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S075 Aggressive Detection and Resection of Recurrent or Persistent I 131–Resistant Papillary Thyroid Cancer

S075 Aggressive Detection and Resection of Recurrent or Persistent I 131–Resistant Papillary... Objective: To determine the optimal detection and management of recurrent/persistent radioactive iodine–resistant papillary thyroid cancer (PTC) in the neck without distant metastases. Design: Retrospective clinical study with institutional review board approval. Median follow-up was 31 months. Setting: University-based tertiary cancer hospital. Patients: Between 1999 and 2005, 97 consecutive patients with recurrent/persistent PTC in the neck underwent exploration. Stimulated thyroglobulin (Tg) levels and high-resolution ultrasound were used to identify recurrent disease. All patients had previously undergone thyroidectomy (with or without lymph node dissection) and received radioactive iodine. Twenty-five patients with antithyroglobulin antibodies were excluded. Main Outcome Measures: Undetectable stimulated Tg was considered as biochemical cure. Results: Ninety-seven lymphadenectomies were undertaken in 72 patients. Median lymph node harvest was 9. Lymphadenectomy failed to identify PTC in 5 patients (7%). Biochemical cure was initially achieved in 13 patients (18%). Of the 54 patients with detectable postoperative Tg, 21 went on to reexploration, with biochemical cure being achieved in 4. In total, biochemical cure was achieved in 17 patients (24%). Patients in whom cure was not achieved after the first operation had significant reduction in Tg levels (P<.001). Of variables analyzed, only undetectable preoperative unstimulated Tg was predictive of biochemical cure (odds ratio, 3.9; 95% confidence interval, 1.09-14.28; P = .04). Hypocalcemia occurred in 2 patients (3%), while no patients suffered recurrent laryngeal nerve injury. Conclusions: Aggressive resection of detectable recurrent I 131–resistant PTC in the neck is feasible and safe. Biochemical cure is possible in almost one quarter of otherwise incurable patients. In those not cured, Tg levels were significantly reduced. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

S075 Aggressive Detection and Resection of Recurrent or Persistent I 131–Resistant Papillary Thyroid Cancer

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S075 Aggressive Detection and Resection of Recurrent or Persistent I 131–Resistant Papillary Thyroid Cancer

Abstract

Objective: To determine the optimal detection and management of recurrent/persistent radioactive iodine–resistant papillary thyroid cancer (PTC) in the neck without distant metastases. Design: Retrospective clinical study with institutional review board approval. Median follow-up was 31 months. Setting: University-based tertiary cancer hospital. Patients: Between 1999 and 2005, 97 consecutive patients with recurrent/persistent PTC in the neck underwent exploration. Stimulated...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.132.8.855-b
Publisher site
See Article on Publisher Site

Abstract

Objective: To determine the optimal detection and management of recurrent/persistent radioactive iodine–resistant papillary thyroid cancer (PTC) in the neck without distant metastases. Design: Retrospective clinical study with institutional review board approval. Median follow-up was 31 months. Setting: University-based tertiary cancer hospital. Patients: Between 1999 and 2005, 97 consecutive patients with recurrent/persistent PTC in the neck underwent exploration. Stimulated thyroglobulin (Tg) levels and high-resolution ultrasound were used to identify recurrent disease. All patients had previously undergone thyroidectomy (with or without lymph node dissection) and received radioactive iodine. Twenty-five patients with antithyroglobulin antibodies were excluded. Main Outcome Measures: Undetectable stimulated Tg was considered as biochemical cure. Results: Ninety-seven lymphadenectomies were undertaken in 72 patients. Median lymph node harvest was 9. Lymphadenectomy failed to identify PTC in 5 patients (7%). Biochemical cure was initially achieved in 13 patients (18%). Of the 54 patients with detectable postoperative Tg, 21 went on to reexploration, with biochemical cure being achieved in 4. In total, biochemical cure was achieved in 17 patients (24%). Patients in whom cure was not achieved after the first operation had significant reduction in Tg levels (P<.001). Of variables analyzed, only undetectable preoperative unstimulated Tg was predictive of biochemical cure (odds ratio, 3.9; 95% confidence interval, 1.09-14.28; P = .04). Hypocalcemia occurred in 2 patients (3%), while no patients suffered recurrent laryngeal nerve injury. Conclusions: Aggressive resection of detectable recurrent I 131–resistant PTC in the neck is feasible and safe. Biochemical cure is possible in almost one quarter of otherwise incurable patients. In those not cured, Tg levels were significantly reduced.

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Aug 1, 2006

Keywords: thyroid carcinoma, papillary

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