ECE2018 Poster Presentations: Thyroid Thyroid cancer (88 abstracts)
Treatment strategies in medullary thyroid carcinoma – outcome following initial surgery with a curative, debulking or prophylactic intent
Vasiliki-Ioanna Mitravela 1 , Nigel Glynn 1 , Mona Waterhouse 1 , Scott Akker 1 , Marta Korbonits 1 , William Drake 1 , Daniel Berney 2 , Nick Plowman 3 , Robert Carpenter 4 , Laila Parvanta 4 & Maralyn Druce 1
1Department of Endocrinology, St Bartholomew’s Hospital, London, UK; 2Department of Pathology, St Bartholomew’s Hospital, London, UK; 3Department of Oncology, St Bartholomew’s Hospital, London, UK; 4Department of Surgery, St Bartholomew’s Hospital, London, UK.
Medullary thyroid carcinoma (MTC) is a rare malignancy which has often metastasised at time of diagnosis. Surgical resection represents the only prospect for cure. However, debulking neck surgery may be beneficial in advanced cases. Prophylactic surgery is increasingly undertaken in asymptomatic patients with known mutations in the RET oncogene. The aim was to describe the outcome following initial surgical treatment for MTC at our institution. We performed a retrospective analysis of medical records of patients diagnosed with MTC and followed up at our centre. Study period extended from 1976 to 2016. Data recorded included demographic, clinical, biochemical and radiological variables. Sixty five patients (27 men) were identified - 36 (55%) sporadic and 29 hereditary cases. Median age at diagnosis was 37 years. Sixty one patients underwent neck surgery, 14 (22%) received adjuvant neck radiotherapy and 4 (6%) received palliative care only. Median overall follow-up 9.3 years. Nine patients (15%) were deemed to have incurable disease but underwent debulking neck surgery – all had stage IV disease. Three patients died of MTC – median survival 23 months. Six (67%) were alive at last follow-up – two had progressive and four stable disease. Thirty six patients (59%) had neck surgery with a curative intent. Seventeen (47%) were in remission post-operatively – subsequently, two patients experienced recurrence. Nineteen patients (53%) did not achieve biochemical remission (normal basal serum calcitonin) post-operatively – disease progression was later detected in 7 patients. Three patients in the “curative intent” group died of MTC – median survival 171 months. Sixteen asymptomatic patients (26%) with germline mutations in the RET oncogene underwent thyroidectomy – so called “prophylactic thyroidectomy”. Median age 24 years; median follow-up 21.5 years. Post-operative biochemical remission was achieved in 10 patients (63%) – one experienced recurrence. All patients in this group were alive at last follow up except one who died of renal carcinoma. In conclusion, neck surgery may induce long-term remission in half of patients with MTC who have potentially resectable disease. However, in advanced or incurable disease, debulking surgery may be useful in selected patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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