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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2014

01-05-2014 | Endocrine Tumors

Outcomes of Total Thyroidectomy with Therapeutic Central and Lateral Neck Dissection with a Single Dose of Radioiodine in the Treatment of Regionally Advanced Papillary Thyroid Cancer and Effects on Serum Thyroglobulin

Authors: David T. Hughes, MD, Barbra S. Miller, MD, Mark S. Cohen, MD, Gerard M. Doherty, MD, Paul G. Gauger, MD

Published in: Annals of Surgical Oncology | Issue 5/2014

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Abstract

Background

Achieving an undetectable serum thyroglobulin (Tg) level (<1.0 ng/mL) after surgical and radioiodine treatment for papillary thyroid cancer (PTC) is associated with low recurrence rates and has been termed biochemical remission. This study aimed to determine the effectiveness of total thyroidectomy with therapeutic central and lateral neck dissection for regionally advanced (T1–4bN1bM0) PTC with regard to posttreatment Tg levels.

Methods

This is a single-institution retrospective cohort study of patients with regionally advanced PTC initially treated with total thyroidectomy and therapeutic levels 2–7 neck dissection from 2002 to 2012. Pathologic findings, complications, serum Tg levels, and outcomes were analyzed.

Results

Sixty-one patients were initially treated with total thyroidectomy and therapeutic central and lateral neck dissection for PTC involving the lateral cervical nodes (N1b). The median number of lymph nodes excised and positive was 27 (range 5–112) and 9 (range 1–67), respectively. Extranodal extension occurred in 48 %. Radioiodine was administered after surgery with a median total dose of 150 mCi (range 30–244 mCi). Recurrent or persistent cervical disease occurred in 8 (13 %) and 3 (5 %) patients, respectively, and required additional radioiodine treatment in 2 and reoperative neck dissection in 10. Three patients developed new distant metastasis, and 1 died during the median follow-up of 20 months (range 1–109 months). Undetectable unstimulated Tg (<1.0 ng/mL) without clinically detectable recurrence was experienced in 68 % of patients with initial treatment.

Conclusions

Biochemical remission can be experienced in most patients presenting with regionally advanced PTC with total thyroidectomy and compartment based therapeutic neck dissection followed by a single dose of radioiodine.
Literature
1.
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;19:1167–214.
2.
National Comprehensive Cancer Network (NCCN). Clinical practice guidelines in oncology: thyroid carcinoma, v.1.2010. http://​www.​nccn.​org. Accessed 12 Aug 2013.
3.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
4.
Machines A, Hine R, Thomusch O, Dralle H.. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002;26:22–8.CrossRef
5.
Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97:418–28.PubMedCrossRef
6.
Lundgren CI, Hall P, Dickman PW, Zedenius J. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer. 2006;106:524–31.PubMedCrossRef
7.
Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71:731–4.PubMed
8.
Saydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144:1070–7.CrossRef
9.
Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144:1070–7.PubMedCrossRef
10.
Ibrahimpasic T, Nixon IJ, Palmer FL, Whitcher MM, Tuttle RM, Shaha A, et al. Undetectable thyroglobulin after total thyroidectomy in patients with low-and intermediate-risk papillary thyroid cancer—is there a need for radioactive iodine therapy? Surgery. 2012;152:1096–105.PubMedCrossRef
11.
Eustatia-Rutten CF, Smit JW, Romijn JA, van der Kleij-Corssmit EP, Pereira AM, Stokkel MP, et al. Diagnostic value of serum thyroglobulin measurements in the follow-up of differentiated thyroid carcinoma, a structured meta-analysis. Clin Endocrinol (Oxf). 2004;61:61–74.PubMedCrossRef
12.
Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery. 2009;145:514–8.PubMedCrossRef
13.
White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer. World J Surg. 2007;31:895–904.PubMedCrossRef
14.
Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148:1100–6.PubMedCrossRef
15.
Carty SE, Cooper DS, Doherty GM, Duh QY, Kloos RT, Mandel SJ, et al. consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19:1153–8.PubMedCrossRef
16.
Hughes CJ, Shaha AR, Shah JP, Loree TR. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck. 1996;18:127–32.PubMedCrossRef
17.
Roh JL, Park JY, Rha KS, Park CI. Is central neck dissection necessary for the treatment of lateral cervical nodal recurrence of papillary thyroid carcinoma? Head Neck. 2007;29:901–6.PubMedCrossRef
18.
Jung SP, Kim M, Choe JH, Kim JS, Nam SJ, Kim JH. Clinical implication of cancer adhesions in papillary thyroid carcinoma: clinicopathologic characteristics and prognosis analyzed with degree of extrathyroidal extension. World J Surg. 2013;37:1606–13.PubMedCrossRef
19.
Arora N, Turgendian HK, Scognamiglio T, Wagner PL, Goldsmith SJ, Zarnegar R, et al. Extrathyroidal extension is not all equal: implications of macroscopic versus microscopic extent in papillary thyroid carcinoma. Surgery. 2008;144:942–7.PubMedCrossRef
20.
Castagna MG, Brilli L, Pilli T, Montanaro A, Cipri C, Fioravanti C, et al. Limited value of repeat recombinant thyrotropin (rhTSH)-stimulated thyroglobulin testing in differentiated thyroid carcinoma patients with previous negative rhTSH-stimulated thyroglobulin and undetectable basal serum thyroglobulin levels. J Clin Endocrinol Metab. 2008;93:76–81.PubMedCrossRef
21.
Kloos RT, Mazzaferri EL. A single recombinant human thyrotropin-stimulated serum thyroglobulin measurement predicts differentiated thyroid carcinoma metastases three to five year later. J Clin Endocrinol Metab. 2005;90:5047–57.PubMedCrossRef
22.
Smallridge RC, Meek S, Morgan MA, Gates GS, Fox TP, Grebe S, et al. Monitoring thyroglobulin in a sensitive immunoassay has comparable sensitivity to recombinant human TSH-stimulated thyroglobulin in follow-up of thyroid cancer patients. J Clin Endocrinol Metab. 2007;92:82–7.PubMedCrossRef
Metadata
Title
Outcomes of Total Thyroidectomy with Therapeutic Central and Lateral Neck Dissection with a Single Dose of Radioiodine in the Treatment of Regionally Advanced Papillary Thyroid Cancer and Effects on Serum Thyroglobulin
Authors
David T. Hughes, MD
Barbra S. Miller, MD
Mark S. Cohen, MD
Gerard M. Doherty, MD
Paul G. Gauger, MD
Publication date
01-05-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3467-7

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