MEDULLARY-THYROID CANCER - ANALYSES OF SURVIVAL AND PROGNOSTIC FACTORS AND THE ROLE OF RADIATION-THERAPY IN LOCAL-CONTROL

Records of 73 patients with medullary thyroid cancer were reviewed to assess prognostic factors and the role of external beam radiation ther apy. Patients were treated between 1954 and 1992. The median age was 4 9 years (range 15-85), M:F ratio 1.6:1, and the median follow-up was 7 .9 years. (2.5-34.6). The primary tumor size was <1 cm in 10%, 1-4 cm in 53%, and >4 cm in 37%. Multifocality was noted in 32%, and 23% had metastasis at presentation. Eight patients presented with inoperable t umors, 40% had gross, and 37% microscopic residual disease postthyroid ectomy. Extraglandular extension was present in 56%, and 74% had patho logically involved lymph nodes. Treatment was by total or near total t hyroidectomy in 41 patients; 37 had a lymph node dissection. Forty-six patients were irradiated, the dose of radiation ranging from 20 to 75 .5 Gy; median was 40 Gy, treatment time median was 28 days and the med ian number of fractions was 20. The overall cause specific survival (C SS) was 70% and 57% at 5 and 10 years, respectively. In a univariate a nalysis, the following factors predicted for lower CSS: age as a conti nuous variable (p = 0.003), male gender (p = 0.008), presence of dista nt metastasis (p < 0.0001), lymph node involvement (p = 0.03), gross r esidual disease (p < 0.0001), tumor size >4 cm (p = 0.05), extraglandu lar invasion (p < 0.004), vascular invasion (p = 0.007), diarrhea (p < .0007), and abnormal postoperative calcitonin (p = 0.02). On multivar iate analysis only two factors were significant: the presence of extra glandular invasion, and postoperative gross residual disease. There wa s no difference in local/regional relapse free rate between patients r eceiving external radiation and those that did not, but in 40 high ris k patients (microscopic residual disease, extraglandular invasion, or lymph node involvement), the local/regional relapse free rate was 86% at 10 years with postoperative external beam radiation (25 patients), and 52% for those with no postoperative external radiation (p = 0.049) . To optimize local/regional tumor control, we therefore continue to a dvise external beam radiation in patients at high risk of local/region al relapse.