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Locally unresectable differentiated thyroid cancer: outcomes and perspectives

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Abstract

Purpose

Differentiated thyroid cancer (DTC) patients with an unresectable primary tumor cannot benefit from curative surgery, and radioiodine treatment for locoregional and distant disease is not possible with the thyroid gland still in place. Due to local invasion, these patients cannot be included in clinical trials, so that treatment options are limited. The aim of this study was to describe the characteristics and the prognosis of patients with these locally unresectable DTC.

Patients and methods

A retrospective and multicentric analysis of consecutive cases of unresectable DTC diagnosed between 2000 and 2015 was performed.

Results

The study population consisted in 22 patients, 13 females (59%); median age: 77 years (range: 52–91). Thyroid tumors were papillary in six, follicular in seven, Hürthle cell in one and poorly differentiated in eight patients. Patients were treated with external beam radiation therapy (EBRT) (57%), locoregional therapy of distant metastases (41%), cytotoxic chemotherapy (38%) and tyrosine kinase inhibitors (TKIs) (33%). TKI treatment resulted in median disease control duration of 7 months with a grade 3–4 toxicity rate of 44%. Only one patient had a total thyroidectomy after neo-adjuvant EBRT. The 1, 3 and 5-year cumulative survival rate was 81%, 27.7% and 21.5%, respectively. The cause of death was DTC in 11 cases (local progression in 7), and to other causes in 7 cases; no patient died from treatment toxicity.

Conclusions

Clinical trials and approved treatments are lacking for unresectable DTC. TKI treatment may allow prolonged disease control with acceptable toxicity.

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Authors and Affiliations

  1. Département de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France

    L. Lamartina, J. Hadoux, A. Berdelou, M. Terroir, E. Baudin, M. Schlumberger & S. Leboulleux

  2. Département de Médecine Nucléaire, Institut Bergonié, 33076, Bordeaux, France

    Y. Godbert

  3. Département de Médecine Nucléaire, Hôpital René Huguenin-Institut Curie, 92210, St Cloud, France

    C. Nascimento & S. Hescot

  4. Département d’Endocrinologie, CHRU de Lille, 5900, Lille, France

    C. Do Cao

  5. Département de Biostatistique et épidémiologie, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France

    I. Borget

  6. Département de Biologie et pathologie médicales, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France

    A. Al Ghuzlan

  7. Département de Chirurgie Cervico-Faciale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France

    D. Hartl

  8. Département d’Imagerie médicale, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France

    E. Pottier & M. Attard

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  1. L. Lamartina
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  2. Y. Godbert
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  3. C. Nascimento
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  4. C. Do Cao
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with the support of the TUTHYREF network

Corresponding author

Correspondence to L. Lamartina.

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Conflict of interest

S.L. is a member of Sanofi Genzyme, EISAI, Loxo and Bayer Advisory Boards; has received research grants from Sanofi Genzyme, Novartis and Bayer. M.S. has received grants from Bayer, Eisai, Sanofi Genzyme and Exelixis-IPSEN; the other authors have nothing to disclose.

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All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Lamartina, L., Godbert, Y., Nascimento, C. et al. Locally unresectable differentiated thyroid cancer: outcomes and perspectives. Endocrine 69, 133–141 (2020). https://doi.org/10.1007/s12020-020-02245-0

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