Stage I and II Papillary and Follicular Thyroid Cancer
Current Clinical Trials
Surgery is the therapy of choice for all primary lesions. Surgical options
include total thyroidectomy or lobectomy. The choice of procedure is
influenced mainly by the age of the patient and the size of the nodule.
Survival results may be similar; the difference between them lies in the rates
of surgical complications and local recurrences.[1-7]
Standard treatment options:
-
Total thyroidectomy: This procedure is advocated because of the high
incidence of multicentric involvement of both lobes of the gland and the
possibility of dedifferentiation of any residual tumor to the anaplastic cell
type. The procedure is associated with a higher incidence of
hypoparathyroidism, but this complication may be reduced when a small amount of
tissue remains on the contralateral side. This approach facilitates follow-up
thyroid scanning.
I131: Studies have shown that a postoperative course of therapeutic
(ablative) doses of I131 results in a decreased recurrence rate among high-risk patients with papillary
and follicular carcinomas.[4] It may be given in addition to exogenous thyroid
hormone but is not considered routine.[8] Patients presenting with papillary
thyroid microcarcinomas (tumors <10 mm) have an excellent prognosis when
treated surgically, and additional therapy with I131 would not be expected to
improve the prognosis.[9]
-
Lobectomy: This procedure is associated with a lower incidence of
complications, but approximately 5% to 10% of patients will have a recurrence
in the thyroid following lobectomy.[10] Patients younger than 45 years will have the longest follow-up period and the greatest opportunity for
recurrence. Follicular thyroid cancer commonly metastasizes to lungs and bone; with a remnant lobe in place, use of I131 as ablative therapy is compromised. Abnormal regional lymph nodes should be biopsied at the time of
surgery. Recognized nodal involvement should be removed at initial surgery, but
selective node removal can be performed, and radical neck dissection is usually not
required.
This
results in a decreased recurrence rate, but has not been shown to improve
survival.
Following the surgical procedure, patients should receive postoperative
treatment with exogenous thyroid hormone in doses sufficient to suppress
thyroid-stimulating hormone (TSH); studies have shown a decreased incidence of
recurrence when TSH is suppressed.
I131: Studies have shown that a postoperative course of therapeutic
(ablative) doses of I131 results in a decreased recurrence rate among high-risk patients with papillary
and follicular carcinomas.[4] It may be given in addition to exogenous thyroid
hormone but is not considered routine.[8] Patients presenting with papillary
thyroid microcarcinomas (tumors <10 mm) have an excellent prognosis when
treated surgically, and additional therapy with I131 would not be expected to
improve the prognosis.[9]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I papillary thyroid cancer, stage I follicular thyroid cancer, stage II papillary thyroid cancer and stage II follicular 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
-
Carling T, Udelsman R: Thyroid tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1502-19.
-
Grant CS, Hay ID, Gough IR, et al.: Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery 104 (6): 954-62, 1988.
[PUBMED Abstract]
-
Cady B, Rossi R: An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 104 (6): 947-53, 1988.
[PUBMED Abstract]
-
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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Staunton MD: Thyroid cancer: a multivariate analysis on influence of treatment on long-term survival. Eur J Surg Oncol 20 (6): 613-21, 1994.
[PUBMED Abstract]
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Tollefsen HR, Shah JP, Huvos AG: Follicular carcinoma of the thyroid. Am J Surg 126 (4): 523-8, 1973.
[PUBMED Abstract]
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Edis AJ: Surgical treatment for thyroid cancer. Surg Clin North Am 57 (3): 533-42, 1977.
[PUBMED Abstract]
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Beierwaltes WH, Rabbani R, Dmuchowski C, et al.: An analysis of "ablation of thyroid remnants" with I-131 in 511 patients from 1947-1984: experience at University of Michigan. J Nucl Med 25 (12): 1287-93, 1984.
[PUBMED Abstract]
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Hay ID, Grant CS, van Heerden JA, et al.: Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112 (6): 1139-46; discussion 1146-7, 1992.
[PUBMED Abstract]
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Hay ID, Grant CS, Bergstralh EJ, et al.: Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124 (6): 958-64; discussion 964-6, 1998.
[PUBMED Abstract]
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