Special ssue Postoperative Adjuvant Therapy and Follow Up of Thyroid Carcinoma Ka Hee Yi, M.D. Department of nternal Medicine Korea Cancer Center Hospital Email : khyi@kcch.re.kr Abstract Differentiated thyroid cancer is usually a curable disease, for which treatment modalities such as surgery, radioiodine, and thyroid hormone have been used for the last 50 years, yet little consensus has been established due to the lack of prospective randomized controlled therapeutic trials. After an initial surgery, the patients' outcome can be predicted by staging classification on the basis of several parameters such as the age of the patient, tumor size, tumor grade or differentiation, presence of local invasion, and regional or distant metastases. However, regardless of the pathologic stage, most patients(except those with micopapillary or minimally invasive follicular carcinomas who underwent only a lobectomies) are supposed to receive radioiodine therapy for ablation of any remnant thyroid tissue, which increases the sensitivity of serum Tg and 131 whole body scan used to detect recurrence or metastasis during a longterm followup. Until recently, a high dose of 131 has been preferred, however, low dose therapy(30mci) is a new trend nowadays, which decreases the incidence of both acute and late complications of radioiodine with the same ablation rate. All patients take thyroid hormone after surgery and radioremnant ablation to suppress the level of serum TSH, which is thought to stimulate tumor cell growth.the T 4 dose should be adjusted according to the age of the patient, other medical conditions and the risk of recurrence. During the followup, the serum Tg level with antitg antibody and the TSH level and 131 whole body scan should be checked regularly. Recently the serum Tg level stimulated by T 4 withdrawal or rhtsh injection is suggested to be the most sensitive marker for the detection of recurrence or metastasis. When the stimulated Tg is undetectable (< 2ng/mL), residual or metastatic cancer can be nearly excluded; when it is higher than 10ng/mL, a high dose 131 therapy and posttherapy 131 whole body scan are needed. n cases where the localization fails(tgpositive/ 131 scannegative cases), other imaging studies such as highresolution ultrasonography of the neck, spiral CT of chest, bone Xray or 99m Tc MDP bone scan and 18 FFDG PET scan can be useful. 18 FFDG PET is especially sensitive to detect poorly differentiated thyroid cancers that have lost the ability to uptake radioiodine. Keywords : Thyroid cancer; Staging; Radioiodine; Thyroid hormone; Follow up 1183
Special ssue (AJCC) Stage 4545 M0 T1 T1 M1 T2 T2~4 VA VB VC T3N0M0 T13N1aM0 T4a N1b T4b M1 N1 M1 1184
Staging or Scoring System EORTC AGES AMES U of C MACS OSU MSKCC (1979) (1987) (1988) (1990) (1993) (1994) (1995) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 :, :, : EORTC = European Organization for Research and Treatment of Cancer AGES ; Lahey clinic AMES, MACS ; Mayo clinic U of C = University of Chicago OSU = Ohio State University MSKCC = Memorial SloanKettering Cancer Center ü 1185
Special ssue National Thyroid Cancer Treatment Cooperation Study Registry (cm) < 1 1~4 > 4 45 45 45 45, V V 1186
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