J Korean Thyroid Assoc.  2014 May;7(1):40-47.

Management of Recurrent Differentiated Thyroid Carcinoma

Affiliations
  • 1Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea. kimwb@amc.seoul.kr
  • 2Department of Internal Medicine, Asan Medical Center, Seoul, Korea.

Abstract

Patients with well differentiated thyroid carcinoma (WDTC) generally have good prognosis with appropriate therapy, but those with recurrences have higher disease specific mortality and poor quality of life requiring clinical attention. Recurrences occur in 5-20% as loco-regional form and as distant metastasis in 10-20% in long-term follow-up after initial therapy. Soft tissue recurrences as a form of local recurrence require aggressive therapy including wide excision and postoperative adjuvant therapy as they have dismal prognosis. There are controversies in proper management of loco-regional recurrences in neck lymph node, because improvement in clinical outcome of those patients through randomized, prospective study had never been documented and because it is not clear if lymph node recurrences could be a focus of further metastasis of cancer cells. Management includes surgery (compartment-oriented lymph node dissection), alcohol injection or radiofrequency ablation and simple observation. Adjuvant radioiodine therapy is not useful after re-operation, especially high dose radioiodine had been done as initial therapy. Recurrences as distant metastasis require thorough evaluation and proper management according to site and progression of each lesion. Palliative surgery if critical structure is endangered, radioiodine therapy in "radioactive iodine (RAI)-avid" lesions, external beam radiation therapy or IV bisphosphonate, embolization should be considered in bone metastasis according to clinical setting. RAI-avid lung metastasis can be managed with radioiodine, but there is no available therapeutic modality in "non-RAI-avid" lung metastatic lesions. Clinical trials using new targeted agents can be considered in those patients. There had been many trials to enhance/restore iodine uptake in metastatic lesions, but there is no clinically available agent yet. Further studies are required for development of agents to restore/enhance iodine uptake to improve efficacy of RAI therapy.

Keyword

Thyroid carcinoma; Recurrence; Metastasis; Management

MeSH Terms

Catheter Ablation
Follow-Up Studies
Humans
Iodine
Lung
Lymph Nodes
Mortality
Neck
Neoplasm Metastasis
Palliative Care
Prognosis
Quality of Life
Recurrence
Thyroid Neoplasms*
Iodine

Figure

  • Fig. 1. Management of patients with recurrent well differentiated thyroid carcinoma.


Reference

References

1. Hundahl SA, Cady B, Cunningham MP, Mazzaferri E, McKee RF, Rosai J. et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma treated in the united states during 1996. U.S. and German Thyroid Cancer Study Group. An American College of Surgeons Commission on Cancer Patient Care Evaluation study. Cancer. 2000; 89(1):202–17.
2. Elisei R, Ugolini C, Viola D, Lupi C, Biagini A, Gianmni R. et al. BRAF(V600E) mutation and outcome of patients with papillary thyroid carcinoma: a 15-year median follow-up study. J Clin Endocrinol Metab. 2008; 93(10):3943–9.
3. Ito Y, Fukushima M, Kihara M, Takamura Y, Kobayashi K, Miya A. et al. Investigation of the prognosis of patients with papillary thyroid carcinoma by tumor size. Endocr J. 2012; 59(6):457–64.
4. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167–214.
5. Coburn M, Teates D, Wanebo HJ. Recurrent thyroid cancer. Role of surgery versus radioactive iodine (I131). Ann Surg. 1994; 219(6):587–93. discussion 93-5.
Article
6. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97(5):418–28.
Article
7. Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid Cancer. J Clin Endocrinol Metab. 2001; 86(4):1447–63.
8. Palme CE, Waseem Z, Raza SN, Eski S, Walfish P, Freeman JL. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2004; 130(7):819–24.
Article
9. Al-Saif O, Farrar WB, Bloomston M, Porter K, Ringel MD, Kloos RT. Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab. 2010; 95(5):2187–94.
Article
10. Schuff KG, Weber SM, Givi B, Samuels MH, Andersen PE, Cohen JI. Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope. 2008; 118(5):768–75.
Article
11. Clayman GL, Shellenberger TD, Ginsberg LE, Edeiken BS, El-Naggar AK, Sellin RV. et al. Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck. 2009; 31(9):1152–63.
12. Yim JH, Kim WB, Kim EY, Kim WG, Kim TY, Ryu JS. et al. The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J Clin Endocrinol Metab. 2011; 96(7):2049–56.
13. Burman KD. Treatment of recurrent or persistent cervical node metastases in differentiated thyroid cancer: deceptively simple options. J Clin Endocrinol Metab. 2012; 97(8):2623–5.
Article
14. Ito Y, Higashiyama T, Takamura Y, Kobayashi K, Miya A, Miyauchi A. Prognosis of patients with papillary thyroid carcinoma showing postoperative recurrence to the central neck. World J Surg. 2011; 35(4):767–72.
Article
15. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD. et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006; 16(12):1229–42.
16. Yim JH, Kim WB, Kim EY, Kim WG, Kim TY, Ryu JS. et al. Adjuvant radioactive therapy after reoperation for locoregionally recurrent papillary thyroid cancer in patients who initially underwent total thyroidectomy and high-dose remnant ablation. J Clin Endocrinol Metab. 2011; 96(12):3695–700.
17. Charboneau JW, Hay ID, van Heerden JA. Persistent primary hyperparathyroidism: successful ultrasound-guided percutaneous ethanol ablation of an occult adenoma. Mayo Clin Proc. 1988; 63(9):913–7.
Article
18. Livraghi T, Paracchi A, Ferrari C, Bergonzi M, Garavaglia G, Raineri P. et al. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results. Work in progress. Radiology. 1990; 175(3):827–9.
19. Goletti O, Lenziardi M, De Negri F, Fiorini I, Lippolis PV, Cristofani E. et al. Inoperable thyroid carcinoma: palliation with percutaneous injection of ethanol. Eur J Surg. 1993; 159(11-12):639–639.
20. Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol. 2002; 178(3):699–704.
Article
21. Heilo A, Sigstad E, Fagerlid KH, Haskjold OI, Groholt KK, Berner A. et al. Efficacy of ultrasound-guided percutaneous ethanol injection treatment in patients with a limited number of metastatic cervical lymph nodes from papillary thyroid carcinoma. J Clin Endocrinol Metab. 2011; 96(9):2750–5.
22. Hay ID, Charboneau JW. The coming of age of ultrasound-guided percutaneous ethanol ablation of selected neck nodal metastases in well-differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2011; 96(9):2717–20.
Article
23. Robenshtok E, Fish S, Bach A, Dominguez JM, Shaha A, Tuttle RM. Suspicious cervical lymph nodes detected after thyroidectomy for papillary thyroid cancer usually remain stable over years in properly selected patients. J Clin Endocrinol Metab. 2012; 97(8):2706–13.
Article
24. Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP. et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006; 91(8):2892–9.
25. Kojic KL, Kojic SL, Wiseman SM. Differentiated thyroid cancers: a comprehensive review of novel targeted therapies. Expert Rev Anticancer Ther. 2012; 12(3):345–57.
Article
26. Muresan MM, Olivier P, Leclere J, Sirveaux F, Brunaud L, Klein M. et al. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008; 15(1):37–49.
27. Gagey O, Court C, Ziad N, Schlumberger M. Pelvic and spinal giant metastases from thyroid carcinomas: report of 8 cases. Rev Chir Orthop Reparatrice Appar Mot. 2001; 87(6):579–84.
28. Brierley JD, Tsang RW. External beam radiation therapy for thyroid cancer. Endocrinol Metab Clin North Am. 2008; 37(2):497–509. xi.
Article
29. Choi HJ, Kim TY, Ruiz-Llorente S, Jeon MJ, Han JM, Kim WG. et al. Alpha-lipoic acid induces sodium iodide symporter expression in TPC-1 thyroid cancer cell line. Nucl Med Biol. 2012; 39(8):1275–80.
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