Management of recurrent and / or metastatic well-differentiated cancer thyroid; retrospective and prospective study

ABSTRACT

The management of recurrent and / or metastatic differentiated thyroid carcinoma is a challenging task. Therapeutic intervention depends on the type of the initial treatment, the site and the extent of the disease. To investigate the patients who presented with local recurrence [LR] and/or distant metastases [DM] from differentiated thyroid carcinoma [DTC] and to evaluate methods of treatment and patients' response to therapy. The study included 90 patients who presented with local recurrence [69 patients, 77%] and/or distant metastases [21 patients, 33%]. Papillary carcinoma was the most common histopathology [61 patients]. Most of the patients who presented with recurrence had suboptimal primary treatment, 42 patients [4 7%] had hemi-thyroidectomy and 19 patients [21%] received no radio-active iodine therapy [RAI]. Patients were managed by combined modalities, mainly surgery and RAI apart from 6 patients who received external beam radiotherapy. The patients were followed up for 3 years using I-131 whole body scan and thy roglobulin level. Disease free survival [DFS] was 61% and 65% excluding the patients lost from follow up. Optimal management of patients with DTC is essential to minimize the incidence of recurrence. Surgery, RAI and to a lesser extent external radiotherapy play the main role in the management of patients with recurrent and/or metastatic DTC