Treatment strategy of thyroid cancer with trachea,larynx, and major vessels involvement / 中国实用外科杂志

Surgical treatment of thyroid cancer with surrounding structures involved remains a challenge for physicians.Trachea and larynx are common affected organs,and complete resection can bring the greatest survival benefit.However,postoperative quality of life may be greatly affected.It is necessary to improve the quality of life of patients by stage Ⅰ or Ⅱ reconstruction. The case of papillary thyroid carcinoma invading the internal jugular vein or with internal jugular vein tumor thrombus can still be safely and completely removed.Some cases with carotid artery invasion could benefit from radical resection,in which case vascular reconstruction should be done simultaneously.Multidisciplinary treatment should be emphasized for the locally advanced cases. Postoperative radioactive iodine therapy,external beam radiotherapy,endocrine therapy should be considered to reduce local recurrence. For inoperable patients,participating a clinical trial or trying targeted therapy could be good choices. Patients with poor general condition may be given palliative care to alleviate the symptoms.

Treatment of Locally Advanced Thyroid Cancer / 대한내분비외과학회지

Thyroid cancer is an indolent condition that usually presents as a limited disease in the neck. Invasion to vital organs is rarely observed; however, it can be a major cause of mortality, even in well-differentiated thyroid cancers. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngo-tracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled invasion to vital organs in the neck and mediastinum can cause significant morbidity and affect quality of life and survival. Limited involvement of the aero-digestive tract can be controlled by conservative surgical treatments such as shaving-off procedures, while radical resection and subsequent reconstructive procedures are the best choice for more serious cases. In planning the treatment, the risk-benefit ratio should be carefully evaluated to reduce the morbidity, as well as achieve maximal therapeutic effects. Postoperative adjuvant therapies have been the subject of controversy, but there is a general consensus, especially for high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external beam radiation therapy are unclear, but it should be considered in patients with microscopic residual disease. In conclusion, radical eradication of lesions followed by proper adjuvant therapy is the treatment of choice for locally advanced thyroid cancers.

Treatment of Locally Advanced Thyroid Cancer

Thyroid carcinoma is a slowly growing tumor and rarely invades adjacent tissues or organs. However, up to 21% of the patients with well-differentiated thyroid cancers show local invasion, and of those 10 to 15% of patients with papillary cancer who eventually die of the disease, active local disease has been the most common finding at the time of death. The common sites of local invasion are strap muscle, recurrent laryngeal nerve, laryngotracheal tree, esophagus, and great vessels in the lateral compartment and mediastinum. Uncontrolled local invasion to vital organs in the neck causes significant morbidity, affects the quality of life, and finally influences the survival. In cases with limited involvement of the larynx or trachea, the option of treatment includes limited shaving-off resection or radical resection followed by reconstructive procedures. When operation is planned, the level of acceptable morbidity and the achievement of therapeutic outcomes should be determined in advance. In cases with aggressive invasion to the adjacent tissues, radical resection is the treatment modality of choice with favorable prognosis. Postoperative adjuvant therapies have been the matter of controversy, however, there is a general consensus, especially for the high-risk patients, that radioiodine therapy and TSH suppression after radical resection are beneficial. The benefits of external radiation therapy in locally advanced thyroid cancers are unclear, however, it can be effective in patients with microscopic residual disease postoperatively. Radical eradication of locally advanced thyroid carcinoma followed by appropriate adjuvant therapy should be considered to be the treatment of choice in locally advanced thyroid cancers.