Medullary thyroid carcinoma: results of a standardized surgical approach in a contemporary series of 80 consecutive patients☆
Section snippets
Methods
We reviewed the medical records of patients in our prospective database who underwent a prophylactic or therapeutic cervical operation for MTC in the Department of Surgical Oncology at The University of Texas M. D. Anderson Cancer Center between 1991 and 2002. All patients were divided into one of five groups according to the nature of their initial operation at M. D. Anderson: (1) initial surgery: therapeutic primary resection for invasive MTC in a patient with no prior history of cervical
Results
From May 1991 to December 2002, 92 patients underwent therapeutic (n = 75) or prophylactic (n = 17) cervical operations for sporadic or hereditary MTC (Table I). Five of the 17 patients who underwent prophylactic thyroidectomy were found to have invasive MTC and 12 had C-cell hyperplasia. Therefore, of the 80 patients with invasive MTC, 10 presented to M. D. Anderson with distant metastatic disease (M1) and the remaining 70 had disease confined to the neck (M0). The median follow-up interval from
Discussion
Our findings in the 92 patients referred for surgical treatment of biopsy-proven or presumed MTC suggest the following: (1) death from MTC is uncommon in the absence of radiographically evident distant metastases at the time of surgery (3/70, 4%); (2) the likelihood of cervical recurrence can be minimized with COS in patients with either primary or recurrent MTC (10/80, 13%); (3) postoperative CT levels can be used to guide clinical management; (4) basal CT levels cannot be used to direct the
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2014, Endocrinology and Metabolism Clinics of North AmericaCitation Excerpt :Situations, such as potential invasiveness into tracheoesophageal tissue, impending neurologic damage from brain metastases or spinal lesions, or pain from destructive bone lesions, necessitate radiotherapy. Although radiotherapy seems effective in preventing and controlling complications associated with MTC activity in the neck and mediastinum, there is no evidence that such therapy has an effect on improving survival.90,91 Radiofrequency ablation and transarterial chemoembolization of hepatic metastases have also been shown to have effectiveness in locoregional control.92
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Presented at the 24th Annual Meeting of the American Association of Endocrine Surgeons, San Diego, California, May 11-14, 2003.