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Treatment and follow-up of metastatic thyroid carcinoma: Experience of the Sestre Milosrdnice University Hospital 1969-1999

Distant metastases (DM) are the most challenging issue in the management of patients (pts) with differentiated thyroid carcinoma (DTC). From the general series of 677 DTC pts followed-up from 1969-1998 we evaluated 74 (11%) pts with DM (papillary: 41; follicular: 33; women: 53; men: 21; mean age at diagnosis: 48,2 yrs). Follow-up ranged from 1-23 yrs. Evident DM at the primary tumor diagnosis had 27 (66%) of papillary DTC pts, and 19 (58%) of follicular DTC pts. Remaining pts had post-operative disease-free intervals from 0.5-15 yrs. There were 14/74 (19%) DM pts < 30 yrs (group A); 35/74 (47%) DM pts from 30-60 yrs (group B) and 25/74 (34%) DM pts > 60 yrs (group C). Pulmonary DM (PuM) alone were detected in 64% group A pts, 60% of group B pts and 28% group C pts. Skeletal DM (SkM) alone were detected in 1 group A pt; 20% group B pts and 36% group C pts. Joined PuM and SkM were diagnosed in 28% group A pts; 17% group B pts; and 28% group C pts. 1 group B and 1 group C pt had multiple organ DM. 131-I uptake had 93% group A pts; 77% group B pts; and 68% group C pts. 58/74 (78%) of DM pts were treated with 131-I, dose range 2.2-39.8 GBq (average 11.95 GBq). Remaining 14/74 (19%) pts were treated with external radiotherapy and chemotherapy. Following 131-I complete DM remission was observed in 27/58 (46%) pts; with 54% PuM pts. Some clinical improvement showed 15/58 (26%) pts. Remaining 16/58 (28%) pts had no therapeutic benefit from 131-I; with 30% SkM pts. Other therapeutic modalities were palliative. Tumor related mortality for all DM pts was 52%; and only 7% in group A. Successful treatment outcome could be expected in younger DTC pts with PuM alone present, accumulating 131-I. In conclusion, important prognostic factors in DTC pts with DM are patient age, extent and localization of metastatic spread as well as tumor’s ability to accumulate 131-I.

Treatment and follow-up of metastatic thyroid carcinoma: Experience of the Sestre Milosrdnice University Hospital 1969-1999

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