Locally invasive thyroid cancer: options for a treatment

Abstract

Local invasion to neighbor organs by thyroid cancer is an important prognosticator and requires different therapeutic approach. Which one is the possible best treatment option and results are evaluated in this study. A single-institution experience in thyroid cancer invading the airway is evaluated retrospectively (1990–2016). Facts regarding patients’ demographics, disease history, comorbidities, condition at first evaluation and reason for referral are analyzed. Hospital records and treatment details are extracted from charts and Institutional folders. Therapeutic indication and treatment option details are assessed. A total of 2203 thyroid cancer patients undergoing evaluation and treatment are found in the Institutional records. According to the current staging system, T4a cancers are 309. Airway has been compromised in 144 cases. All patients have been referred after receiving indicative workup imaging or airway-related symptoms. Well-differentiated histology is reported in 97; non-differentiated pattern is described in the remaining ones. Airway endoscopy is performed in all patients prior to every treatment planned. In 37 cases, the airway is found to get benefit from resection with curative intent; stenting has been indicated in 41 cases while tracheostomy has been performed in 44 cases as permanent treatment option. Rigid bronchoscopy is apparently a mandatory preliminary step for patients undergoing resection and reconstruction of a segmental airway tract. Tracheostomy is performed when the disease could not be submitted to exeresis or when the tumor biology shows a tumultuous disease. Forty patients had a stable symptoms relief after stenting. The rate of patients presenting with respiratory symptoms due to thyroid cancer infiltrating the airway is decreasing thank to screening programs and the greater attention to early detection. When possible, the segmental resection and reconstruction of the compromised airway produces good outcome and represents a surgical subspecialty requiring a multidisciplinary approach with specific technical competences. Stenting and tracheotomy are end-stage treatment with possible stable outcome for highly variable time span.