Treatment of thyroid cancer in 293 patients

Staunton, Marie; Greening, W P

doi:10.1002/bjs.1800630402

Cited by 47 publications

(19 citation statements)

References 18 publications

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“…Unfortunately, this approach led to low survival rates ranging from 30% to 50%. Using this approach, at least 50% of the patients relapsed within 5 years secondarily to disease outside of the irradiated fields or in distant sites [20][21][22]. This relapse lead to the use of multimodality therapy.…”

Section: Imaging and Stagingmentioning

confidence: 96%

Primary thyroid lymphomas

Widder¹,

Pasieka

2004

Curr. Treat. Options in Oncol.

151

107

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Primary thyroid lymphoma is a rare disease that continues to produce diagnostic and therapeutic dilemmas. There was great difficulty in distinguishing thyroid lymphoma from anaplastic thyroid carcinoma but, because of new immunocytochemical staining techniques and increased cytopathologic knowledge, our ability to diagnose thyroid lymphoma has improved drastically over the past decade. Surgery that was once the mainstay of treatment for this disease, now plays a minimal role. Current treatment regimens for primary thyroid lymphoma consist of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone) and external beam radiation. The overall and distant relapse rates have been shown to be significantly lower in those patients receiving combined modality therapy compared to chemotherapy or radiation alone. Although the role of surgery has changed over time, it continues to play an important role, especially in confirming diagnoses through open biopsies, potentially providing local control in the more indolent subtypes, and may play a role in the palliation of symptoms for large obstructive lymphomas. The evolving classification of extranodal lymphomas has brought about a better understanding of the biologic behavior of these tumors. Most thyroid lymphomas are B-cell origin, with six different histologic subtypes, but there appears to be two distinct clinical and prognostic groupings of these rare tumors. The more indolent lymphomas are the subgroup of mucosa-associated lymphoid tissue (MALT) lymphomas comprising approximately 6% to 27% of thyroid lymphomas. This subgroup, when localized to the thyroid (stage IE), responds well to total thyroidectomy or radiation with a complete response rate of more than 90%, leading some authors to recommend surgery as primary therapy in the treatment of localized MALT lymphomas. Therefore, surgery as a primary treatment for thyroid lymphomas would only be recommended under ideal conditions, such as MALT subtype stage IE only, and completely resectable with minimal morbidity. Unfortunately, this scenario is rarely the case. The more common subtype, comprising up to 70% of cases, is diffuse large B-cell lymphoma. This subtype appears to have the most aggressive clinical course with almost 60% of these tumors diagnosed with disseminated disease. Up to 40% of all diffuse large cell lymphomas appear to have undergone transformation from a MALT lymphoma, but they behave in a similar fashion to diffuse large cell lymphomas. Treatment for these tumors should include chemotherapy and radiation. The overall 5-year survival for this aggressive group is less then 50%. Surgery is rarely beneficial in diffuse large cell lymphoma and the mixed large cell subtypes because the disease is generally disseminated and surgical excision of all disease is not possible or associated with increased morbidity. However, there may be a role for palliative surgical debulking to alleviate obstructive symptoms while the patient is undergoing standard chemotherapy and radiation.

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Section: Imaging and Stagingmentioning

confidence: 96%

Primary thyroid lymphomas

Widder¹,

Pasieka

2004

Curr. Treat. Options in Oncol.

151

107

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“…A total of 535 patients with malignant neoplasms of the thyroid was treated at the Royal Marsden (formerly Royal Cancer) Hospital, London, between 1931 and1972. Past reports on this work are listed elsewhere (Staunton and Greening, 1976). We studied all the original case notes and transferred the relevant facts to a proforma.…”

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confidence: 99%

Thyroid cancer: Prognosis in 469 patients

Staunton

Skeet²

1979

Journal of British Surgery

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A computer study of 469patients with thyroid cancer is p.esented. There were 40 per cent anaplastic, 30 per cent papillary, 15 per cent follicular and 15 per cent rarer tumours. The 20-year survival was 7.5 per cent for anaplastic, 55 per cent for papillary and 35 per cent for follicular carcinoma. The ~o m i n a~~ role of histology in prognosis is confirmed.Other important factors are: all patients under 45 reap benefit; females survive longer than males with papillary and follicular tumours. Cervical node metastases confer no depression in papillary tumours. Local tumour advance depresses survival but facilitates diagnosis. We find merit in the T N M classification, but warn against overelaboration.We regret our failure to assess the differential eflect of individual treatment, which poses a continuing challenge to oncologists.ACCURACY in prognosis allows rational management of cancer. For common cancers, such as those of the lung or stomach, it required years of labour to achieve the present degree of knowledge of their behaviour. So much more difficult is it to reach the same level of knowledge about a rare cancer, such as that of the thyroid, with the added difficulty of its many variants. Thus, there is a need for reports on thyroid cancer from as many centres as possible, particularly from hospitals where relatively large numbers are treated and the patients are followed through life. Patients and methods

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“…1980). Accordingly, TSH suppression by thyroid hormones is used in the medical management of DTC to prevent tumour recurrence and to suppress tumour growth (Crile, 1966;Hill et al, 1974;Staunton & Greenings, 1976 Klee & Hay, 1987). L-Thyroxine is usually preferred to triiodothyronine for complete TSH suppression (Larsen, 1982) with mean suppressive daily doses ranging from 150 to 300 jtg (Hoffman, 1977; Lamberg et al, 1979; Edmonds et al.…”

Section: Discussionmentioning

confidence: 99%

TSH suppression by octreotide in differentiated thyroid carcinoma

Maini¹,

Sciuto²,

Tofani³

1994

Clinical Endocrinology

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OBJECTIVE This study evaluates the addition of octreotide and L-thyroxine to shorten the perlod of exposure to unduly elevated TSH levels in patients with differentiated thyroid carcinoma undergoing total body scan with '% DESIGN Fourteen thyroldectomized patients were studied after total body scan and the restarting of dlfferent doses of thyroxlne. After one year a second total body scan and a schedule of the same dose of thyroxine combined with octreotide were performed In each subject. PATIENTS Patients were divided into four groups according to the treatment seven patients recelved initlaily 100 pg of L-thyroxine (Group 1) and after 1 year 100 pg of L-thyroxine plus 300 pg of octreotidelday (Group 3): the other seven received lnitiaily 150 pg of L-thyroxine (Group 2) and then 150 pg of L-thyroxine plus 300 pg of octreotldel day (Group 4).MEASUREMENTS Serum TSH, T3 and T4 were measured on the day of radlolodine administration (day 0) and after 14,21,30,45,60 and 90 days.

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Treatment of thyroid cancer in 293 patients

Cited by 47 publications

References 18 publications

Primary thyroid lymphomas

Primary thyroid lymphomas

Thyroid cancer: Prognosis in 469 patients

TSH suppression by octreotide in differentiated thyroid carcinoma

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