Long-term follow-up of 92 patients with locally advanced follicular or papillary thyroid cancer after combined treatment.

Between 1960 and 1988, 92 patients with a locally advanced follicular or papillary thyroid cancer have been treated with surgery and radiotherapy consisting of iodine-131 or external (ext RT) radiotherapy or both. Locoregional control in patients less than 38 years of age at diagnosis and in older patients with a papillary cancer and a macroscopically complete resection was 100% with or without ext RT. Locoregional control in patients 38 years of age or older and without palpable postsurgical residual mass was 89% with ext RT and 60% without. In patients with a palpable residual mass, one of ten treated with iodine-131 alone had a permanent local control compared to six of 14 treated with addition of ext RT. Published data concerning iodine-131 and ext RT in the treatment of locally advanced follicular or papillary thyroid cancer are discussed. Routine surgery in our region consists of a near total thyroid resection, followed by iodine-131 ablation of the remnant thyroid. In younger patients with a limited T4 tumour and complete resection, we do not use ext RT. In all older patients with a T4 tumour as well as in younger patients with an extensive T4 tumour, ext RT is added.