Surgical management of patients with persistent or recurrent medullary thyroid cancer

Abstract

Residual or recurrent medullary thyroid carcinoma (MTC), manifested by elevated calcitonin levels, occurs commonly following primary treatment of MTC. Re-operation in appropriately selected patients is the only treatment modality which consistently and reliably reduces stimulated calcitonin levels, and results in excellent local disease control. We report improved results of surgical management of recurrent MTC in two consecutive series of patients. In our most recent series (1992-96), 38% of patients (17 out of 45) had normal postoperative stimulated calcitonin levels, compared to 28% (nine of 32) in our first series (1990-92). In the most recent series, only 13% (six of 45) of patients had no decrease in calcitonin levels following re-operation, compared to 31% (10 of 32) in our first series (P = 0.07, Fisher's exact test). This improvement has mainly occurred through better preoperative selection of patients, and the institution of routine laparoscopic liver examination preoperatively, which identified metastases in 10 patients, nine of whom had normal CT or MRI imaging.

Long-term outcome of medullary thyroid carcinoma in patients with normal postoperative medical imaging

“…Selective venous sampling catheterisation with plasma CT measurements appears to be the most sensitive and specific method for localising persistent disease. However, even after further surgery based on the results of venous sampling, 62 -98% of the patients still have elevated CT levels (Frank- Raue et al, 1992;Abdelmoumene et al, 1994;Moley et al, 1998;Kebebew et al, 2000b).…”

Cáncer medular de tiroides metastásico a la cavidad oral: caso clínico

“…Se expresa en células derivadas de la cresta neural: células C, paratiroides, células cromafines de la médula adrenal, plexo autonó-mico entérico y tracto urogenital 3 . Los CMT normalmente producen CT y antígeno carcinoembrionario (ACE), que se pueden medir con pruebas de sangre 12 . La CT es un péptido de 32 aminoácidos, codificado en el cromosoma 11.…”

“…Uno de estos fármacos es el vandetanib (Caprelsa), el cual ha sido aprobado por la Food and Drug Administration (FDA) de EE.UU. para pacientes seleccionados con CMT 12 .…”

“…Tiene la característica de secretar CT, un marcador útil para el estadiaje, la enfermedad residual y el seguimiento de los pacientes a largo plazo. Es una neoplasia relativamente agresiva, ya que, a pesar de su lenta progresión, en el momento del diagnóstico el 60-80% tienen metástasis linfáticas [8][9][10][11][12] , lo que dificulta una terapia totalmente curativa, ya que se ha visto que después de la primera cirugía más del 50% de los pacientes mantienen niveles de CT elevados 2 . Los pacientes con la forma hereditaria tienden a ser más jóve-nes y a presentar una enfermedad de curso más agresivo, con un cáncer que suele ser multifocal y bilateral 2 .…”

In Vitro and In Vivo Activity of Cabozantinib (XL184), an Inhibitor of RET, MET, and VEGFR2, in a Model of Medullary Thyroid Cancer

“…MTC occurs either sporadically (75% of cases) or via heritable germline mutations (25% of cases), exemplified by the inherited syndromes multiple endocrine neoplasia (MEN) syndromes MEN2A, MEN2B, and familial MTC (8,9) As MTC is generally unresponsive to standard chemotherapy and radiotherapy (10), nearly all MTC patients are treated with surgery, typically involving total thyroidectomy and extensive lymph-node dissection (8). However, most patients with sporadic MTC present with metastatic disease, and fewer than half are candidates for curative surgery (11,12). The Exelixis, Inc., South San Francisco, California.…”