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Influence of previous radiation exposure on pathologic features and clinical outcome in patients with thyroid cancer
Archives of Otolaryngology, 04/23/09

Seaberg RM et al. - In a trial to determine whether previous radiation exposure to the head and neck is related to less favorable pathologic and clinical outcome in pts after surgical management of thyroid cancer, it was concluded that pts who have been exposed to radiation have more aggressive disease and worse clinical outcome than other pts with thyroid cancer.

Methods

All pts with diagnosed thyroid cancer who had been exposed to radiation before surgical treatment were retrospectively identified from the thyroid cancer database.
125 pts (95 women and 30 men) were included.
Inclusion criteria included surgical treatment for thyroid cancer and a history of exposure to radiation at least 3 yrs before diagnosis.
Outcome measures included pathologic features and data related to disease recurrence, distant metastasis, and survival.

Results

Mean age at first exposure to radiation was 19.4 yrs, and mean lag time to diagnosis of disease was 28.7 yrs.
Pts were treated surgically with either total or near-total thyroidectomy (83%) or partial or subtotal thyroidectomy (17%).
Pathologic diagnoses included 111 papillary carcinomas (89%).
63% of pts had multifocal disease, 12% had lymphovascular tumor invasion, and 26% had direct extrathyroid extension of disease.
25% of pts had metastases to cervical lymph nodes, and 9% had distant metastases.
16% of pts experienced local recurrence of disease.
At last follow-up, 86% of pts were alive and free of disease, 8% were alive with disease, 4% had died of thyroid cancer, and 2% had died of an unrelated cause.
Compared with other pts with thyroid cancer, this radiation-exposed cohort was more likely to undergo total thyroidectomy, multiple operative procedures, and external radiotherapy.
A higher percentage had multifocal disease, extrathyroid extension, stage IV disease, and distant metastases.
At follow-up, fewer pts were free of disease, and more pts had died of thyroid disease.

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Reuters, 10/28/09 Relevance Score: 68%