PROGNOSTIC VALUE OF CALCITONIN POST-SURGERY LEVEL MEASUREMENT IN PATIENTS WITH MEDULLAR THYROID CANCER (MTC)
AIM: to study the adequacy of surgery and detect MTC recurrences by means of serum calcitonin.
METHODS: 30 patients with MTC were examined and followed-up for 5.5 years in the average. Radio-inmmunological examination, serum CT measurement was performed by means of commercially available kit RIA DCL-1200. Norm is up to 42picograms per ml.
RESULTS: as the result of analysis of the surgery types MTC prognosis parameters, such as, tumor size and stage in accordance with TNM system, invasive growth, differentiation degree, the surgery adequacy. Of the total number of patients total thyroidectomy was performed in 18, subtotal thyroid resection in 7, subtotal thyroid lobe in 3, spare thyroid resection in 2 subjects. Among inadequate surgeries the recurrences were 20%. In one patient (T2N0M0) inter-surgery period was 1 year and pre-operation CT level was increased (basal 721picograms per ml, stimulated 980picograms per ml), but 2 weeks after final surgery it decreased to the normal one. Despite total thyroidectomy in two patients with high degree of MTC malignancy post-surgery CT level was high (in the 1st patient: basal 310picograms per ml, stimulated 951picograms per ml; in 2nd patient: basal 454picograms per ml, stimulated 1057picograms per ml). It is conditioned by the surgery metastases into regional neck lymph nodes to be confirmed by clinical manifestations 2 and 3 months after surgery. After bilateral lymphoectomy and radiotherapy course CT level decreased to 84pickgrams per ml (basal) and 212pickgrams per ml (stimulated) in the1st and to 96pickgrams per ml (basal) and 307picograms per ml (stimulated) in the 2nd patient.
CONCLUSIONS: Thus, the study showed that the measurement of the basal and stimulated CT level after surgery is an important prognostic test for assessment of surgery adequacy and a ground for surgery on regional lymph collector, high post-surgery CT level indicates the presence of metastases.