Abstract
IntroductionIn patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC.MethodsThis is a cohort study of patients with initially unresectable DTC who received EBRT. Cohort A received EBRT followed by rescue surgery and cohort B, EBRT only. The Kaplan-Meier method and Cox model were employed for survival analysis.ResultsThirty-three patients were included; 69.6% females and 30.3% males. Mean age was 60.6 and mean tumor diameter was 10.4 cm; 17 and 16 patients were included in cohorts A and B, respectively. Belonging to cohort A (Hazard ratio [HR] 0.177, 95% CI 0.05–0.7) and use of intensity modulated radiotherapy (HR 0.177, 95% CI 0.03–1.08) were associated to better PFS, while high-risk histopathology (HR 6.6, 95% CI 0.9–50) and EBRT dose (HR 1.05, 95% CI 1.01–1.08) were independently associated with lower PFS. Patients from cohort A (HR 0.061, 95% CI 0.01–0.3) had improved OS, while high-risk histopathology (HR 5.7, 95% CI 1.1–28.6) and EBRT dose (HR 1.05, 95% CI 1.01–1.09) were independently associated to worse OS.ConclusionEBRT, and when feasible, salvage surgery, should be an integral part of the therapeutic strategy in initially unresectable DTC.
Highlights
In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation
Unresectable DTC, patients have been treated with external beam radiotherapy (EBRT), mainly to obtain palliation [5, 6]
Unresectable DTC was defined as T4a/T4b DTC and/or metastatic lymph nodes with invasion and more than 180° –without cleavage plane– surrounding of the following vascular structures: vascular structures of the root of the neck, superior vena cava and/or pulmonary artery system, anterosuperior mediastinum, as well as extension to spine and neurovascular structures –including vertebral artery, which precluded a complete excision of the mass without major risk for function or life [9]
Summary
In patients with unresectable Differentiated thyroid cancer (DTC), the use of external beam radiation therapy (EBRT), leads mostly to palliation. Our aim is to define the role of upfront EBRT, followed or not by salvage surgery, on Progression-free survival (PFS) or Overall survival (OS) in patients with DTC. Differentiated thyroid cancer (DTC) is mostly treated with total thyroidectomy and subsequent 131I radioiodine to ablate residual thyroid tissue or micrometastases. The indications for external beam radiotherapy (EBRT) have been reported previously. The use of EBRT in patients with highrisk features for relapse and gross residual disease has been described and subject to controversy [5]. Unresectable DTC, patients have been treated with EBRT, mainly to obtain palliation [5, 6]
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