Papillary and follicular thyroid carcinoma. Individualization of the treatment according to the prognosis of the disease.
A retrospective study of a continuous series of 152 patients is presented: the patients were treated between 1 January 1955 and 31 December 1981 for a papillary or a follicular thyroid carcinoma. The prognostic index, proposed by the EORTC Thyroid Cancer Cooperative Group in 1979, was calculated for each patient. According to the survival curves and recurrences after treatment, the study shows a clear-cut difference in prognosis if the prognostic index is below 50 or is equal to or above 50. This observation supports the proposal of minimal treatment for less aggressive tumors and extensive treatment for the high risk patients. The actual treatment plan is: (1) total lobectomy when the tumor is unilateral and the prognostic index below 50, but total thyroidectomy in the other cases; (2) lymph node surgery only in cases of node involvement. Instead of a radical neck dissection, a more conservative procedure should be performed, removing the lymphatic chains and preserving the sterno-cleidomastoid muscle, the internal jugular vein and the spinal accessory nerve; (3) no postoperative radioiodine for low risk patients with complete removal of the tumor; (4) postoperative thyroid hormone at doses suppressing secretion of TSH for all patients.
Andry
G
G
Department of Head and Neck Surgery, Institut Jules Bordet, Bruxelles, Belgium.
Chantrain
G
G
van Glabbeke
M
M
Dor
P
P
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy