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- Title
The long-term outcome of patients with locally advanced thyroid carcinoma
- Authors
Arora, Asit; Powles, James; Vini, Louise; Harmer, Clive; Rhys-Evans, Peter; Hodge, Kenneth M.; Breau, Randall; Vitti, Robert L.
- Abstract
Problem: To analyze the long-term outcome of patients with locally advanced (pT4) differentiated thyroid carcinoma.Methods: A 62-year retrospective analysis (1940–2002) of 1536 patients with differentiated thyroid carcinoma identified 312 patients with locally advanced tumor (pT4). Of those, 110 were male and 202 were female (ratio 1:1.8). Mean age was 52 years. Median follow-up was 64 months (range, 1–60 years).Results: There were 239 papillary, 60 follicular, and 13 Hurthle cell carcinomas. Of these, 65% were well differentiated and 20% poorly differentiated. One hundred and eighty-six patients (60%) had involved nodes; 97 (31%) were ipsilateral (N1a) and 89 (29%) were bilateral, midline, or mediastinal (N1b). Sixty-four distant metastatic sites were found in 56 patients (18%). Initial management included total/subtotal thyroidectomy in 195 cases, lobectomy/hemi-thyroidectomy in 63, and biopsy/enucleation in 49. Selective neck dissection was performed in 70 patients. Simple node excision occurred in 57 patients. Two hundred and eighteen patients received radio-iodine; 57 were given a single ablative dose and the rest received additional doses (median cumulative activity 8.5GBq, 0.8–45). Eighty-eight patients received external beam radiotherapy. Seventy-five patients developed loco-regional recurrence, which was managed by further surgery, radio-iodine, or external beam radiotherapy. Cause-specific survival at 5, 10, 20, and 30 years was 76%, 64%, 50%, and 50%, respectively. Age, tumor grade, distant metastases, and extent of surgery were independent prognostic factors for survival. Age, tumor grade, and histology were independent prognostic factors for loco-regional recurrence.Conclusion: Locally advanced differentiated thyroid carcinoma is associated with aggressive behavior and should be managed with total thyroidectomy and selective neck dissection followed by radioactive iodine. External beam radiotherapy should be considered in noniodine avid patients.Significance: This study identifies prognostic factors that affect the long-term outcome in pT4 thyroid cancer in terms of patient characteristics and extent of disease. Given the controversy surrounding both extent of surgery required and role of adjuvant therapy, optimal management is discussed.Support: None reported.
- Subjects
THYROID cancer; CANCER patients; TUMORS; CANCER
- Publication
Otolaryngology-Head & Neck Surgery, 2004, Vol 131, Issue 2, pP183
- ISSN
0194-5998
- Publication type
Abstract
- DOI
10.1016/j.otohns.2004.06.332