Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer

Outcomes and Morbidity With Conformal Treatment

David Schwartz, Mark J. Lobo, K. Kian Ang, William H. Morrison, David I. Rosenthal, Anesa Ahamad, Douglas B. Evans, Gary Clayman, Steven I. Sherman, Adam S. Garden

Research output: Contribution to journalArticle

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Abstract

Purpose: To review institutional outcomes for patients treated for differentiated thyroid cancer with postoperative conformal external beam radiotherapy (EBRT). Methods and Materials: This is a single-institution retrospective review of 131 consecutive patients with differentiated thyroid cancer who underwent EBRT between January 1996 and December 2005. Histologic diagnoses included 104 papillary, 21 follicular, and six mixed papillary-follicular types. American Joint Committee on Cancer stage distribution was Stage III in 2 patients, Stage IVa-IVc in 128, and not assessable in 1. Thirty-four patients (26%) had high-risk histologic types and 76 (58%) had recurrent disease. Extraglandular disease spread was seen in 126 patients (96%), microscopically positive surgical margins were seen in 62 patients (47%), and gross residual disease was seen in 15 patients (11%). Median EBRT dose was 60 Gy (range, 38-72 Gy). Fifty-seven patients (44%) were treated with intensity-modulated radiotherapy (IMRT) to a median dose of 60 Gy (range, 56-66 Gy). Median follow-up was 38 months (range, 0-134 months). Results: Kaplan-Meier estimates of locoregional relapse-free survival, disease-specific survival, and overall survival at 4 years were 79%, 76%, and 73%, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior locoregional relapse-free survival, whereas high-risk histologic features, M1 disease, and gross residual disease predicted for inferior disease-specific and overall survival. The IMRT did not impact on survival outcomes, but was associated with less frequent severe late morbidity (12% vs. 2%). Conclusions: Postoperative conformal EBRT provides durable locoregional disease control for patients with high-risk differentiated thyroid cancer if disease is reduced to microscopic burden. Patients with gross disease face significantly worse outcomes. The IMRT may significantly reduce chronic radiation morbidity, but requires additional study.

Original languageEnglish (US)
Pages (from-to)1083-1091
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number4
DOIs
StatePublished - Jul 15 2009

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Thyroid Neoplasms
radiation therapy
Radiotherapy
cancer
Morbidity
Intensity-Modulated Radiotherapy
Survival
Therapeutics
Recurrence
dosage
Thyroid Diseases
Kaplan-Meier Estimate
Disease-Free Survival
Multivariate Analysis
margins
Radiation

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer : Outcomes and Morbidity With Conformal Treatment. / Schwartz, David; Lobo, Mark J.; Ang, K. Kian; Morrison, William H.; Rosenthal, David I.; Ahamad, Anesa; Evans, Douglas B.; Clayman, Gary; Sherman, Steven I.; Garden, Adam S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 4, 15.07.2009, p. 1083-1091.

Research output: Contribution to journalArticle

Schwartz, David ; Lobo, Mark J. ; Ang, K. Kian ; Morrison, William H. ; Rosenthal, David I. ; Ahamad, Anesa ; Evans, Douglas B. ; Clayman, Gary ; Sherman, Steven I. ; Garden, Adam S. / Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer : Outcomes and Morbidity With Conformal Treatment. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 74, No. 4. pp. 1083-1091.
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abstract = "Purpose: To review institutional outcomes for patients treated for differentiated thyroid cancer with postoperative conformal external beam radiotherapy (EBRT). Methods and Materials: This is a single-institution retrospective review of 131 consecutive patients with differentiated thyroid cancer who underwent EBRT between January 1996 and December 2005. Histologic diagnoses included 104 papillary, 21 follicular, and six mixed papillary-follicular types. American Joint Committee on Cancer stage distribution was Stage III in 2 patients, Stage IVa-IVc in 128, and not assessable in 1. Thirty-four patients (26{\%}) had high-risk histologic types and 76 (58{\%}) had recurrent disease. Extraglandular disease spread was seen in 126 patients (96{\%}), microscopically positive surgical margins were seen in 62 patients (47{\%}), and gross residual disease was seen in 15 patients (11{\%}). Median EBRT dose was 60 Gy (range, 38-72 Gy). Fifty-seven patients (44{\%}) were treated with intensity-modulated radiotherapy (IMRT) to a median dose of 60 Gy (range, 56-66 Gy). Median follow-up was 38 months (range, 0-134 months). Results: Kaplan-Meier estimates of locoregional relapse-free survival, disease-specific survival, and overall survival at 4 years were 79{\%}, 76{\%}, and 73{\%}, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior locoregional relapse-free survival, whereas high-risk histologic features, M1 disease, and gross residual disease predicted for inferior disease-specific and overall survival. The IMRT did not impact on survival outcomes, but was associated with less frequent severe late morbidity (12{\%} vs. 2{\%}). Conclusions: Postoperative conformal EBRT provides durable locoregional disease control for patients with high-risk differentiated thyroid cancer if disease is reduced to microscopic burden. Patients with gross disease face significantly worse outcomes. The IMRT may significantly reduce chronic radiation morbidity, but requires additional study.",
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AU - Morrison, William H.

AU - Rosenthal, David I.

AU - Ahamad, Anesa

AU - Evans, Douglas B.

AU - Clayman, Gary

AU - Sherman, Steven I.

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