Article
Treatment of Locally Invasive Thyroid Cancer
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Published: | March 20, 2006 |
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Outline
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Introduction: Prognosis in differentiated thyroid cancer is fairly good. However, this is not true for locally advanced cancers. Radical surgery may not be achieved and patients die from local complications. In a retrospective study we try to establish therapeutic guidelines by defining risk groups.
Patients and Methods: 96 patients with locally advanced tumors underwent surgery with curative intent. Surgical procedures were classified into: curative shaving resections (defined as R0, R1), incomplete shaving resections (defined as R2), resection of exclusive muscle infiltration and major visceral resections.
Results: Overall survival was 53% in papillary thyroid cancer compared to 35% in follicular thyroid cancer (p=0,001). In case of organ invasion, prolonged survival was only seen after radical resection (defined as R0 or R1 resection). Radioiodine treatment increased survival in patients with papillary thyroid cancer after nonradical resection.
Conclusion: Resections with gross residual disease were associated with poor outcome. Therefore massive invasion demands complete cervicovisceral resection, whenever possible. For only superficial invasion, shaving resections of the larynx or trachea are recommended because of lower morbidity and similar survival rates compared to en bloc resections.