Time-Varying Pattern of Mortality and Recurrence from Papillary Thyroid Cancer: Lessons from a Long-Term Follow-Up

Abstract Objective: The objective of the study was to determine the outcome of surgical resection of metastatic papillary thyroid cancer (PTC) in cervical lymph nodes after failure of initial surgery and I131 therapy. Design: This was a retrospective clinical study. Setting: The study was conducted at a university-based tertiary cancer hospital. Patients: A cohort of 95 consecutive patients with recurrent/persistent PTC in the neck underwent initial reoperation during 1999–2005. All had previous thyroidectomy (±nodal dissection) and I131 therapy. Twenty-five patients with antithyroglobulin (Tg) antibodies were subsequently excluded. Main Outcome Measures: Biochemical complete remission (BCR) was stringently defined as undetectable TSH-stimulated serum Tg. Results: A total of 107 lymphadenectomies were undertaken in these 70 patients through January 2010. BCR was initially achieved in 12 patients (17%). Of the 58 patients with detectable postoperative Tg, 28 had a second reoperation and BCR was achieved in five (18%), seven had a third reoperation, and none achieved BCR. No patient achieving BCR had a subsequent recurrence after a mean follow-up of 60 months (range 4–116 months). In addition, two more patients achieved BCR during long-term follow-up without further intervention. In total, 19 patients (27%) achieved BCR and 32 patients (46%) achieved a TSH-stimulated Tg less than 2.0 ng/ml. Patients who did not achieve BCR had significant reduction in Tg after the first (P < 0.001) and second (P = 0.008) operations. No patient developed detectable distant metastases or died from PTC. Conclusions: Surgical resection of persistent PTC in cervical lymph nodes achieves BCR, when most stringently defined, in 27% of patients, sometimes requiring several surgeries. No biochemical or clinical recurrences occurred during follow-up. In patients who do not achieve BCR, Tg levels were significantly reduced. The long-term durability and impact of this intervention will require further investigation.

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Long-Term Efficacy of Lymph Node Reoperation for Persistent Papillary Thyroid Cancer: 13-Year Follow-Up

Annals of Surgical Oncology ◽

10.1245/s10434-019-07263-5 ◽

2019 ◽

Vol 26 (6) ◽

pp. 1737-1743 ◽

Cited By ~ 1

Author(s):

Amblessed E. Onuma ◽

Eliza W. Beal ◽

Fadi Nabhan ◽

Tasha Hughes ◽

William B. Farrar ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Papillary Thyroid Cancer ◽

Papillary Thyroid ◽

Term Efficacy

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Excellent long-term control in locoregionally recurrent radioactive iodine-refractory papillary thyroid cancer with the addition of external beam radiation therapy to maximal surgical resection.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16035 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16035-e16035

Author(s):

William A. Wilson ◽

Joseph Valentino ◽

Thomas Gal ◽

David Sloan ◽

Kenneth B. Ain ◽

...

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Radioactive Iodine ◽

External Beam Radiotherapy ◽

External Beam ◽

Papillary Thyroid ◽

The Mean ◽

Grade Iii

e16035 Background: Locoregionally recurrent radioactive iodine (RAI) refractory papillary thyroid cancer represents a small percentage of papillary thyroid cancers but is an aggressive disease with significantly lower survival rates. This retrospective review is our experience with these cancers treated with maximal surgical resection followed by external beam radiotherapy. Methods: 26 patients treated from 2001-2011 were eligible for review. After obtaining IRB approval, medical records were reviewed for clinical outcome. All patients had histologically proven recurrences that were negative on I-131 scans. All patients were maximally resected. All patients received external radiotherapy to the thyroid bed, bilateral cervical lymph node levels II-IV, level VI, and superior mediastinal nodes. 15/26 patients received intensity modulated, 9/26 patients received 3-D conformal, and 2/26 patients received Tomotherapy radiation treatment. The mean dose was 5790 cGy (range 5280-6800 cGy). Results: All histologies were papillary thyroid cancer with 4/26 exhibiting tall cell features and 1/26 diffuse sclerosing features. All patients had locoregional relapse in the cervical nodes (16/26) or in the mediastinum (5/26) or both areas (5/26). The mean pre-treatment thyroglobulin was 5.2 (range <0.1 to 599.1). The mean post-treatment thyroglobulin was 1.0 (range <0.1-5.2). Median follow-up was 55 months (range 7-123 months). 0/26 patients failed locoregionally. 2/26 patients failed distantly (lungs). 20/26 patients (77%) of patients had undetectable thyroglobulin at last follow-up. 4/26 patients had detectable thyroglobulin (2.5-16.9), but had not recurred on imaging. 2/26 required PEG placement during treatment, but 0/26 patients were PEG-dependent on long-term follow-up. 1/26 patients experienced grade III osteoradionecrosis of the mandible. Conclusions: External beam radiotherapy provides excellent locoregional control for locoregionally recurrent radioactive iodine-refractory papillary thyroid cancers. Long-term grade III and IV toxicities are uncommon.

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Long-Term Efficacy of Lymph Node Reoperation for Persistent Papillary Thyroid Cancer: 10-Year Follow-Up

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.08.247 ◽

2016 ◽

Vol 223 (4) ◽

pp. e97

Author(s):

Eliza W. Beal ◽

William B. Farrar ◽

John E. Phay ◽

Matthew D. Ringel ◽

Richard T. Kloos ◽

...

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Papillary Thyroid Cancer ◽

Papillary Thyroid ◽

Term Efficacy

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Faculty Opinions recommendation of Long-term follow-up of patients with papillary and follicular thyroid cancer: a prospective study on 715 patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.9701956.10381054 ◽

2011 ◽

Author(s):

Sebastiano Filetti ◽

Cosimo Durante

Keyword(s):

Thyroid Cancer ◽

Prospective Study ◽

Follicular Thyroid Cancer ◽

Long Term Follow Up ◽

A Prospective Study

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Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

Endocrine ◽

10.1007/s12020-020-02418-x ◽

2020 ◽

Vol 70 (2) ◽

pp. 280-291

Author(s):

Alfredo Campennì ◽

Daniele Barbaro ◽

Marco Guzzo ◽

Francesca Capoccetti ◽

Luca Giovanella

Keyword(s):

Nuclear Medicine ◽

Thyroid Cancer ◽

Clinical Practice ◽

Molecular Imaging ◽

Routine Clinical Practice ◽

Whole Body ◽

Neck Ultrasound ◽

Long Term Follow Up

Abstract Purpose The standard of care for differentiated thyroid carcinoma (DTC) includes surgery, risk-adapted postoperative radioiodine therapy (RaIT), individualized thyroid hormone therapy, and follow-up for detection of patients with persistent or recurrent disease. In 2019, the nine Martinique Principles for managing thyroid cancer were developed by the American Thyroid Association, European Association of Nuclear Medicine, Society of Nuclear Medicine and Molecular Imaging, and European Thyroid Association. In this review, we present our clinical practice recommendations with regard to implementing these principles in the diagnosis, treatment, and long-term follow-up of patients with DTC. Methods A multidisciplinary panel of five thyroid cancer experts addressed the implementation of the Martinique Principles in routine clinical practice based on clinical experience and evidence from the literature. Results We provide a suggested approach for the assessment and diagnosis of DTC in routine clinical practice, including the use of neck ultrasound, measurement of serum thyroid-stimulating hormone and calcitonin, fine-needle aspiration, cytology, and molecular imaging. Recommendations for the use of surgery (lobectomy vs. total thyroidectomy) and postoperative RaIT are also provided. Long-term follow-up with neck ultrasound and measurement of serum anti-thyroglobulin antibody and basal/stimulated thyroglobulin is standard, with 123/131I radioiodine diagnostic whole-body scans and 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography suggested in selected patients. Management of metastatic DTC should involve a multidisciplinary team. Conclusions In routine clinical practice, the Martinique Principles should be implemented in order to optimize clinical management/outcomes of patients with DTC.

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