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Nuklearmedizin 2009; 48(03): 89-98
DOI: 10.3413/nukmed-0221
Original article
Schattauer GmbH

Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer

Results after 874 patient-years of follow-up in the MSDS-trialKlinische Resultate der adjuvanten perkutanen Strahlentherapie bei differenziertem Schild-drüsenkarzinomErgebnisse der MSDS-Studie nach 874 Patient jahren Nachbeobachtungszeit
M. Biermann   *
1   Department of Radiology, Haukeland University Hospital, Bergen, Norway
,
M. K. Pixberg   *
2   Department of Nuclear Medicine, Münster University, Germany
,
B. Riemann   *
2   Department of Nuclear Medicine, Münster University, Germany
,
A. Schuck   *
3   Department of Radiooncology, Münster University, Germany
,
A. Heinecke   *
4   Department of Biometrics, Münster University, Germany
,
K. W. Schmid   *
5   Institute of Pathology and Neuropathology, University Hospital of Essen, West German Cancer Center, University of Duisburg-Essen, Germany
,
N. Willich   *
3   Department of Radiooncology, Münster University, Germany
,
H. Dralle   *
6   Department of General Surgery, University Halle-Wittenberg, Halle, Germany
,
O. Schober   *
2   Department of Nuclear Medicine, Münster University, Germany
› Author Affiliations
Further Information

Publication History

received: 25 October 2008

accepted in revised form: 26 March 2008

Publication Date:
22 January 2018 (online)

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Summary

Aim: Evaluate the clinical benefit of external beam radiotherapy (RTx) for locally invasive thyroid carcinoma with follicular cell differentiation (DTC). Patients, methods: The Multicentre Study on Differentiated Thyroid Cancer (MSDS) was planned as a prospective multicenter trial on the benefit of adjuvant RTx in locally invasive DTC (pT4; UICC 1997) with or without lymph node metastases and no known distant metastases. All patients were treated with thyroidectomy, 131I-therapy, and TSH-suppression and were randomized to receive additional RTx or not. In 4/2003 the trial became a prospective cohort study after only 45 of then 311 patients had consented to randomization. 351 of 422 patients met the trial's inclusion criteria. Age was 48 ± 12 years (mean ± SD). 25% were men. Tumours were papillary in 90% and follicular in 10%. Of 47 patients randomized or allocated to RTx, 26 actually received RTx. Results: Mean followup was 930 days. In an actual treatment analysis, 96% (25/26) of the RTx-patients reached complete remission (CR) vs. 86% in the non-RTx patients. Recurrences occurred in 0 vs. 3 % of patients: 6 reoperated for regional lymph node metastases, 1 tracheal invasion treated with tracheoplasty, 1 local invasion necessitating laryngectomy, 2 distant metastases (1 lung, 1 lung + bone). Serious chronic RTx toxicity occurred in 1/26 patients. Conclusion: The MSDS trial showed low mortality and recurrence rates and a weak benefit of RTx in terms of local control that did however not reach statistical significance. Routine RTx in locally invasive DTC can no longer be recommended .

Zusammenfassung

Ziel: Nachweis des klinischen Nutzens der adjuvanten perkutanen Strahlentherapie für lokal organüberschreitendes Schilddrüsenkarzinom mit Follikelzelldifferenzierung (DTC). Patienten, Methoden: Die Multizentrische Studie Differenziertes Schilddrüsenkarzinom (MSDS) war ge-plant als prospektive randomisierte Multizenterstudie zum Nutzen der adjuvanten perkutanen Radiatio bei lokal überschreitendem DTC (pT4; UICC 1997) mit oder ohne Lymphknotenmetastasen und ohne Fernmetastasen. Die Behandlung umfasste Thyreoidektomie, Radioiodablation und TSH-Suppressionsterapie sowie randomisiert die zusätzliche perkutane Radiatio. 4/2003 wurde die Studie als prospektive Kohortenstudie weitergeführt, nachdem lediglich 45 von 311 Patienten in die Randomisierung eingewilligt hatten. 351 von 422 erfüllten die Einschlußkriterien. Das mittlere Alter betrug 48 ± 12 Jahre (± Standardabweichung) bei einem Anteil männlicher Patienten von 25%. 90% der Tumoren waren papillär, 10% follikulär. Von 47 Patienten, die der Radiatio zugewiesen worden waren, wurden 26 bestrahlt. Ergebnisse: Die mittlere Nachsorgeperiode ist 930 Tage. 96% (25/26) der bestrahlten Patienten erreichen eine komplette Remission gegenüber 86% der nicht bestrahlten. Rezidive ereigneten sich bei keinem der bestrahlten und 3% der nicht-bestrahlten Patienten: 6 Rezidivoperationen wegen regionaler Lymphknotenmetastasen, 1 Trachealinvasion (behandelt mit Tracheoplastie) und 1 Lokalinvasion (Laryngektomie) und 2 Patienten mit Fernmetastasen (1 Lunge, 1 Lunge und Skelett). Bei 1/26 Patienten führte die Radiatio zu schwerer chronischer Toxizität. Schlussfolgerung: Die MSDS-Studie ergab niedrige Letalität und Rezidivraten. Eine geringgradige Verbesserung der lokalen Kontrolle durch die Radiatio war statistisch nicht signifikant. Die routinemäßige Radiatio kann bei lokal invasivem DTC nicht länger empfohlen werden.

Keywords

Thyroid cancer - external beam radiotherapy - radioiodine treatment - survival

Schlüsselwörter

Schilddrüsenkarzinom - perkutane Strahlentherapie - Radioiodablation - Überleben

* for the MSDS study group


 

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