Treatment and prognosis in follicular and papillary carcinoma of the thyroid

The course in 200 patients with papillary or follicular thyroid cancer is reported. Treatment included: subtotal lobectomy or thyroidectomy, total lobectomy and subtotal lobectomy on the contralateral side, excision of clinically enlarged cervical nodes, elimination of residual thyroid tissue by 131-iodine, in the majority of the patients percutaneous irradiation of the cervical region and diagnostic as well as therapeutic 131-iodine applications at later dates and thyroid hormone substitution. 10-year survival rates are: between 80 and 100% in patients with early stages of papillary or follicular cancer or in patients under the age 40 at the time of diagnosis, between 50 and 70% in patients with locoregional advanced papillary cancer, about 60% in patients with papillary cancer and distant metastases and about 20% in patients with follicular cancer and distant metastases. The frequency of clinically manifest locoregional recurrences was not greater than after radical surgical treatment in the published data. In eradicating occult manifestations, the efficiency of percutaneous irradiation of the lower cervical and upper mediastinal region is stressed. This treatment can reduce the whole-body radiation dose by reducing the number of later 131-iodine applications for locoregional tumour manifestations. The importance of early treatment of distant metastases is noted and the limitations of 131-iodine treatment are stressed: in large tumors, there is a decrease of iodide clearance (per gr) and the tolerated activity of 131-iodine is limited by the whole-body radiation dose. In these cases, additional surgery and percutaneous irradiation should be considered. In small tumors part of the beta-dose is deposited of the tumor. There is a discrepancy between the frequency of thyroid cancer in histological specimens of thyroid glands in autopsies and the frequency of clinically symptomatic thyroid cancer. (orig./AJ)