Role of metastasectomy in the management of thyroid carcinoma: The NIH experience

• Published in: Journal of surgical oncology Vol. 82; no. 1; pp. 10 - 18
• Main Authors: Pak, Ho, Gourgiotis, Loukas, Chang, Wen-I, Guthrie, Lori C., Skarulis, Monica C., Reynolds, James C., Merino, Maria J., Schrump, David S., Libutti, Steven K., Alexander Jr, H. Richard, Sarlis, Nicholas J.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.01.2003; Wiley-Liss
• Subjects: Adenocarcinoma, Follicular - secondary; Adenocarcinoma, Follicular - surgery; Adolescent; Adult; Aged; Biological and medical sciences; Carcinoma, Papillary - secondary; Carcinoma, Papillary - surgery; Combined Modality Therapy; Endocrinopathies; Female; Follow-Up Studies; Humans; Iodine Radioisotopes - therapeutic use; Male; Malignant tumors; Medical sciences; metastasis; Middle Aged; multimodality therapy; National Institutes of Health (U.S.); Neoplasm Metastasis - therapy; resection; Retrospective Studies; surgery; survival; Survival Analysis; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroid. Thyroid axis (diseases); Treatment Outcome; United States; United States; Endocrinopathy; Human; Kaplan Meier estimator; Relapse; Prognosis; Space occupying lesion; Treatment efficiency; Thyroid diseases; Stage classification; survival; Surgical resection; Thyroid gland; Case control study; Metastasis; Malignant tumor; resection; Retrospective; Cohort study; multimodality therapy; Survival curve; surgery
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.10189

Background and Objectives We studied the impact of metatasectomy on disease outcome in 29 advanced nonmedullary thyroid carcinoma (ThyrCa) patients who were operated on between 1969 and 2001 at NIH to further define its role in the management of this malignancy. Methods Data were extracted by retrospective chart review. A Kaplan‐Meyer survival curve was constructed, and comparative stratification for various parameters was performed. Results During 47 surgeries, the following lesions were resected from mid‐mediastinum/hila, 17; lung parenchyma, 12; skeleton, 14; kidneys, 2; and brain, 2. All patients received multiple radioiodine (RAI) treatments. External‐beam radiotherapy, chemotherapy and other palliative measures were used in selected patients. Six patients (21%) died within 74.7 ± 54.7 months after the first distant metastasectomy. The outcome of the remaining patients was as follows: complete remission, 3; partial remission, 10; and 10: progressive disease, 10, with a follow‐up of 175 patient‐years. Metastasectomy led to a decrease of 38% in thyroglobulin levels in 23 patients. Cumulative survival rates were 78.5 ± 8.4% at 5 years and 50.2 ± 12.5% at 10 years (mean ±SEM) after initial distant metastasectomy. Conclusions Our data show that extensive targeted metastasectomy in the setting of a tertiary center can be beneficial to patients with disseminated ThyrCa with persistent or recurrent distant disease, when used in conjunction with nonsurgical treatment modalities. J. Surg. Oncol. 2003;82:10–18. © 2002 Wiley‐Liss, Inc.