title: Role of external beam radiotherapy in patients with advanced or recurrent nonanaplastic thyroid cancer: Memorial Sloan-kettering Cancer Center experience.
abstract: OBJECTIVE
  External beam radiotherapy (EBRT) plays a controversial role in the management of nonanaplastic thyroid cancer. We reviewed our institution's outcomes in patients treated with EBRT for advanced or recurrent nonanaplastic thyroid cancer.
  
  
  METHODS
  Between April 1989 and April 2006, 76 patients with nonanaplastic thyroid cancer were treated with EBRT. The median follow-up for the surviving patients was 35.3 months (range, 4.2-178.4). The lesions were primarily advanced and included Stage T2 in 5 (7%), T3 in 5 (7%), and T4 in 64 (84%) patients. Stage N1 disease was present in 60 patients (79%). Distant metastases before EBRT were identified in 27 patients (36%). The median total EBRT dose delivered was 6,300 cGy. The histologic features examined included medullary in 12 patients (16%) and nonmedullary in 64 (84%). Of the 76 patients, 71 (93%) had undergone surgery before RT, and radioactive iodine treatment was used in 56 patients (74%).
  
  
  RESULTS
  The 2- and 4-year overall locoregional control rate for all histologic types was 86% and 72%, respectively, and the 2- and 4-year overall survival rate for all patients was 74% and 55%, respectively. No significant differences were found in locoregional control, overall survival, or distant metastases-free survival for patients with complete resection, microscopic residual disease, or gross residual disease. Grade 3 acute mucositis and dysphagia occurred in 14 (18%) and 24 (32%) patients, respectively. Late adverse toxicity was notable for percutaneous endoscopic gastrostomy tube use in 4 patients (5%).
  
  
  CONCLUSIONS
  The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced or recurrent nonanaplastic thyroid malignancies, with acceptable acute toxicity.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. terezaks@mskcc.org
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Terezakis
authors.forename: Kyungmouk S
authors.initials: KS
authors.lastname: Lee
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Ghossein
authors.forename: Michael
authors.initials: M
authors.lastname: Rivera
authors.forename: Robert M
authors.initials: RM
authors.lastname: Tuttle
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: David G
authors.initials: DG
authors.lastname: Pfister
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002173:Cancer Care Facilities; D018276:Carcinoma, Medullary / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018365:Neoplasm, Residual; D009519:New York City; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D047368:Tumor Burden