CLINICAL OUTCOME OF PATIENTS WITH PAPILLARY THYROID-CARCINOMA WHO HAVE RECURRENCE AFTER INITIAL RADIOACTIVE IODINE THERAPY

BACKGROUND. Among patients with well differentiated papillary thyroid carcinoma who generally have an excellent prognosis and a near-normal lifespan, there exist subsets of patients who have significant risk fo r morbidity and mortality from this disease. It is important to define the patterns of disease progression and the clinical outcome of such patients to develop effective surveillance and treatment strategies. P atients with recurrence after surgery and therapeutic administration o f radioactive iodine (RAI) for papillary thyroid carcinoma represent o ne such subset of highrisk patients. METHODS, At The University of Tex as M. D. Anderson Cancer Center, 65 patients with papillary thyroid ca rcinoma were diagnosed between 1970 and 1990. Their medical records we re reviewed with particular attention to disease recurrence and outcom e as well as RAI imaging and treatment. RESULTS, Following diagnosis a nd initial therapy, 19 patients died from thyroid carcinoma after a me dian of 64 months; 34 had no evidence of disease for a median of 112 m onths of available follow-up; and 7 are alive with disease 61 to 153 m onths after diagnosis. Cervical lymph node metastases were present in 41 patients and extrathyroidal or extranodal tumor invasion was seen i n 25 patients at the time of initial surgery; distant metastases (lung , bone, brain, Liver, and adrenal) developed later in 18 patients. RAI uptake by recurrent tumor deposits in the neck was seen most frequent ly in patients with no direct invasion of adjacent tissues but with re currence limited to cervical lymphadenopathy; this group of patients w as the most Likely to become clinically and radiologically disease fre e. RAI generally did not concentrate in invasive cancers with extrathy roidal or extranodal extension in the neck; patients with this type of invasive carcinoma were also more likely to die from the disease. CON CLUSIONS, We suggest that among patients with recurrent papillary thyr oid carcinoma, invasive cancers are less likely to concentrate RAI, wh ereas patients with disease confined to lymph nodes are more likely to have RAI-avid tumors and to benefit from RAI therapy. (C) 1996 Americ an Cancer Society.