BACKGROUND: Controversy persists regarding the role of surgery in the treatment of stage IE non-Hodgkin's lymphoma of the thyroid. Treatment options vary from complete surgical resection only to needle biopsy as the only invasive procedure required. METHODS: During a 29-year period 15 patients with stage IE non-Hodgkin's lymphoma were treated, with complete follow-up available in all patients. All patients had surgical exploration, followed in most cases by radiation therapy and/or chemotherapy. RESULTS: After operation six patients exhibited no gross residual tumor, all with intrathyroid disease, and all remained disease free; five of nine patients with residual disease, all with extrathyroid lesions, had persistent or recurrent disease (p < 0.04). Among patients with residual disease after operation five of six receiving postoperative radiation therapy exclusively have died of or had recurrence of disease, whereas no further persistent or recurrent disease occurred in the three patients who received adjuvant chemotherapy (p < 0.02). CONCLUSIONS: Surgery permitted the distinction between intrathyroid tumor, which may be treatable by local therapy alone, and extrathyroid lesions, which appear to require systemic chemotherapy. Surgery provides not only the same diagnostic ability as needle biopsy but also important therapeutic implications regarding adjuvant therapy.
BACKGROUND: Controversy persists regarding the role of surgery in the treatment of stage IE non-Hodgkin's lymphoma of the thyroid. Treatment options vary from complete surgical resection only to needle biopsy as the only invasive procedure required. METHODS: During a 29-year period 15 patients with stage IE non-Hodgkin's lymphoma were treated, with complete follow-up available in all patients. All patients had surgical exploration, followed in most cases by radiation therapy and/or chemotherapy. RESULTS: After operation six patients exhibited no gross residual tumor, all with intrathyroid disease, and all remained disease free; five of nine patients with residual disease, all with extrathyroid lesions, had persistent or recurrent disease (p < 0.04). Among patients with residual disease after operation five of six receiving postoperative radiation therapy exclusively have died of or had recurrence of disease, whereas no further persistent or recurrent disease occurred in the three patients who received adjuvant chemotherapy (p < 0.02). CONCLUSIONS: Surgery permitted the distinction between intrathyroid tumor, which may be treatable by local therapy alone, and extrathyroid lesions, which appear to require systemic chemotherapy. Surgery provides not only the same diagnostic ability as needle biopsy but also important therapeutic implications regarding adjuvant therapy.
Authors: Pragya Shrestha; Kimberly Aderhold; Sharon Swierczynski; Catherine Lin; Ronald Herb Journal: J Community Hosp Intern Med Perspect Date: 2018-02-06