignancy. More than 98% of patients achieve an excellent response with no evidence of clinical, biochemical, or structural disease after initial treatment. In these patients structural recurrence is rare, more frequently diagnosed in the first 5 years from initial treatment...
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Purpose To test whether the prognostic risk of male sex in papillary thyroid cancer (PTC) is determined by BRAF V600E and can thus be stratified by BRAF status. Patients and Methods We retrospectively investigated the relationship between male sex and clinicopathologic outcomes in PTC, particularly mortality, with respect to BRAF status in 2,638 p...
Article
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Anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC) are very aggressive cancers whose histological diagnosis is not always straightforward. Clinical, pathological and genetic features may be useful to improve the identification of these rare histotypes. In the present study the clinical, pathological and genetic features of two groups...
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Purpose and patients: The M.O.S.CA.TI. (Metastases of the Skeleton from CArcinoma of the ThyroId) is a multicenter, retrospective study investigating the real-life outcome and management of bone metastases (BM) in 143 patients (63 M, 80 F; median age 64 years, range 11-87) with differentiated thyroid carcinoma (DTC). Results: Radio-active iodine...
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Purpose For the past 65 years, patient age at diagnosis has been widely used as a major mortality risk factor in the risk stratification of papillary thyroid cancer (PTC), but whether this is generally applicable, particularly in patients with different BRAF genetic backgrounds, is unclear. The current study was designed to test whether patient age...
Article
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Background: Precise risk stratification-based treatment of solitary intrathyroidal papillary thyroid cancer (SI-PTC) that is larger than 1.0 cm and 4.0 cm or less is undefined. Methods: A genetic-clinical risk study was performed on BRAF V600E in 955 patients (768 women and 187 men) with SI-PTC, with median age of 46 years and median clinical fo...
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Background The diffuse sclerosing variant of papillary thyroid cancer (DSV-PTC) is a rare variant of papillary thyroid cancer (PTC) with different clinicopathological features compared to conventional PTC. Case an advanced DSV-PTC was diagnosed in a 39-year-old man. The radioiodine post-therapeutic whole-body-scan showed only an uptake in the cent...
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Context: Multifocality is often treated as a risk factor for papillary thyroid cancer (PTC), prompting aggressive treatments, but its prognostic value remains unestablished. Objective: To investigate the role of tumor multifocality in clinical outcomes of PTC. Methods: Multicenter study of the relationship between multifocality and clinical ou...
Article
The last ten years have been characterized by the introduction in the clinical practice of new drugs named tyrosine kinase inhibitors for the treatment of several human tumors. After the positive conclusion of two international multicentric, randomized phase III clinical trials, two of these drugs, sorafenib and lenvatinib, have been recently appro...
Article
Thyroid cancer typically has a good outcome following standard treatments, which include surgery, radioactive iodine ablation for differentiated tumours and treatment with thyrotropine hormone-suppressive levothyroxine. Thyroid cancers that persist or recur following these therapies have a poorer prognosis. Cytotoxic chemotherapy or external beam r...
Article
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Context: For many years, total thyroidectomy (TTx) and radioiodine remnant ablation (RRA) represented the initial treatment of differentiated thyroid cancer (DTC). There is currently much debate surrounding the clinical impact of RRA, particularly in low (LR) and intermediate (IR) risk DTC. Objective: To evaluate the role of postoperative High-S...
Article
Context: Yes-associated protein-1 (YAP-1) is a player of the Hippo pathway and is involved in regulating cell proliferation. YAP-1 is overexpressed in papillary and anaplastic thyroid cancers. However, a correlation between YAP-1 expression and outcome in thyroid carcinoma has not been conclusively demonstrated. Objective: This study was designe...
Article
Context: Approximately 40% of papillary thyroid carcinomas (PTC) harbor the BRAF V600E mutation, which is significantly associated with the advanced clinico-pathological features of PTC at diagnosis, higher recurrence rate and disease-related mortality. BRAF alterations other than V600E are less common in PTC, and their clinical significance remai...
Article
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Background: The RET proto-oncogene is responsible for the pathogenesis of hereditary (98%) and sporadic (40%) medullary thyroid carcinoma (MTC). In sporadic MTC, somatic RET mutations are associated with a poor prognosis. Objectives: We looked at the genetic profile of patients with advanced and metastatic MTC. The correlation between these muta...
Article
Thyroid cancer is rare, but it is the most frequent endocrine malignancy. Its prognosis is generally favorable, especially in cases of well-differentiated thyroid cancers (DTCs), such as papillary and follicular cancers, which have survival rates of approximately 95% at 40 years. However, 15-20% of cases became radioiodine refractory (RAI-R), and u...
Article
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Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data demonstrating differential risks of PTC variants to support. Objective: To establish the differential clinicopathological risk of major PTC variants-convention...
Article
Introduction: Until recently, no therapeutic options were available for the treatment of advanced medullary thyroid cancer (MTC). Cabozantinib (XL184) is a novel tyrosine kinase inhibitor (TKI) that inhibits several tyrosine kinase receptors, in particular those coded by MET, VEGFR-2 and RET oncogenes that are considered to be involved in the patho...
Conference Paper
Full-text available
Background: Serum thyroglobulin (Tg) and Thyroglobulin Antibodies (TgAb) assays are considered as the cornerstone for the post-operative management of patients with differentiated thyroid cancer (DTC) after the initial treatment. Less is known about the significance of this parameters in pts who do not perform radioiodine ablation (RRA) as in case...
Article
Full-text available
Background: The benefits of prophylactic central compartment lymph node dissection (pCCND) in papillary thyroid cancer (PTC) are still under investigation. This treatment seems to reduce PTC recurrence/mortality rates but has a higher risk of surgical complications. The lack of prospective randomized trials does not allow definitive recommendation...
Article
Medullary thyroid carcinoma (MTC) is a rare disease that can be inherited or sporadic; its pathogenesis is related to activating mutations in the RET gene. This study describes our 20 year experience regarding RET genetic screening in MTC. We performed RET genetic screening in 1556 subjects, 1007 with an apparently sporadic MTC, 95 with a familial...
Article
Full-text available
Purpose: To investigate the prognostic value of BRAF V600E mutation for the recurrence of papillary thyroid cancer (PTC). Patients and methods: This was a retrospective multicenter study of the relationship between BRAF V600E mutation and recurrence of PTC in 2,099 patients (1,615 women and 484 men), with a median age of 45 years (interquartile...
Article
Medullary thyroid carcinoma (MTC) originates from thyroid parafollicular C cells, and it accounts for 5% of thyroid malignancies. MTC is sporadic in approximately 80% and hereditary in 20% of cases. When hereditary it can be associated with other benign endocrine neoplasias and/or typical nonendocrine diseases, thus configuring the multiple endocri...
Article
Serum thyroglobulin (sTg) is the marker for monitoring persistence/recurrence of differentiated thyroid cancer, in patients without sTg antibodies. Patients with undetectable basal sTg or peak sTg <2 ng/mL are cured with low risk to recur. Newly detectable level of sTg indicates the recurrence. The significance of increasing sTg in patients treated...
Article
La maggior parte dei pazienti con carcinoma tiroideo guarisce con i trattamenti convenzionali (chirurgia e iodio radioattivo). Tuttavia, alcuni tumori tiroidei sono resistenti al radioiodio, perché perdono le caratteristiche della cellula follicolare da cui originano o perché originano dalle cellule C (carcinoma midollare della tiroide). Fino al 20...
Article
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Thyroid cancer is a malignant neoplasm that originates from follicular or parafollicular thyroid cells and is categorized as papillary (PTC), follicular (FTC), anaplastic (ATC) or medullary thyroid carcinoma (MTC). The alteration of the Rearranged during trasfection (RET) (proto-oncogene, a gene coding for a tyrosine-kinase receptor involved in the...
Article
L’ablazione con radioiodio (RRA) in pazienti con carcinoma differenziato della tiroide a rischio basso/intermedio è un argomento di acceso dibattito sia per l’attività di 131I che per la modalità di preparazione [ipotiroidismo vs eutiroidismo con TSH umano ricombinante (rhTSH)]. Recentemente è stato dimostrato che la percentuale ablativa era simile...