Management of differentiated adenocarcinoma of thyroid: a ten years experience and a suggested protocol

ABSTRACT

Through a retrospective study of 320 cases of differentiated adenocarcinoma of thyroid presented to us or referred to Kasr El-Eini Center of Radiation Oncology and Nuclear Medicine [NEMROCK] treated initially surgically followed by other modalities of treatment varying between 131I, external irradiation and/or variable dose of thyroxine, a trial was made to divide such patients into a high risk and another low risk groups. Various treatment modalities were given according to certain parameters. A trial was made to provide a score system for the risk factors of cases of differentiated adenocarcinoma of thyroid to be able to start a prospective study through the suggested protocol of management. The main risk factors were, the age of the patient, the degree of differentiation, whether purely papillary, mixed or purely follicular, the size of the primary lesion and the sex of the patient. Near total thyroidectomy was done for about half of the patients. In the remaining half, lobectomy, hemithyroidectomy or subtotal thyroidectomy was performed. External irradiation was used in less than one fourth of the cases. Post operative variable dose of 131I was given in most of the cases, but our tendency is towards more limited use in the low risk group. In the low risk group we felt that ipsilateral near total lobectomy and contralateral subtotal lobectomy with a very selective neck dissection in presence of palpable nodal disease should be more than enough as a surgical treatment. Total thyroidectomy could carry the hazards of hypoparathyroidism and recurrent laryngeal nerve injury without due benefits in the so-called low risk group of patients. Total or near total thyroidectomy with selective neck dissection could be advocated in the high risk group. Radio-iodine therapy was found to be a safe and effective modality of treatment specially in adults and elderly patients