Role of metastasectomy in the management of thyroid carcinoma: the NIH experience.
OBJECTIVE
We studied the impact of metatasectomy on disease outcome in 29 advanced nonmedullary thyroid carcinoma (ThyrCa) patients who were operated on between 1969 and 2001 at NIH to further define its role in the management of this malignancy.


METHODS
Data were extracted by retrospective chart review. A Kaplan-Meyer survival curve was constructed, and comparative stratification for various parameters was performed.


RESULTS
During 47 surgeries, the following lesions were resected from mid-mediastinum/hila, 17; lung parenchyma, 12; skeleton, 14; kidneys, 2; and brain, 2. All patients received multiple radioiodine (RAI) treatments. External-beam radiotherapy, chemotherapy and other palliative measures were used in selected patients. Six patients (21%) died within 74.7 +/- 54.7 months after the first distant metastasectomy. The outcome of the remaining patients was as follows: complete remission, 3; partial remission, 10; and 10: progressive disease, 10, with a follow-up of 175 patient-years. Metastasectomy led to a decrease of 38% in thyroglobulin levels in 23 patients. Cumulative survival rates were 78.5 +/- 8.4% at 5 years and 50.2 +/- 12.5% at 10 years (mean +/-SEM) after initial distant metastasectomy.


CONCLUSIONS
Our data show that extensive targeted metastasectomy in the setting of a tertiary center can be beneficial to patients with disseminated ThyrCa with persistent or recurrent distant disease, when used in conjunction with nonsurgical treatment modalities.
Pak
Ho
H
Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1758, USA.
Gourgiotis
Loukas
L
Chang
Wen-I
WI
Guthrie
Lori C
LC
Skarulis
Monica C
MC
Reynolds
James C
JC
Merino
Maria J
MJ
Schrump
David S
DS
Libutti
Steven K
SK
Alexander
H Richard
HR
Sarlis
Nicholas J
NJ
D018263:Adenocarcinoma, Follicular / Q000556:secondary* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009362:Neoplasm Metastasis / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
D007457:Iodine Radioisotopes