José F Carrillo1, Jesús Manuel Flores2, Gilberto Espinoza3, Rafael Vázquez-Romo3, Margarita C Ramírez-Ortega4, Liliana C Carrillo5, Beatriz Y Cortés-García6, Francisco J Ochoa-Carrillo3, Luis F Oñate-Ocaña5. 1. Departamento de Cabeza y Cuello, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. 2. Departamento de Radioterapia, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. 3. Subdirección de Cirugía, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. 4. Direccion de Investigación, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico. 5. Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico. 6. Departamento de Imagen, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
Abstract
INTRODUCTION: In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS: This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS: Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION: EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
INTRODUCTION: In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. METHODS: This is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis. RESULTS: Thirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05-0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03-1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9-50) and EBRT dose (HR 1.05, 95% CI 1.01-1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01-0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1-28.6) and EBRT dose (HR 1.05, 95% CI 1.01-1.09) were independently associated to worse OS. CONCLUSION: EBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
Authors: Maisie L Shindo; Salvatore M Caruana; Emad Kandil; Judith C McCaffrey; Lisa A Orloff; John R Porterfield; Ashok Shaha; Jennifer Shin; David Terris; Gregory Randolph Journal: Head Neck Date: 2014-08-23 Impact factor: 3.147
Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568
Authors: Ana P Kiess; Nishant Agrawal; James D Brierley; Umamaheswar Duvvuri; Robert L Ferris; Eric Genden; Richard J Wong; R Michael Tuttle; Nancy Y Lee; Gregory W Randolph Journal: Head Neck Date: 2015-12-30 Impact factor: 3.147
Authors: Stephanie A Terezakis; Kyungmouk S Lee; Ronald A Ghossein; Michael Rivera; Robert M Tuttle; Suzanne L Wolden; Michael J Zelefsky; Richard J Wong; Snehal G Patel; David G Pfister; Ashok R Shaha; Nancy Y Lee Journal: Int J Radiat Oncol Biol Phys Date: 2009-03-01 Impact factor: 7.038