Endocrine Abstracts (2011) 26 MTE3

Management difficulties in recurrences and metastases of thyroid cancer

Laurence Leenhardt

Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Paris, France.

Patients with thyroid carcinoma are usually considered as having a good prognosis although the disease may take an aggressive course. Indeed, 5–27% of patients develop locoregional recurrences located in cervical lymph nodes (60–75%), thyroid bed (20%) and trachea or muscle (5%), thus worsening the prognosis. Distant metastases develop in 10% of patients and are located mainly in the bones and the lungs but also in the liver leading to a risk of cancer-related death.

Firstly, the most difficult complication for the clinician to manage is radioiodine refractory thyroid cancer particularly when it is progressive or advanced with distant metastases that remain difficult to treat. Local treatments, such as surgery, radiofrequency, embolisation, cement injection or external radiation therapies can be beneficial in selected patients. Cytotoxic chemotherapy with partial responses has been reported. Recently therapies that inhibit angiogenic signaling pathways have emerged as potentially effective treatment options and are reviewed in this ‘meet the expert’ session. However, not all patients respond well to these treatments.

Secondly, recurrences of thyroid cancer can be difficult to manage because of their small size and/or very slow development. Detected with highly sensitive tools during follow up, small recurrences raise questions regarding the benefits (versus secondary effects) of treatments and highlight the need for preserving good quality of life among patients in whom the disease can remain stable for many years. Alternative treatments for small recurrences are discussed. Very slow progression of recurrences also raises questions regarding both the frequency of follow-up and imaging examinations and the relevance of RECIST criteria in such patients with slowly progressing recurrences.

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