Universität zu Köln

Chiapponi, Costanza ORCID: 0000-0002-4681-2835, Hartmann, Milan J. M., Schmidt, Matthias, Faust, Michael, Schultheis, Anne M., Bruns, Christiane J. and Alakus, Hakan ORCID: 0000-0002-3889-3276 (2021). Radioiodine Refractory Follicular Thyroid Cancer and Surgery for Cervical Relapse. Cancers, 13 (24). BASEL: MDPI. ISSN 2072-6694

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Abstract

Simple Summary Differentiated thyroid cancer includes papillary (PTC) and follicular thyroid cancer (FTC). Eighty-five percent of patients are cured by thyroidectomy and one single radioiodine treatment. Relapse is rare and can mostly be cured by a second radioiodine therapy. Between 5% and 10% of differentiated thyroid cancers are, or become, unresponsive to radioiodine treatment during the course of disease. For these patients repeated surgery is the only curative option: chemotherapy and external beam radiation play a minor role, targeted therapy is started in a palliative setting for rapidly progressing tumors. In most studies on radioiodine refractory differentiated thyroid cancer, there is a predominance of PTC, due to its higher incidence compared to FTC. In the present study we critically evaluate indications and outcome of repetitive cervical surgery for radioiodine refractory FTC at our university clinic. Compared to its more common counterpart papillary thyroid cancer (PTC), follicular thyroid cancer (FTC) has a less favorable outcome, due to its higher incidence of distant metastases and advanced stages at diagnosis. Despite radioiodine (RAI) avidity, metastatic FTC often progresses after radioiodine treatment (RAIT). We aimed at evaluating the indications and outcomes of surgery for cervical relapse of radioiodine refractory FTC. Patients receiving RAIT between 2005 and 2015 at the University Hospital of Cologne, Germany, were screened. Patients with FTC were identified. Demographics, clinic-pathologic characteristics, treatment, and outcome of patients diagnosed with RAI refractory FTC, who underwent cervical surgery in the course of disease, were analyzed. FTC accounted for 8.8% of all thyroid carcinomas undergoing RAIT. In 35.2% of FTC patients, disease persisted or recurred despite a cumulative mean RAI activity of 18.7 GBq +/- 11.6 (follow-up 83.5 +/- 56.7 months). Distant metastases were diagnosed in 75% of these patients, as bone (57.6%), lung (54.6%), and liver metastases (12.1%). Cervical relapse occurred in 63.6% of these patients and was treated in 57.1% with surgery with, and without, external beam radiation therapy (EBRT). Despite surgery and EBRT, in 75% of patients, cervical relapse recurred again. In conclusion, surgery for cervical radioiodine refractory FTC relapse is often performed in metastatic setting. With and without EBRT, cure is rare, although metastases can appear radioiodine avid. Early biological marker and systemic treatments for these patients are still needed.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Chiapponi, Costanza UNSPECIFIED orcid.org/0000-0002-4681-2835 UNSPECIFIED Hartmann, Milan J. M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Faust, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Schultheis, Anne M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruns, Christiane J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Alakus, Hakan UNSPECIFIED orcid.org/0000-0002-3889-3276 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-565608
DOI:	10.3390/cancers13246230
Journal or Publication Title:	Cancers
Volume:	13
Number:	24
Date:	2021
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2072-6694
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EXTERNAL-BEAM RADIATION; ASSOCIATION GUIDELINES; DISTANT METASTASIS; CARCINOMA; PAPILLARY; OUTCOMES; RADIOTHERAPY; THERAPY; IODINE Multiple languages Oncology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/56560