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Open Access Journal of Endocrinology Research Article 3 min read

Locally Advanced Thyroid Cancer, series of cases, January 2003 – December 2013

<p class="MsoNormal" style="margin-bottom: .0001pt, text-align: justify, text-justify: inter-ideograph, line-height: 150%, "><span style="font-family: 'Cambria', 'serif', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, ">Medrano F<sup>1*</sup>*, Morin L<sup>2</sup>, Palacios R<sup>3 </sup>and Torres E</span><span style="font-family: 'Cambria', 'serif', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, "><sup>4</sup></span></p>
* Corresponding author
ISSN: 2578-4641  10.23880/oaje-16000116  Received: October 27, 2017  Published: January 18, 2018
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Keywords
<p>Thyroid Radiotherapy Prognostic</p>
Abstract

<p>Objective: The aim of this study is to describe the patients characteristics, histophatologic type, prognosis factor, Shin’s classification and treatment in patients with locally advance thyroid cancer.</p> <p>Methods: Descriptive study. Series of case: 10 patients with diagnosis thyroid cancer locally advance. AMES was used as the prognosis factor system, Shin’s classification to locally advance. The univariatereview was realized with frequency and percentage.</p> <p>Results: 10 patients with locally advance thyroid cancer, 6 male and 4 female, the age range was between 42 and 86 years old, the media was 66.1 years old.</p>

Introduction

Locally advance thyroid cancer, represent between 15- 20% of them [1]. The most frequent presentation is a neck gross tumor. The fatal clinical debut is a patient with stridor and asfixia when arrive to the emergency room [2, 3, 4, 5]. The multimodal treatment with radiotherapy and chemotherapy is still in controversy. The overall survival is uncertain as shown in Figure 1 & 2.

Figure 1: Locally advance thyroid cancer and sex.
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Figure 1: Locally advance thyroid cancer and sex.
Figure 2: Locally advance thyroid cancer and age group. The histophatologic type was papillary cancer 70%, Anaplastic cancer 20% and Follicular cancer 10% in Figure 3.
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Figure 2: Locally advance thyroid cancer and age group. The histophatologic type was papillary cancer 70%, Anaplastic cancer 20% and Follicular cancer 10% in Figure 3.
Figure 3: Locally advance thyroid cancer and histophatologic subtype. With AMES prognostic factor 90% were patients with more than 45 years old, 40% with metastasis, 3 with lung metastasis and one patient with spinal metastasis. 100% patients with extra glandular extension and gross tumor major 4 cm [6,7] (Figure 4).
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Figure 3: Locally advance thyroid cancer and histophatologic subtype. With AMES prognostic factor 90% were patients with more than 45 years old, 40% with metastasis, 3 with lung metastasis and one patient with spinal metastasis. 100% patients with extra glandular extension and gross tumor major 4 cm [6,7] (Figure 4).
Figure 4: Locally advance thyroid cancer and AMES prognostic factor. 70% were III Stage, 30% II Stage Shin’s classification [8].
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Figure 4: Locally advance thyroid cancer and AMES prognostic factor. 70% were III Stage, 30% II Stage Shin’s classification [8].

The clinic presentation was neck gross tumor, in all patients, disphonia 50%, stridor 40%, hoarseness 50% and disphagia 30% in Figure 5A & 5B.

Figure 5
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Figure 5

Figure 5A: 58 year old man with gross anterior mass in the neck.

Figure 6: 59 years old woman Total thyroidectomy plus Shave laryngotracheal plus Reconstruction.
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Figure 6: 59 years old woman Total thyroidectomy plus Shave laryngotracheal plus Reconstruction.

Figure 5B: CT scan show thyroid cancer invading right larynx. The treatment was Total thyroidectomy plus shave laryngotracheal, plus left radical neck dissection, plus radiotherapy one patient. In Figure 6 Total thyroidectomy plus I-131 plus radiotherapy one patient, total thyroidectomy plus debulking, plus radiotherapy one patient, total thyroidectomy plus, radiotherapy one patient. Radiotherapy one patient, and two patients refused the treatment in Figure 6,7 [9, 10, 11, 12, 13, 14, 15].

Figure 7: 80 years old woman anaplastic cancer. In Figure 8, 3 patients tracheotomy palliative 30%.
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Figure 7: 80 years old woman anaplastic cancer. In Figure 8, 3 patients tracheotomy palliative 30%.
Figure 8
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Figure 8

Figure 8A: 75 years old man with larynx stridor.

Figure 8B: Rx after tracheostomy.

Conclusion

Locally advance thyroid cancer is the most frequent in the elder patients, gender male and papillary histophatologic type, with the majority of prognostic factor’s high risk and tracheal and larynx wall invasion, still is (in fact) multimodal treatment and controversial treatment.

References

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  2. Honings J, Stephen AE, Marres HA, Gaissert HA (2010) The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 120(4): 682-689.
  3. Lee YS, Chung WY, Chang HS, Park CS (2010) Treatment locally advance thyroid cancer invading great vessel. Inter actcardiovascular Thoracic Surgery 10(6): 1039-1041.
  4. A Shaha (2008) Air way management in anaplastic thyroid cancer. The Laryngoscope 118(7): 1195- 1198.
  5. A Shaha (2008) Revision of thyroid Surgery, technical considerations. Otolaryngol Clin N Am 41(6): 1169- 1183.
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  8. Shin DH, Mark EJ, Suen HC, Grillo HC (1993) athologic staging of papillary carcinoma of the thyroid with air way invasion. Hum Pathol 24(8): 866-870.
  9. Lee N, Tuttle M (2006) The Role of external beam radiotherapy in the thyroid cancer. Endo Releat Cancer 13(4): 971-977.
  10. A Shaha, Patel KN (2002) Locally advance thyroid cancer. Head and neck surgery 13(2): 112-116.
  11. Kowalsky LP, Filho JG (2002) Results of the treatment of locally invasive thyroid carcinoma. Head and Neck 24: 340-344.
  12. Kim KH, Sung MW, Chang KH, Kang BS (2000) Therapeutic dilemma in the management of thyroid cancer with laryngotracheal involvement. Otolarngol head and neck surgery 122(5): 763-767.
  13. Czaja J, McCaffrey TV (1997) Surgical management of laryngotracheal invasion of well differentiated thyroid cancer. Arch Otolarngol head and neck surg 123(5): 484-490.
  14. Namori H (1990) The incidence of laryngotracheal invasion and esophageal invasion by well differentiated thyroid carcinoma. J Surg Oncol 44: 78.
  15. Shah JP, Cody III HS (1981) locally invasive well differentiated thyroid cancer, 22 years experience of Memorial Sloan Kaettering cancer centers. Am J Surg 142(4): 480-483.
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@article{2018,
  title   = {Locally Advanced Thyroid Cancer, series of cases, January 2003 – December 2013},
  author  = {text-align: justify, text-justify: inter-ideograph, line-height: 150%, \">, \'serif\', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, \">Medrano F1, Morin L2, Palacios R3 and Torres E, \'serif\', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, \">4},
  journal = {Open Access Journal of Endocrinology},
  year    = {2018},
  volume  = {2},
  number  = {1},
  doi     = {10.23880/oaje-16000116}
}
text-align: justify, text-justify: inter-ideograph, line-height: 150%, ">, 'serif', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, ">Medrano F1, Morin L2, Palacios R3 and Torres E, 'serif', mso-ascii-theme-font: major-latin, mso-hansi-theme-font: major-latin, ">4 (2018). Locally Advanced Thyroid Cancer, series of cases, January 2003 – December 2013. Open Access Journal of Endocrinology, 2(1). https://doi.org/10.23880/oaje-16000116
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JO  - Open Access Journal of Endocrinology
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