[Role of non surgical therapeutics in the treatment of patients with medullary cancer of the thyroid].
Medullary thyroid carcinoma (MTC) is a rare endocrine tumour secreting the calcitonin (CT), its main tumoral marker, occuring as a sporadic or a familial disease. These diseases are associated with a 5-years prognostic from less than 50 to 100%, depending on the tumoral stage at the diagnosis time. The surgical management is demonstrated to be able to obtain a biological recovery in some patients. The other therapeutic means have no or poorly effects on the MTC evolution. Partial and transient responses are described for 15 to 20% of the patients with the use of multiple trials of chemotherapy. The external radiotherapy may have some little effects on local tumoral involvement without influence on the survival rates as compared to the surgery alone. The hormonal therapy with somatostatin analogues and the metabolic scintigraphies using MIBG, somatostatine analogues, radio-active iodine have no therapeutic effects demonstrated. The development of targeted therapy by the use of specific monoclonal antibodies, such as anti-CEA radiolabeled antibodies, is to be evaluated. The prognostic factors, as defined in large series of patients studied, does not necessary reflect the aggressiveness of the tumour. Thus, the therapeutic approach of MTC patients must take into consideration that the biologic activity of the disease does not implicate an aggressive disease. The evaluation of CT and CEA circulating levels remains of prognostic value and a useful tool for the practicians for the management of MTC patients.
Guliana
J M
JM
Service d'Endocrinologie Diabétologie, Hôpital Saint-Antoine, Paris.
D018276:Carcinoma, Medullary / Q000601:surgery / Q000628:therapy*; D006801:Humans; D013964:Thyroid Neoplasms / Q000601:surgery / Q000628:therapy*
Place des thérapeutiques non chirurgicales dans le traitement des patients atteints de cancer médullaire de la thyroïde.