Radioiodine Refractory Follicular Thyroid Cancer and Surgery for Cervical Relapse

Abstract

Compared to its more common counterpart papillary thyroid cancer (PTC), follicular thyroid cancer (FTC) has a less favorable outcome, due to its higher incidence of distant metastases and advanced stages at diagnosis. Despite radioiodine (RAI) avidity, metastatic FTC often progresses after radioiodine treatment (RAIT). We aimed at evaluating the indications and outcomes of surgery for cervical relapse of radioiodine refractory FTC. Patients receiving RAIT between 2005 and 2015 at the University Hospital of Cologne, Germany, were screened. Patients with FTC were identified. Demographics, clinic-pathologic characteristics, treatment, and outcome of patients diagnosed with RAI refractory FTC, who underwent cervical surgery in the course of disease, were analyzed. FTC accounted for 8.8% of all thyroid carcinomas undergoing RAIT. In 35.2% of FTC patients, disease persisted or recurred despite a cumulative mean RAI activity of 18.7 GBq ± 11.6 (follow-up 83.5 ± 56.7 months). Distant metastases were diagnosed in 75% of these patients, as bone (57.6%), lung (54.6%), and liver metastases (12.1%). Cervical relapse occurred in 63.6% of these patients and was treated in 57.1% with surgery with, and without, external beam radiation therapy (EBRT). Despite surgery and EBRT, in 75% of patients, cervical relapse recurred again. In conclusion, surgery for cervical radioiodine refractory FTC relapse is often performed in metastatic setting. With and without EBRT, cure is rare, although metastases can appear radioiodine avid. Early biological marker and systemic treatments for these patients are still needed.

Hürthle Cell Carcinoma: Single Center Analysis and Considerations for Surgical Management Based on the Recent Literature

“…In the present study, the clinic-pathologic features and clinical course of 51 patients treated at our institution in a period of 15 years were analyzed. Despite initial surgery and radioiodine treatment, recurrence rate was as high as 23.5%, which is similar to that previously reported in our patients with follicular thyroid cancer ( 21 ) but higher than that reported in some recent literature ( 1 , 2 ). The reasons underlying these differences are unclear and might be of demographic, ethnic or environmental nature.…”

Updates in Thyroid Cancer Surgery

“…Extensive research is ongoing to identify specific biomarkers [ 11 ], genetic alterations [ 12 , 13 , 14 , 15 ] or risk factors [ 16 , 17 ] that can predict disease behavior, underpin cancer development and progression, or aid in prevention and treatment [ 1 ]. For example, surgery represents the only option for the treatment of non-responsive radioiodine cancers and avoids or delays the onset of local complications, although in most cases it is not possible to achieve either cure or local clearance; in fact, there is still a lack of early biological markers and systemic treatments that allow for the safe and definitive treatment of these patients [ 18 ].…”