Management of the patient with progressive radioiodine non-responsive disease

Differentiated thyroid cancer accounts for a majority of the nearly 200,000 people in the United States with thyroid cancer. A significant minority of patients with thyroid cancer do not respond to conventional therapy (surge ry, radioiodine, levothyroxine [LT4]). Current therapy for progressive, rad ioiodine non-responsive differentiated thyroid cancer includes surgery and external-beam irradiation (with or without low-dose weekly Adriamycin) for neck disease, and high-dose Adriamycin therapy for widely metastatic diseas e. Adriamycin therapy provides a 30% to 30% partial response of disease, bu t long-term cures are rare. Studies of combination chemotherapy do not show greater benefit than therapy with Adriamycin alone and carry understandabl y greater toxicity. Retinoic acid, octreotide, and tamoxifen therapies are currently being studied as future therapeutic possibilities. Chemotherapy m ay prove useful not only as a tumoricidal agent but as therapy for tumor re -differentiation in preparation for radioiodine therapy. (C) 1999 Wiley-Lis s, Inc.