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]

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

1. Ross DS: Long-term management of differentiated thyroid cancer. Endocrinol Metab Clin North Am 19 (3): 719-39, 1990.  [PUBMED Abstract]
   
   
2. 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]
   
   
3. Goretzki PE, Simon D, Frilling A, et al.: Surgical reintervention for differentiated thyroid cancer. Br J Surg 80 (8): 1009-12, 1993.  [PUBMED Abstract]
   
   
4. 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]
   
   
5. 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]
   
   
6. 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]
   
   
7. 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]
   
   
8. 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]
   
   
9. 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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