PhD defence H.I. (Hannelore) Coerts

Below is a brief summary of the dissertation:

The dissertation ‘Risk-Adapted Individual Management of Thyroid Cancer: The New Paradigm of Selective Intensification’ investigates how the diagnosis and treatment of thyroid cancer can be more accurately tailored to the individual risk profile of the patient. Thyroid cancer encompasses a broad clinical spectrum, ranging from indolent, slow-growing tumors requiring minimal intervention, to aggressive malignancies for which intensive multimodal therapy is essential. The central premise is that treatment intensity should be commensurate with disease risk, and that de-escalation where oncologically justified leads to improved outcomes with reduced treatment-related morbidity.
The first part of the dissertation focuses on refining pre-operative risk stratification. Key areas of investigation include the comparative diagnostic value of novel imaging modalities for early and accurate detection of malignant thyroid disease, the appropriate clinical management of incidental thyroid findings on PET/CT imaging, and the applicability and calibration of the Bethesda classification system for thyroid cytopathology within the Dutch clinical context.
The second part evaluates personalized treatment strategies aimed at avoiding unnecessary intervention, encompassing the use of adjuvant radioactive iodine therapy, minimally invasive alternatives to surgery, and the optimization of care delivery within regional oncological networks.
Collectively, these findings provide the evidence base for a fundamental paradigm shift in thyroid oncology: moving away from uniform, maximal treatment toward a model of minimal intervention with selective escalation only when clinically warranted. Thyroid cancer thus emerges as a model for precision medicine in oncology.​​​​​​​​​​​​​​​​