Radiothérapie postopératoire des carcinomes médullaires de la thyroïde à haut risque de rechute locorégionale

Compagnon, F.; Zerdoud, Slimane; Rives, M.; Laprie, Anne; Sarini, J.; Grunenwald, Solange; Chaltiel, Léonor; Gräff, P.

doi:10.1016/j.canrad.2016.05.010

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…analyzed a group of 51 patients and concluded that radiotherapy could be used to improve local control in patients after non-radical surgical approach and recommended high radiation doses, at least 60 Gy (20). Similar results, supporting radiotherapy in MTC, were published in 2016 (14). Compagnon et al .…”

Section: Discussionsupporting

confidence: 88%

“…Compagnon et al . proposed to apply adjuvant radiotherapy after surgery in high-risk patients as a protective method providing a good local control (14). The authors of the most recent analysis, which involved a group of 302 MTC patients, among whom 51 patients after EBRT, suggested that EBRT should be considered in patients with positive surgical margins as it may improve local control rates (21).…”

Section: Discussionmentioning

confidence: 99%

“…However, the vast majority of them did not demonstrate any improvement in the survival of MTC patients (9, 10). Nevertheless, radiotherapy may result in a better locoregional control, particularly in patients showing a high risk of local MTC relapse (11, 12, 13, 14).…”

Section: Introductionmentioning

confidence: 99%

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The role of postoperative adjuvant radiotherapy in local recurrence risk in medullary thyroid carcinoma

Kukulska

Krajewska

Kołosza

et al. 2020

Endocrine Connections

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The value of postoperative radiotherapy in the treatment of medullary thyroid carcinoma (MTC) has not been unequivocally demonstrated. Therefore our study aimed to answer the question of whether adjuvant radiotherapy showed any impact on the risk of local recurrence and whether there were any differences in response to radiotherapy between hereditary and sporadic MTC. Methods A retrospective analysis involved 254 MTC patients, among them 73 patients with a hereditary disease. Two hundred and twenty-four patients, including 43 persons at a high risk of local relapse, underwent only initial surgery; 18 other patients were operated due to MTC recurrences, whereas the remaining 12 patients had cytoreductive procedure or were not amenable for surgery. Radiotherapy was carried out in 132 patients. One hundred and twenty patients underwent adjuvant radiotherapy, among them 102 patients after initial surgery. The median follow-up was 10 years (range 0.5–29 years). Results Local recurrence occurred in 107/254 patients, among them in 63 subjects after prior radiotherapy. The frequency of relapse showed significantly increasing trend toward higher MTC stages (P <0.001). More relapses occurred in patients with lymph node metastases present at MTC onset. Adjuvant radiotherapy was associated with a lower risk of nodal recurrence only in high-risk patients, particularly if lymph node metastases were present at MTC diagnosis. The differences between hereditary and sporadic subgroups were not significant. Conclusions Adjuvant radiotherapy has a limited importance in MTC treatment. It should be considered in high-risk MTC patients. The presence of RET mutation does not influence the response to radiation.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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The role of postoperative adjuvant radiotherapy in local recurrence risk in medullary thyroid carcinoma

Kukulska

Krajewska

Kołosza

et al. 2020

Endocrine Connections

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“…Similarly, in the sub-group of patients without medullar thyroid cancer patients, LRF remained lower in pEBRT patients after IPTW method (HR 0.25; 95% CI, 0.13–0.49, p < 0.001). However, patients with medullary thyroid cancer did not receive radioiodine per standard of care and also benefited from pEBRT; thus, the question of pEBRT is also relevant in this subtype of non-anaplastic carcinomas [19]. Similarly, PDTC had poorer prognosis, but also benefitted from pEBRT.…”

Section: Discussionmentioning

confidence: 99%

10-Year Locoregional Control with Postoperative External Beam Radiotherapy in Patients with Locally Advanced High-Risk Non-Anaplastic Thyroid Carcinoma De Novo or at Relapse, a Propensity Score Analysis

Vernat

Khalifa

Sun

et al. 2019

Cancers

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(1) Background: To assess the role of postoperative external beam radiotherapy (pEBRT) on locoregional failure (LRF) for patients with locally advanced high-risk non-anaplastic thyroid carcinoma (naTC) at primary event or relapse. (2) Methods: Between 1995 and 2015, postoperative naTC patients with a theoretical indication for EBRT were included based on criteria that were common to American-British-French current guidelines, i.e., pT3-4, pN+, gross or microscopic residual disease. Inverse probability of treatment weighting (IPTW) after multiple imputation was used to reduce selection biases. (3) Results: Of 254 naTC patients, 216 patients underwent pEBRT (106 de novo, 110 at relapse, median dose 60 Gy) and 38 underwent surgery only. pEBRT patients had more gross residual disease, a major prognostic factor (p = 0.027) but less perineural invasion (p = 0.008) or lymphovascular emboli (p = 0.009). pEBRT patients more frequently underwent radioiodine therapy (p = 0.026). The 10-year cumulative incidence of LRF was 56% (95% CI, 32–74%) in operated patients, and 23% (95% CI, 17–30%) in pEBRT patients. After IPTW method, pEBRT reduced the risk of LRF (hazard ratio 0.30; 95% CI [0.18–0.49], p < 0.001), but had no impact on OS. In the pEBRT group, non-Intensity Modulated RadioTherapy (IMRT) plans and interruption of the radiotherapy were associated with poorer survival, while extended versus limited field strategy and dose were not. (4) Conclusions: In naTC patients who have pT3-4, pN+ disease or R1-2 resection, pEBRT improved LRF. Limited-field IMRT is preferred.

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“…The role of radiotherapy in MTC has been confined to patients in whom surgical treatment or the administration of tyrosine kinase inhibitors are not possible or contraindicated. Published data regarding the effectiveness of radiotherapy are equivocal [ 7 – 11 ]. It is routinely applied as palliative therapy.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiotherapy is a useful treatment option for patients with medullary thyroid cancer

et al. 2021

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The role of radiotherapy in advanced medullary thyroid carcinoma (MTC) is confined to patients in whom surgical treatment or the administration of tyrosine kinase inhibitors are not possible or contraindicated. High fractionated radiation doses during radiosurgery or fractionated stereotactic radiotherapy are applied to reduce cancer-related symptoms and stabilize irradiated lesions. This study aimed to retrospectively evaluate the therapeutic effect of stereotactic radiotherapy in MTC patients. Material and methods The study group involved 11 MTC patients, treated due to 16 cancer lesions, mainly bone metastases (10 lesions), lymph node (2 lesions) metastases, or liver metastases (2 lesions), one primary thyroid tumor, and one MTC recurrence in the thyroid bed. The fractionated and total radiation doses ranged between 5 and 12 Gy and 8–44 Gy, respectively. Six lesions were treated with a single radiation fraction, three lesions with 2 fractions, another 6 lesions with 3 fractions, whereas the remaining one metastatic lesion with 9 fractions of stereotactic radiosurgery. Results The beneficial effect of stereotactic radiosurgery was obtained in all treated lesions. None of treated lesions progressed in the further disease course. Fourteen lesions were stable (87.5 %), including eight lesions showing progression before radiosurgery (good response). Disease control was obtained in all soft-tissue metastases. Regarding bone metastases, partial regression was achieved in 20 % lesions, whereas in 30 % lesions progressive before radiotherapy, the treatment led to disease stabilization. Conclusions Our data pointed to the effectiveness of high-dose fractionated radiotherapy in MTC. However, an observation of a larger group of patients is required to confirm it.

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Radiothérapie postopératoire des carcinomes médullaires de la thyroïde à haut risque de rechute locorégionale

Cited by 8 publications

References 29 publications

The role of postoperative adjuvant radiotherapy in local recurrence risk in medullary thyroid carcinoma

The role of postoperative adjuvant radiotherapy in local recurrence risk in medullary thyroid carcinoma

10-Year Locoregional Control with Postoperative External Beam Radiotherapy in Patients with Locally Advanced High-Risk Non-Anaplastic Thyroid Carcinoma De Novo or at Relapse, a Propensity Score Analysis

Stereotactic radiotherapy is a useful treatment option for patients with medullary thyroid cancer

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