Recurrent Thyroid Cancer
Current Clinical Trials
Patients treated for differentiated thyroid cancer should be followed carefully
with physical examinations, serum quantitative thyroglobulin levels, and radiologic studies based
on individual risk for recurrent disease.[1] Approximately 10% to 30% of
patients thought to be disease-free after initial treatment will develop
recurrence and/or metastases. Of these patients, approximately 80% develop recurrence
with disease in the neck alone, and 20% develop recurrence with distant metastases. The most
common site of distant metastasis is the lung. In a single series of 289
patients who developed recurrences after initial surgery, 16% died of cancer at
a median time of 5 years following recurrence.[2]
The prognosis for patients
with clinically detectable recurrences is generally poor, regardless of cell
type.[3] Those patients who recur with local or regional tumor
detected only by I131 scan, however, have a better prognosis.[4] The selection of
further treatment depends on many factors, including cell type, uptake of
I131, prior treatment, site of recurrence, and individual patient
considerations. Surgery with or without I131 ablation can be useful in
controlling local recurrences, regional node metastases, or, occasionally,
metastases at other localized sites.[5] Approximately 50% of the patients
operated on for recurrent tumors can be rendered free of disease with a second
operation.[3] Local and regional recurrences detected by I131 scan and not
clinically apparent can be treated with I131 ablation and have an excellent
prognosis.[6]
Up to 25% of recurrences and metastases from well-differentiated thyroid cancer
may not show I131 uptake. For these patients, other imaging techniques shown
to be of value include imaging with thallium-201, magnetic resonance imaging,
and pentavalent dimercaptosuccinic acid.[7] When recurrent disease does not
concentrate I131, external-beam or intraoperative radiation therapy can be
useful in controlling symptoms related to local tumor recurrences.[8] Systemic
chemotherapy can be considered. Chemotherapy has been reported to produce
occasional objective responses, usually of short duration.[4,9]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent thyroid cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Ross DS: Long-term management of differentiated thyroid cancer. Endocrinol Metab Clin North Am 19 (3): 719-39, 1990.
[PUBMED Abstract]
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Mazzaferri EL, Jhiang SM: Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97 (5): 418-28, 1994.
[PUBMED Abstract]
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Goretzki PE, Simon D, Frilling A, et al.: Surgical reintervention for differentiated thyroid cancer. Br J Surg 80 (8): 1009-12, 1993.
[PUBMED Abstract]
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De Besi P, Busnardo B, Toso S, et al.: Combined chemotherapy with bleomycin, adriamycin, and platinum in advanced thyroid cancer. J Endocrinol Invest 14 (6): 475-80, 1991.
[PUBMED Abstract]
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Pak H, Gourgiotis L, Chang WI, et al.: Role of metastasectomy in the management of thyroid carcinoma: the NIH experience. J Surg Oncol 82 (1): 10-8, 2003.
[PUBMED Abstract]
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Coburn M, Teates D, Wanebo HJ: Recurrent thyroid cancer. Role of surgery versus radioactive iodine (I131) Ann Surg 219 (6): 587-93; discussion 593-5, 1994.
[PUBMED Abstract]
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Mallin WH, Elgazzar AH, Maxon HR 3rd: Imaging modalities in the follow-up of non-iodine avid thyroid carcinoma. Am J Otolaryngol 15 (6): 417-22, 1994 Nov-Dec.
[PUBMED Abstract]
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Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. Am J Surg 150 (4): 485-7, 1985.
[PUBMED Abstract]
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Shimaoka K, Schoenfeld DA, DeWys WD, et al.: A randomized trial of doxorubicin versus doxorubicin plus cisplatin in patients with advanced thyroid carcinoma. Cancer 56 (9): 2155-60, 1985.
[PUBMED Abstract]
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