Locally unresectable differentiated thyroid cancer: outcomes and perspectives
- 8 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Endocrine
- Vol. 69 (1), 133-141
- https://doi.org/10.1007/s12020-020-02245-0
Abstract
Purpose Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC. Patients and methods A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed. Results The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52–91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3–4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity. Conclusions Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.This publication has 51 references indexed in Scilit:
- Vandetanib in locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 2 trialThe Lancet Oncology, 2012
- Do histological, immunohistochemical, and metabolic (radioiodine and fluorodeoxyglucose uptakes) patterns of metastatic thyroid cancer correlate with patient outcome?Endocrine-Related Cancer, 2010
- Efficacy of pazopanib in progressive, radioiodine-refractory, metastatic differentiated thyroid cancers: results of a phase 2 consortium studyThe Lancet Oncology, 2010
- The management of thyroid carcinoma invading the larynx or tracheaThe Laryngoscope, 2010
- Differentiated Thyroid Cancer with Extrathyroidal Extension: Prognosis and the Role of External Beam RadiotherapyJournal of Thyroid Research, 2010
- Phase II Study of Safety and Efficacy of Motesanib in Patients With Progressive or Symptomatic, Advanced or Metastatic Medullary Thyroid CancerJournal of Clinical Oncology, 2009
- Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer: Outcomes and Morbidity With Conformal TreatmentInternational Journal of Radiation Oncology*Biology*Physics, 2009
- New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)European Journal of Cancer, 2009
- Local and regional control in patients with papillary thyroid carcinoma: specific indications of external radiotherapy and radioactive iodine according to T and N categories in AJCC 6th editionEndocrine-Related Cancer, 2006