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See Latest ArticlesThe role of external beam radiation in recurrent differentiated thyroid cancer
Australian and New Zealand Journal of Surgery, 05/04/09
Allison R - In a review of the role of external beam radiation (EBR) in recurrent differentiated thyroid cancer, it appears that extra cervical metastatic disease, which is iodine non-avid or non-responsive and symptomatic, is best palliated by EBR. Often a short course of 20 Gy in 5 fractions may suffice but with oligometastases in structurally important bones a more prolonged course aimed at local control is appropriate. Inoperable primary disease, whilst often iodine avid, rarely responds sufficiently to control the disease and EBR is helpful in providing local control.
Methods- As with other tumours, local control at the thoracic inlet is highly desirable to prevent strangulation, fungation, and dysphagia.
- Current standard chemotherapy has no well defined role.
- Newer agents, such as tyrosine kinase inhibitors and angiogenic agents, are starting to show promise.
- EBR treatment is very effective in establishing local control but the dose required is high in the range of 60 Gy and the target volume is often large.
- Whilst the acute side effects settle quickly, the late effects of atrophy and fibrosis and possible induction of second malignancy may be considerable.
- The question is then one of the timing of this intervention, given the growth pattern and the potentially long natural history of these tumours.
- Treatment delivery has been markedly improved by modern imaging planning techniques.
- Optimal timing of this intervention mandates close cooperation between oncologists and surgeons.
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