[Therapeutic concepts and long-term outcome in thyroid gland carcinoma].

UNLABELLED

Data of all (n = 131) patients carrying thyroid carcinoma and operated on between January 1st, 1979, and September 30th, 1994 in our center were analyzed retrospectively. Patient's files were reviewed concerning histological diagnosis, TNM-classification, operation procedure and complications. Follow-up data were obtained in all cases from local cancer registry as well as from personal records. Statistical analysis was performed using PCS-software (TopSoft, Hannover).

RESULTS

Follow-up data from 3-191 months (mean: 50.4 mo.) postoperatively were obtained from 72 patients with papillary thyroid carcinoma (PTC) including 27 cases of occult papillary thyroid carcinoma (oPTC, < 1.5 cm), 30 patients with follicular thyroid carcinoma (FTC), 10 patients with medullary thyroid carcinoma (MTC) and 19 patients carrying anaplastic tumor (ATC). In case of oPTC 51.8% of the patients received total thyroidectomy or lobectomy and contralateral near-total resection. In PTC, both procedures were performed in 68.9% combined with neck dissection in 31%. Radioiodine treatment was given to 59.7%. Treatment of FTC consisted mainly of thyroidectomy (60%) followed by radioiodine therapy (76.7%). In patients with MTC preference was given to thyroidectomy and bilateral neck dissection, more recently completed by mediastinal lymph node dissection. 90% of the patients with ATC were inoperable. No patient received chemotherapy pre- or postoperatively, respectively. Five-and 10-year survival of patients with PTC (oPTC) was 91.6% (93.7%) and 80.2% (93.7%), respectively. Corresponding data for FTC were 70.5% and 50.3%, and 71.6 % and 47.9%, for MTC respectively. ATC showed 10.3% 3-year survival.

CONCLUSIONS

Despite therapy of choice was not performed in all patients, our long-term results generally confirm those reported by others. Despite of this, limited radical therapy should be restricted to oPTC in our opinion. In case of MTC presenting rising or elevated tumor markers postoperatively, early mediastinal lymph node dissection should be considered.