Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T03:52:41.847Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical management of medullary thyroid cancer: which guidelines should we follow?

Published online by Cambridge University Press:  21 May 2015

A Bowen ,
N Mani ,
S Penney ,
S Loughran  and
B Yap
A Bowen*
Affiliation:
Department of ENT, Central Manchester NHS Foundation Trust, Manchester, UK
N Mani
Affiliation:
Department of Head and Neck Oncology, The Christie NHS Foundation Trust, Manchester, UK
S Penney
Affiliation:
Department of ENT, Central Manchester NHS Foundation Trust, Manchester, UK
S Loughran
Affiliation:
Department of ENT, Central Manchester NHS Foundation Trust, Manchester, UK
B Yap
Affiliation:
Department of Head and Neck Oncology, The Christie NHS Foundation Trust, Manchester, UK
*
Address for correspondence: Mr A Bowen, 1-2 Bridge Cottages, Knowle, Devon EX9 6AW E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Surgery is currently the only curative treatment for medullary thyroid cancer. Unfortunately, the surgical strategy that will offer patients at each disease stage the best chance of a biochemical cure remains unclear. The American Thyroid Association and British Thyroid Association guidelines offer different strategies.

Methods:

A retrospective analysis of the surgical management of 47 patients with medullary thyroid cancer diagnosed between 1994 and 2013 was performed. Surgical management was compared with current American Thyroid Association and British Thyroid Association guidelines. Outcome was defined as the first post-operative calcitonin measurement.

Results:

All patients with stage I–III disease achieved a post-operative biochemical cure regardless of the guidelines followed. The overall biochemical cure rate for patients with stage IVa disease was significantly reduced to 10 per cent (p < 0.01), but the biochemical cure rate for stage IVa disease patients who underwent bilateral lateral lymph node dissection was 33.3 per cent.

Conclusion:

The conservative, surveillance-driven approach recommended by the American Thyroid Association is appropriate for stage I–III disease. However, the more aggressive approach advocated by the British Thyroid Association might provide stage IVa disease patients a greater chance of achieving a biochemical cure.

Keywords

Medullary Thyroid Cancer (MTC)SurgeryGuidelines
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 5 , May 2015 , pp. 478 - 483
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a podium talk at the 2nd World Congress on Thyroid Cancer, 10–14 July 2013, Toronto, Canada

References

1Harrison, B. Medullary thyroid cancer. In: Watkinson, JC, and Gilbert, RW, eds. Stell and Maran's Textbook of Head and Neck Surgery and Oncology, 5th edn.London: Hodder Arnold, 2012:453–73Google Scholar
2Aschebrook-Kilfoy, B, Ward, MH, Sabra, MM, Devesa, SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992–2006. Thyroid 2011;21:125–34CrossRefGoogle ScholarPubMed
3Sippel, RS, Kunnimalaiyan, M, Chen, H. Current management of medullary thyroid cancer. Oncologist 2008;13:539–47CrossRefGoogle ScholarPubMed
4Pacini, F, Castagna, MD, Cipri, C, Schlumberger, M. Medullary thyroid carcinoma. Clin Oncol (R Coll Radiol) 2010;6:475–85CrossRefGoogle Scholar
5Modigliani, E, Cohen, R, Campos, JM, Conte-Devolx, B, Maes, B, Boneu, A et al. Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d'etude des tumeurs a calcitonine. Clin Endocrinol (Oxf) 1998;48:265–73CrossRefGoogle Scholar
6American Thyroid Association Guidelines Task Force, Kloos, RT, Eng, C, Evans, DB, Francis, GL, Gagel, RF et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009;19:565–612CrossRefGoogle ScholarPubMed
7Guidelines for the management of thyroid cancer, 2007. British Thyroid Association. In: http://www.british-thyroid-association.org/Guidelines/ [30 June 2014]Google Scholar
8Moley, JF, Fialkowski, EA. Evidence-based approach to the management of sporadic medullary thyroid carcinoma. World J Surg 2007;31:946–56CrossRefGoogle Scholar
9Sobin, LH, Gospodarowicz, MK, Wittekind, C, eds. TNM Classification of Malignant Tumours, 7th edn.Washington: Wiley Blackwell, 2009:61Google Scholar
10Ukkat, J, Gimm, O, Brauckhoff, M, Bilkenroth, U, Dralle, H. Single center experience in primary surgery for medullary thyroid carcinoma. World J Surg 2004;28:1271–4CrossRefGoogle ScholarPubMed
11Panigrahi, B, Roman, SA, Sosa, JA. Medullary thyroid cancer: are practice patterns in the United States discordant from American Thyroid Association guidelines? Ann Surg Oncol 2010;17:1490–8CrossRefGoogle ScholarPubMed
12Dralle, H, Damm, I, Scheumann, GF, Kotzerke, J, Kupsch, E, Geerlings, H et al. Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Surg Today 1994;24:112–21CrossRefGoogle ScholarPubMed
13Ito, Y, Miyauchi, A, Yabuta, T, Fukushima, M, Inoue, H, Tomoda, C et al. Alternative strategies and favourable outcomes in patients with medullary thyroid cancer in Japan: Experience of a single institution. World J Surg 2009;33:58–66CrossRefGoogle ScholarPubMed
14Hamy, A, Pessaux, P, Mirallié, E, Mucci-Hennekinne, S, Gibelin, H, Mor-Martinez, C et al. Central neck dissection in the management of sporadic medullary thyroid microcarcinoma. Eur J Surg Oncol 2005;31:774–7CrossRefGoogle ScholarPubMed
15Franc, S, Niccoli-Sire, P, Cohen, R, Bardet, S, Maes, B, Murat, A et al. French Medullary Study Group (GETC). Complete surgical lymph node resection does not prevent authentic recurrences of medullary thyroid carcinoma. Clin Endocrinol (Oxf) 2001;55:403–9CrossRefGoogle Scholar
16Moley, JF, DeBenedetti, MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg 1999;229:880–7CrossRefGoogle ScholarPubMed
17Scollo, C, Baudin, E, Travagli, JP, Caillou, B, Bellon, N, Leboulleux, S et al. Rationale for central and bilateral lymph node dissection in sporadic and hereditary medullary thyroid cancer. J Clin Endocrinol Metab 2003;88:2070–5CrossRefGoogle ScholarPubMed
18Machens, A, Dralle, H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab 2010;95:2655–63CrossRefGoogle ScholarPubMed
19Kouvaraki, MA, Shapiro, SE, Fornage, BD, Edeiken-Monro, BS, Sherman, SI, Vassilopoulou-Sellin, R et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 2003;134:946–55CrossRefGoogle ScholarPubMed
20Chisholm, EJ, Kulinskaya, E, Tolley, NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared to thyroidectomy alone. Laryngoscope 2009;119:1135–9CrossRefGoogle ScholarPubMed
21White, ML, Gauger, PG, Doherty, GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg 2007;31:895–904CrossRefGoogle ScholarPubMed
22Gimm, O, Ukkat, J, Dralle, H. Determinative factors of biochemical cure after primary and reoperative surgery for sporadic medullary thyroid carcinoma. World J Surg 1998;22:562–8CrossRefGoogle ScholarPubMed
23Cohen, R, Campos, JM, Salaün, C, Heshmati, HM, Kraimps, JL, Proye, C et al. Preoperative calcitonin levels are predictive of tumour size and postoperative calcitonin normalization in medullary thyroid carcinoma. Groupe d'Etudes des Tumeurs à Calcitonine (GETC). J Clin Endocrinol Metab 2000;85:919–22CrossRefGoogle ScholarPubMed
24Yip, DT, Hassan, M, Pazaitou-Panayiotou, K, Ruan, DT, Gawande, AA, Gaz, RD et al. Preoperative basal calcitonin and tumour stage correlate with postoperative calcitonin normalization in patients undergoing initial surgical management of medullary thyroid carcinoma. Surgery 2011;150:1168–77CrossRefGoogle ScholarPubMed
25Machens, A, Dralle, H. Benefit-risk balance of reoperation for persistent medullary thyroid cancer. Ann Surg 2013;257:751–7CrossRefGoogle ScholarPubMed