Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer: Outcomes and Morbidity With Conformal Treatment
- Department of Radiation Oncology, UT M.D. Anderson Cancer Center, Houston, TX (United States)
- Department of Surgical Oncology, UT M.D. Anderson Cancer Center, Houston, TX (United States)
- Department of Head and Neck Surgery, UT M.D. Anderson Cancer Center, Houston, TX (United States)
- Department of Endocrine Neoplasia and Hormonal Disorders, UT M.D. Anderson Cancer Center, Houston, TX (United States)
Purpose: To review institutional outcomes for patients treated for differentiated thyroid cancer with postoperative conformal external beam radiotherapy (EBRT). Methods and Materials: This is a single-institution retrospective review of 131 consecutive patients with differentiated thyroid cancer who underwent EBRT between January 1996 and December 2005. Histologic diagnoses included 104 papillary, 21 follicular, and six mixed papillary-follicular types. American Joint Committee on Cancer stage distribution was Stage III in 2 patients, Stage IVa-IVc in 128, and not assessable in 1. Thirty-four patients (26%) had high-risk histologic types and 76 (58%) had recurrent disease. Extraglandular disease spread was seen in 126 patients (96%), microscopically positive surgical margins were seen in 62 patients (47%), and gross residual disease was seen in 15 patients (11%). Median EBRT dose was 60 Gy (range, 38-72 Gy). Fifty-seven patients (44%) were treated with intensity-modulated radiotherapy (IMRT) to a median dose of 60 Gy (range, 56-66 Gy). Median follow-up was 38 months (range, 0-134 months). Results: Kaplan-Meier estimates of locoregional relapse-free survival, disease-specific survival, and overall survival at 4 years were 79%, 76%, and 73%, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior locoregional relapse-free survival, whereas high-risk histologic features, M1 disease, and gross residual disease predicted for inferior disease-specific and overall survival. The IMRT did not impact on survival outcomes, but was associated with less frequent severe late morbidity (12% vs. 2%). Conclusions: Postoperative conformal EBRT provides durable locoregional disease control for patients with high-risk differentiated thyroid cancer if disease is reduced to microscopic burden. Patients with gross disease face significantly worse outcomes. The IMRT may significantly reduce chronic radiation morbidity, but requires additional study.
- OSTI ID:
- 21276900
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 74, Issue 4; Other Information: DOI: 10.1016/j.ijrobp.2008.09.023; PII: S0360-3016(08)03497-4; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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