Application of multidisciplinary treatment of advanced thyroid malignancy with respiratory obstruction

Abstract

Objective To explore the application of multidisciplinary treatment (MDT) mode in the treatment of local advanced thyroid cancer with respiratory obstruction. Methods The clinical data of thirty-one cases with locally advanced thyroid cancer were retrospectively analyzed from Sichuan Cancer Hospital & Institute during October 2015 to July 2017, 13 of whom were accompanied by obvious respiratory tract obstruction symptoms. Preoperative bronchoscopy and CT examination showed clear diagnosis of tracheal tumor invasion and severe stenosis, with 9 cases of surgery and 4 cases of non-surgical treatment under MDT mode. Results There were 7 cases of papillary carcinoma, 1 case of papillary squamous carcinoma, 3 cases of low differentiation, 1 case of undifferentiated carcinoma, and 1 case of thyroid lymphoma. According to a 2017 AJCC version 8 clinical oncology, 4 cases were clinical stage Ⅲ, 7 cases stage Ⅳa, 1 case stage Ⅳb, 1 case stage Ⅳ. Dyspnea improved obviously after emergency tracheal stent implantation. 9 patients complete the surgery before deadline, 8 of whom underwent thyroid carcinoma combined radical prostatectomy and tracheal sleeve shape stage I tracheal reconstruction, and 1 underwent thyroid carcinoma combined radical neck and throat, section and part of the thoracic trachea, trachea-slow colostomy. Except 1 case died of cardiopulmonary failure on the 7th day after surgery, the other 7 cases of tracheal resection I - end anastomosis of the reconstructive patients were all healed with no tracheal fistula. The tracheal - steroid hilt was discharged 15 days after surgery, and all patients were treated with 131- iodine therapy and TSH inhibition. The follow-up time was 4 to 22 months, with no tumor survival. 4 cases underwent non-surgical treatment, 2 of local radiotherapy in the later period, and the survival period was 1 year and 9 months respectively; 1 case of chemotherapy for thyroid lymphoma; 1 case of undifferentiated carcinoma was treated with only palliative care, and the survival period was 3 months. Conclusions The airway obstruction caused by the trachea is a direct threat to patients, while MDT and the formulation of the individualized diagnosis and treatment scheme have significant advantages. For patients who need surgical treatment, MDT mode can significantly reduce perioperative risks and improve survival rates. For patients with no surgical indications, MDT can assess the condition in detail, and develop a reasonable treatment plan to provide the opportunity to prolong the life of patients. Key words: Multidisciplinary diagnosis and treatment; Thyroid neoplsams; Respiratory obstruction; Stents; Tracheal neoplsams; Surgery