L Lamartina1, Y Godbert2, C Nascimento3, C Do Cao4, S Hescot3, I Borget5, A Al Ghuzlan6, D Hartl7, J Hadoux8, E Pottier9, M Attard9, A Berdelou8, M Terroir8, E Baudin8, M Schlumberger8, S Leboulleux8. 1. Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. livia.lamartina@gustaveroussy.fr. 2. Département de Médecine Nucléaire, Institut Bergonié, 33076, Bordeaux, France. 3. Département de Médecine Nucléaire, Hôpital René Huguenin-Institut Curie, 92210, St Cloud, France. 4. Département d'Endocrinologie, CHRU de Lille, 5900, Lille, France. 5. Département de Biostatistique et épidémiologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. 6. Département de Biologie et pathologie médicales, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. 7. Département de Chirurgie Cervico-Faciale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. 8. Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France. 9. Département d'Imagerie médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
Abstract
PURPOSE: Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC. PATIENTS AND METHODS: A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed. RESULTS: The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52-91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3-4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity. CONCLUSIONS: Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.
PURPOSE: Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC. PATIENTS AND METHODS: A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed. RESULTS: The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52-91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3-4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity. CONCLUSIONS: Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.
Authors: Cesare Piazza; Davide Lancini; Michele Tomasoni; Anil D'Cruz; Dana M Hartl; Luiz P Kowalski; Gregory W Randolph; Alessandra Rinaldo; Jatin P Shah; Ashok R Shaha; Ricard Simo; Vincent Vander Poorten; Mark Zafereo; Alfio Ferlito Journal: Front Endocrinol (Lausanne) Date: 2021-11-11 Impact factor: 5.555
Authors: Hugh Andrew Jinwook Kim; Anthony Charles Nichols; Ramanamurthy Rachakonda; Richard Inculet; Jinka Sathya; Irina Rachinsky; Eric Winquist Journal: Cancer Rep (Hoboken) Date: 2022-06-17