Poorly differentiated thyroid carcinoma presenting with gross extrathyroidal extension: 1986-2009 Memorial Sloan-Kettering Cancer Center experience Journal Article

  

Authors:	Ibrahimpasic, T.; Ghossein, R.; Carlson, D. L.; Chernichenko, N.; Nixon, I.; Palmer, F. L.; Lee, N. Y.; Shaha, A. R.; Patel, S. G.; Tuttle, R. M.; Balm, A. J. M.; Shah, J. P.; Ganly, I.
Article Title:	Poorly differentiated thyroid carcinoma presenting with gross extrathyroidal extension: 1986-2009 Memorial Sloan-Kettering Cancer Center experience
Abstract:	Purpose: To describe the outcome of patients with poorly differentiated thyroid cancer (PDTC) presenting with gross extrathyroidal extension (ETE). Materials and Methods: After obtaining Institutional Review Board approval, we performed a retrospective review of a consecutive series of thyroid cancer patients treated by primary surgical resection with or without adjuvant therapy at Memorial Sloan-Kettering Cancer Center from 1986 to 2009. Out of 91 PDTC patients, 27 (30%) had gross ETE (T4a), and they formed the basis of our study. Of 27 patients, 52% were women. The median age was 70 years (range 27-87 years). Ten patients (37%) presented with distant metastases; four to bone, three to lung, and three to both bone and lung. All patients had extended total thyroidectomy, except two who had subtotal thyroidectomy. Twenty patients (74%) had central compartment neck dissection and 11 also had lateral neck dissection. Four patients had pN0, six (30%) pN1a, and 10 (50%) pN1b neck disease. Twenty-one patients (77%) had adjuvant therapy: 15 (55%) radioactive iodine (RAI) only, three (11%) postoperative external beam radiation (EBRT) only, and three (11%) had both RAI and EBRT. Overall survival (OS), disease-specific survival (DSS), local recurrence-free survival (LRFS), and regional recurrence-free survival (RRFS) were calculated by the Kaplan Meier method. Results: The median follow-up time was 57 months (range 1-197 months). The 5 year OS and DSS were 47% and 49%, respectively. This poor outcome was due to distant metastatic disease; 10 patients had distant metastases at presentation and a further six developed distant metastases during follow-up. Locoregional control was good with 5-year LRFS and RRFS of 70% and 62%, respectively. Overall, eight patients (30%) had recurrences: two had distant alone, two regional, two regional and distant, one local and distant, and one had local, regional, and distant recurrence. Conclusion: Aggressive surgery in patients with PDTC showing gross ETE resulted in satisfactory locoregional control. Due to the small proportion of patients who received EBRT (22%), it is not possible to analyze its benefit on locoregional control. Of significance is the observation that the majority of patients (60%) who presented with or subsequently developed distant metastases eventually died of distant disease. New systemic therapies to target distant metastatic disease are required for improvements in outcome. © Copyright 2013, Mary Ann Liebert, Inc. 2013.
Keywords:	adult; treatment outcome; aged; cancer surgery; major clinical study; overall survival; neck dissection; conference paper; adjuvant therapy; cancer patient; cancer staging; follow up; distant metastasis; cancer center; radioactive iodine; thyroidectomy; esophagus resection; external beam radiotherapy; disease specific survival; recurrence free survival; subtotal thyroidectomy; local recurrence free survival; poorly differentiated thyroid cancer; upper respiratory tract
Journal Title:	Thyroid
Volume:	23
Issue:	8
ISSN:	1050-7256
Publisher:	Mary Ann Liebert, Inc
Date Published:	2013-08-01
Start Page:	997
End Page:	1002
Language:	English
DOI:	10.1089/thy.2012.0403
PROVIDER:	scopus
PUBMED:	23311700
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84883105746&partnerID=40&md5=6a87882ee04d04804312a8b69e5a9ad6
Notes:	--- - "Export Date: 1 October 2013" - "CODEN: THYRE" - "Source: Scopus"

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