Throid carcinoma                                                                                                                                       231

47. Thyroid Carcinoma

47.1 General considerations

Stage grouping (AJCC/ UICC)

Papillary or follicular carcinomas

Stage age < 45 years age > 45 years

I any T any N M0 T1 N0 M0

II any T any N M1 T2,3 N0 M0

III T4 N0 M0

anyT N1 M0

IV anyT anyN M1

Undifferentiated carcinoma

IV anyT any N any M (all cases are stage IV)

Well – differentiated (papillary and follicular) thyroid carcinoma is well treatable with a good prognosis, Current therapeutic protocots include surgery (predominantly total thyroidectomy), followed, if necessary by complementary radioiodine (131 I) and/ or external beam radiation. The administration of thyroxin is another measure to reduce the proliferation of residual thyroid tissue or metastases and additionally it is given for hormonal substitution. For patients not or no longer treatable by surgery or radiotherapy palliative chemotherapy is indicated .

About 30 % of the tumors dedifferentiate and may finally develop into highly malignant anaplastic thyroid carcinoma. These are inaccessible to conventional therapy, but aggressive multimodality treatment regimens which combine surgery, chemotherapy and radiotherapy have shown some promise in disase control.

Medullary thyroid carcinomas (see Neuro-endocrine Malignancies) are also highly aggressive tumors. Multimodality treatment with surgery and/or external beam radiotherapy and chemotherapy can result in local control of disease and enhanced survival.

Literature: for review e.g.

AIN. Baillieres Best Pract. Res. Clin. Endocrinol. Metab. 14 (2000): 615 –

629 (management of undifferentiated thyroid cancer)

GIMM, Cancer Lett. 26 (2001): 143-156

GIUFFRIDA and GHARIB, Ann. Ocnol. 11(2000): 1083-1089 (diagnosis and treatment of anaplastic thyroid carcinoma)

HAUGEN, Rev. Endocr. Metab. Disord. 1 (2000): 147 – 154 (initial treatment of differentiated thyroid carcinoma)

HURLEY, Endocr. Pract. 6(2000): 401- 406

ORLANDI et al, Endocr. Relat. Cancer 8 (2001) : 135 – 147 (medullary

thyroid carcinoma)

SCHLUMBERGER and TORLANTANO, Baillieres Best Pract. Res.

Clin.

Endocrinol. Metab. 14 (2000): 601 – 613 (papillary and follicular thyroid

carcinoma)

SCHMUTZLER and KOEHRLE, Eur. J. Endocrinol. 143 (2000): 15 – 24

(innovative treatment strategies)

SHERMAN, Rev. Endocr. Metab Disord. 1 (2000): 165-171 (management of metastatic differentiated thyroid carcinoma)

Van TOL et al, Crit. Rev. Oncol. Hematol. 38 (2001): 79 – 91 (differentiated thyroid carcinoma in the elderly )

232                                                                                                                                      Thyroid Carcinoma

47.2 Radioiodine

Literature: e.g.

De KEIZER et al, Eur. J. Nucl. Med. 28 (2001): 198 – 202

MAXON, Q. J. Nucl. Med. 43 (1999): 313- 323

PETRICH et al, Eur. J. Nucl. Med. 28 (2001): 203-208

REINERS and FARAHATI, Q. J. Nucl. Med. 43 (1999): 324-335

ROOS and SMITH, Int. J. Radiat. Oncol. Biol. Phys. 44(1999):493-495

47.3 Single agent chemotherapy

Treatment may be attempted with doxorubicin or cisplatin. paclitaxel appears to have some activity against anaplastic thyroid carcinoma.

47.3.1 Doxorubicin

Coxorubicin 75 mg/m2 i.v. (bolus) d 1

To be repeted every 3 weeks

Literature:

GOTTLIEB and STRATTON HILL, Cancer Chemother. Rep. 6 ( 1975):

283- 296

47.3.2. Paclitaxel

Paclitaxel 140 mg/m2 i.v. (96 h inf) d 1-4* or

225 mg/m2 i.v. ( 1 h inf) weekly

*To be repeted every 3 weeks

Literature:

AIN. et , al , Thyroid 10 (2000): 587-594

47.4 Combination chemotherapy

Coxorubicin + cisplatin

Coxorubicin 60 mg/m2 i.v. (bolus) d 1

Cisplatin 40 mg/m2 i.v. (30 min inf) d 1

To be repeted every 3(-4) weeks

Literature:

SHIMAOKA et al, Cancer 56 (1985): 2155-2160