Recurrent Differentiated Thyroid Cancer: The Current Treatment Options

Abstract

Differentiated thyroid carcinomas (DTC) have an excellent prognosis, but this is sometimes overshadowed by tumor recurrences following initial treatment (approximately 15% of cases during follow-up), due to unrecognized disease extent at initial diagnosis or a more aggressive tumor biology, which are the usual risk factors. The possible sites of recurrence are local, regional, or distant. Local and regional recurrences can usually be successfully managed with surgery and radioiodine therapy, as are some isolated distant recurrences, such as bone metastases. If these treatments are not possible, other therapeutic options such as external beam radiation therapy or systemic treatments should be considered. Major advances in systemic treatments have led to improved progression-free survival in patients previously considered for palliative treatments; among these treatments, the most promising results have been achieved with tyrosine kinase inhibitors (TKI). This review attempts to give a comprehensive overview of the current treatment options suited for recurrences and the new treatments that are available in cases where salvage surgery is not possible or in cases resistant to radioiodine.

Ultrasound-guided approach to surgery for nodal recurrence following lateral neck dissection for differentiated thyroid carcinoma. A single institution experience

“…There are some alternative treatments to surgery, such as or limited lesions (less than 2 cm) that show RAI uptake, 131I can serve as an alternative treatment, or other treatments that have been used for cases of isolated metastasis include ethanol injection and US-guided percutaneous ablation (radiofrequency, laser, microwave, or cryotherapy), but surgery remains the first choice in all cases of resectable disease ( 11 , 12 ).…”

Research progress of plant-derived natural products in thyroid carcinoma

“…Patients with DTC without local progression and local/distant metastases can usually achieve better outcomes with surgery and radioactive iodine (RAI) therapy ( Liu et al, 2023 ). Nonetheless, the rates of structural recurrence (locoregional or distant metastases) in low-risk, intermediate-risk, and high-risk patients are 3%–13%, 21%–36%, and 68%, respectively, and patients are classified by the American Thyroid Association risk stratification criteria ( Coca-Pelaz et al, 2023 ).For patients with unresectable or metastatic DTC, RAI therapy is considered the primary therapeutic approach. Only one-third of patients achieve complete remission, and those outside of it become RAI refractory (RAIR) and have a poor overall prognosis, which is an unavoidable problem in the current medical management of the disease ( Jin et al, 2018 ).…”