Journal List > J Korean Med Assoc > v.47(12) > 1080336

Chang: Treatment of Locally Advanced Thyroid Cancer

Abstract

Thyroid carcinoma is a slowly growing tumor and rarely invades adjacent tissues or organs. However, up to 21% of the patients with well-differentiated thyroid cancers show local invasion, and of those 10 to 15% of patients with papillary cancer who eventually die of the disease, active local disease has been the most common finding at the time of death. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngotracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled local invasion to vital organs in the neck causes significant morbidity, affects the quality of life, and finally influences the survival. In cases with limited involvement of the larynx or trachea, the option of treatment includes limited shaving-off resection or radical resection followed by reconstructive procedures. When operation is planned, the level of acceptable morbidity and the achievement of therapeutic outcomes should be determined in advance. In cases with aggressive invasion to the adjacent tissues, radical resection is the treatment modality of choice with favorable prognosis. Postoperative adjuvant therapies have been the matter of controversy, however, there is a general consensus, especially for the high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external radiation therapy in locally advanced thyroid cancers are unclear, however, it can be effective in patients with microscopic residual disease postoperatively. Radical eradication of locally advanced thyroid carcinoma followed by appropriate adjuvant therapy should be considered to be the treatment of choice in locally advanced thyroid cancers.

Figures and Tables

Figure 1
jkma-47-1168-g001
Figure 2
jkma-47-1168-g002
Figure 3
jkma-47-1168-g003
Figure 4
jkma-47-1168-g004
Figure 5
jkma-47-1168-g005
Figure 6
jkma-47-1168-g006

References

1. Tubiana M, Schlumberger M, Rougier P, Laplanche A, Benhamou E, Parmentier C, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer. 1985. 55:794–804.
crossref
2. Hirabayashi RN, Lindsay S. Carcinoma of the thyroid gland : a statistical study of 390 patients. J Clin Endocrinol Metab. 1961. 21:1596–1610.
3. McConahey WM, Hay ID, Woolner LB, van Heerden JA, Taylor WF. Papillary thyroid cancer treated at the Mayo Clinic, 1946 through 1970 : initial manifestations, pathologic findings, therapy, and outcome. Mayo Clin Proc. 1986. 61:978–996.
crossref
4. Grillo HC, Zannini P. Resectional management of airway invasion by thyroid carcinoma. Ann Thorac Surg. 1986. 42:287–298.
crossref
5. Park CS, Suh KW, Min JS. Cartilage-shaving procedure for the control of tracheal cartilage invasion by thyroid carcinoma. Head Neck. 1993. 15:289–291.
crossref
6. Ozaki O, Sugion K, Mimura T, Ito K. Surgery for patients with thyroid carcinoma invading the trachea : circumferential sleeve resection followed by end-to-end anastomosis. Surgery. 1995. 117:268–271.
crossref
7. Czaja JM, McCaffrey TV. The surgical management of laryngotracheal invasion by well-differentiated papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 1997. 123:484–490.
crossref
8. Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion : indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg. 1997. 114:84–92.
crossref
9. Cody HS III, Shah JP. Locally invasive, well differentiated thyroid cancer. 22 years' experience at Memorial Sloan-Kettering Cancer Center. Am J Surg. 1981. 142:480–483.
11. Machens A, Hinz R, Lautenschlager C, Thomusch O, Dralle H. Thyroid carcinoma invading the cervicoviceral axis : Route of invasion and clinical implications. Surgery. 2001. 129:23–28.
crossref
12. Grillo HC. Circumferential resection and resection of the mediastinal and cervical trachea. Ann Surg. 1965. 162:374–388.
crossref
13. Mulliken JB, Grillo HC. The limits of tracheal resection with primary anastomosis; further anastomosis studies in man. J Thorac Cardiovasc Surg. 1968. 55:418–421.
14. Liptom RJ, McCaffrey TV, van Heerden JA. Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma. Am J Surg. 1987. 154:363–367.
crossref
15. Tsumori T, Nakao K, Miyata M, Izukura M, Monden Y, Nakahara K, et al. Clinicopathologic study of thyroid carcinoma infiltrating the trachea. Cancer. 1985. 56:2843–2848.
crossref
16. Ishihara T, Kobayashi K, Kikuchi K, Kato R, Kawamura M, Ito K. Surgical treatment of advanced thyroid carcinoma invading the trachea. J Thorac Cardiovasc Surg. 1991. 102:717–720.
crossref
17. Gillenwater AM, Goepfert H. Surgical management of laryngotracheal and esophageal involvement by locally advanced thyroid cancer. Semin Surg Oncol. 1999. 16:19–29.
crossref
18. Kebebew E, Clark OH. Differentiated thyroid cancer : "complete" rational approach. World J Surg. 2000. 24:942–951.
19. Goretzki PE, Simon D, Frilling A, Witte J, Reiners C, Roher HD, et al. Surgical reintervention for differentiated thyroid carcinoma. Br J Surg. 1993. 80:1009.
20. McCaffrey TV, Bergstarlh EJ, Hay ID. Locally invasive papillary thyroid carcinoma : 1940-1990. Head Neck. 1994. 16:165. 172.
crossref
21. Kebebew E, Clark OH. Locally advanced differentiated thyroid cancer. Surg Oncol. 2003. 12:91–99.
crossref
22. Djalilian M, Beahrs OH, Devine KD, Weiland LH, DeSanto LW. Intraluminal involvement of the larynx and trachea by thyroid cancer. Am J Surg. 1974. 128:500–504.
crossref
23. Friedman M, Danielzadeh JA, Caldarelli DD. Treatment of patients with carcinoma of the thyroid invading the airway. Arch Otolaryngol Head Neck Surg. 1994. 120:1377–1381.
crossref
24. Fujimoto Y, Obara T, Ito Y, Kodama T, Yashiro T, Suzuki K, et al. Aggressive surgical approach for locally invasive papillary carcinoma of the thyroid in patients over forty-five years of age. Surgery. 1986. 100:1098–1107.
25. Grossman TW, Wilson JF, Toohill RJ. Delayed aerodigestive tract complications following combined therapy for thyroid cancer. Ann Otol Rhinol Laryngol. 1985. 94:505–508.
crossref
26. Talpos GB. Tracheal and laryngeal resections for differentiated thyroid cancer. Am Surg. 1999. 65:754–759.
27. Pak H, Gourgiotis L, Chang WI, Guthrie LC, Skarulis MC, Sarlis NJ, et al. Role of metastasectomy in the management of thyroid carcinoma : the NIH experience. J Surg Oncol. 2003. 82:10–18.
crossref
28. Hay ID, Feld S, Garcia M. AACE clinical practice guidelines for the management of thyroid carcinoma. Endocr Pract. 1997. 3:60.
29. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med. 1992. 93:359–362.
crossref
30. Mazzarotto R, Cesaro MG, Lora O, Rubello D, Casara D, Sotti G. The role of external beam radiotherapy in the management of differentiated thyroid cancer. Biomed Pharmacother. 2000. 54:345–349.
crossref
31. Lalak NJ, Campbell PR. Infiltrating papillary carcinoma of the thyroid with macroscopic extension into the internal jugular vein. Otolaryngol Head Neck Surg. 1997. 117:S228–S230.
crossref
32. Yamashita H, Noguchi S, Murakami N, Kawamoto H, Watanabe . Extracapsular invasion of lymph node metastasis is an indicator of distant metastasis and poor prognosis in patients with thyroid papillary carcinoma. Cancer. 1997. 80:2268–2272.
crossref
33. McCaffrey TV, Lipton RJ. Thyroid carcinoma invading the upper aerodigestive system. Laryngoscope. 1990. 100:824–830.
crossref
34. Nishida T, Nakao K, Hamaji M, Kamiike W, Kurozumi K, Matsuda H. Preservation of recurrent laryngeal nerve invaded by differentiated thyroid cancer. Ann Surg. 1997. 226:85–91.
crossref
35. Brierley JD, Sang RW. External-beam radiation therapy in the treatment of differentiated thyroid cancer. Semin Surg Oncol. 1999. 16:42–49.
crossref
36. Shin DH, Mark EJ, Suen HC, Grillo HC. Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea : a clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection. Hum Pathol. 1993. 24:866–870.
crossref
37. Friedman M. Surgical management of thyroid carcinoma with laryngotracheal invasion. Otolaryngol Clin North Am. 1990. 23:495–507.
crossref
38. Ballantyne AJ. Resections of the upper aerodigestive tract for locally invasive thyroid cancer. Am J Surg. 1994. 168:636–639.
crossref
39. Musholt TJ, Mushot PB, Behrend M, Raab R, Scheumann GFW, Klempnauer J. Invasive differentiated thyroid carcinoma : tracheal resection and reconstruction procedures in the hands of the endocrine surgeon. Surgery. 1999. 126:1078–1087.
crossref
40. Hopkins C, Stearns M, Watkinson AF. Palliative tracheal stenting in invasive papillary carcinoma. J Laryngol Otol. 2001. 115:935–937.
41. Melliere DJM, Yahia NEB, Becquemin JP, Lange F, Boulahdour H. Thyroid carcinoma with tracheal or esophageal involvement : Limited or maximal surgery? Surgery. 1993. 113:166–172.
42. Gardner RE, Tuttle RM, Burman KD, Haddady S, Truman C, Ringel MD, et al. Prognostic importance of vascular invasion in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2000. 126:309–312.
crossref
43. Niederle B, Hausmaninger C, Kretschmer G, Polterauer P, Neuhold N, Roka R, et al. Intraatrial extension of thyroid cancer : technique and results of a radical surgical approach. Surgery. 1990. 108:951–956.
44. Onaran Y, Terzioglu T, Oguz H, Kapran Y, Tezelman S. Great cervical vein invasion of thyroid carcinoma. Thyroid. 1998. 8:59–61.
crossref
45. Yousem DM, Hatabu H, Hurst RW, Seigerman HM, Montone KT, Kotapka MJ, et al. Carotid artery invasion by head and neck masses : Prediction with MR imaging. Radiology. 1995. 195:715–720.
crossref
46. Thompson NW, Brown J, Orringer M, Sisson J, Nishiyama R. Follicular carcinoma of the thyroid with massive angioinvasion : extension of tumor thrombus to the heart. Surgery. 1978. 83:451–457.
47. Perez D, Brown L. Follicular carcinoma of the thyroid appearing as an intraluminal superior vena cava tumor. Arch Surg. 1984. 119:323–326.
crossref
48. Breaux GP Jr, Guillamondegui OM. Treatment of locally invasive carcinoma of the thyroid : How radical? Am J Surg. 1980. 140:514–517.
49. Tsang RW, Brierley JD, Simpson WJ, Panzarella T, Gospodarowicz MK, Sutcliffe SB. The effects of surgery, radioiodine, and external radiation therapy on the clinical outcome of patients with differentiated thyroid carcinoma. Cancer. 1998. 82:375–388.
crossref
50. Phlips P, Hanzen C, Andry G, Van Houtte P, Fruuling J. Postoperative irradiation for thyroid cancer. Eur J Surg Oncol. 1993. 19:399–404.
51. Sarlis N. Metastatic thyroid cancer unresponsive to conventional therapies : novel management approaches through translational clinical research. Curr Drug Targets Immune Endocr Metabol Disord. 2001. 1:103–115.
crossref
TOOLS
Similar articles