CASE REPORT
The paper describes the author’s practice case of successful radiotherapy (gamma-teletherapy) using the radio modifier 5-fluorouracil for squamous cell carcinoma of the palatine tonsils and surgery for metachronous papillary thyroid cancer occurring 15 years later.
DIAGNOSIS AND TREATMENT OF HEAD AND NECK TUMORS
Levothyroxine therapy with purpose to suppress thyroid stimulating hormone (TSH) after surgery in patients with well-differentiated thyroid cancer is implemented since 1937. Accumulated results of levothyroxine suppressive therapy (LST) application are attesting its heterogeneous efficacy in various risk groups of tumor recurrence: low, medium and high. Similar risk groups are emphasized towards adverse effect risk due to LST. The more intensivity and duration of TSH suppression the higher risk of adverse effects. First, they include osteopenia or osteoporosis and atrial fibrillation. Contemporary approaches to intensivity and duration of LTS are based on accounting of its potential efficiency into various clinical risk groups of tumor recurrence as well as adverse effects risk groups.
The paper deals with current trends in the diagnosis and treatment of locally advanced, recurrent and metastatic medullary and low-grade thyroid cancer. It highlights problems in the diagnosis and surgical treatment of this pathology on the basis of our clinic’s experience. Data on global trends in medical treatment for low-grade radioactive iodine therapy-refractory thyroid tumors, as well as disseminated and metastatic medullary cancer are given.
The paper gives the immediate and late (more than 10-year) results of central lymphadenectomy (CLAE) (removal of the 6th group of cervical lymph nodes) in 912 patients with primary thyroid cancer (TC) in the Saint Petersburg Center for Endocrine Surgery and Oncology in 1973 to 2011. It is established that CLAE under the visual guidance of recurrent laryngeal nerves and parathyroids should be simultaneously performed during all primary operations for differentiated TC. It is clearly brought out that precision surgical techniques can prevent severe complications – recurrent nerve injuries and hypothyroidism.
The paper presents many years’ international experience in treating medullary thyroid cancer (TC). Two hundred and forty-two patients with different stages of the disease were followed up. The morphological and genetic features of this tumor are given. The results of used treatment options for medullary cancer, such as surgical, radiation, multimodality, and drug therapies, are analyzed. Surgery is a leading treatment option for this disease. The volume of surgery on a primary tumor focus depends on both the shape of a (sporadic or hereditary) tumor and its sizes. Removal of pre- and paratracheal fat is indicated for any volume of surgery for TC due to the high risk of its metastases to lymph nodes at this site. For radiotherapy there are three main indications: 1) the dubious, macroscopically and microscopically evaluated efficiency of an operation; 2) inoperable cancer; 3) distant bone metastases for palliative and symptomatic care. The now chemicals available at an oncologist’s disposal exert no significant effect on increased survival in a patient with medullary TC.
Medullary thyroid carcinoma belongs to orphan diseases affecting a small part of the population. Multicenter trials are required to elaborate a diagnostic algorithm, to define treatment policy, and to predict an outcome.
To estimate the regional spread of low-grade thyroid cancer (TC) is a topical problem. The paper analyzes the problems of preoperative diagnosis of low-grade TC metastasizing to cervical lymph nodes (LN), which an oncologist faces. Primary ultrasonography (USG) of the neck is noted to have a low quality. The authors propose to use repeat (duplicate) USC of the neck during the clarifying diagnosis of TC and their developed method for USG of the cervical LN and the improved technique for determining the level of thyroglobulin in the cervical LN biopsy specimens. Introduction of these techniques could improve the preoperative diagnosis of low-grade TC metastases to the cervical LN.
ISSN 2411-4634 (Online)