External beam radiation therapy for recurrent or residual thyroid cancer: What is the best treatment time and the best candidate for long‐term local disease control?

External beam radiation therapy for recurrent or residual thyroid cancer: What is the best treatment time and the best candidate for long‐term local disease control?

Introduction Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial. Purpose To identify clinical and molecular factors associated with control of cervical disease with EBRT. Methods Retrospect...

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Published in:Head & neck Vol. 46; no. 6; pp. 1340 - 1350
Main Authors: Cavalcante, Lara Bessa Campelo Pinheiro, Treistman, Natalia, Gonzalez, Fabiola Maria Teresa Torres, Fernandes, Pollyanna Iemini Weyll, Alves Junior, Paulo Alonso Garcia, Andrade, Fernanda Accioly, Ferreira, Elisa Napolitano, Brito, Tarcisio Fontenele De, Pane, Attilio, Corbo, Rossana, Erlich, Felipe, Bulzico, Daniel Alves, Vaisman, Fernanda
Format: Journal Article
Language:English
Published: Hoboken, USA John Wiley & Sons, Inc 01-06-2024
Wiley Subscription Services, Inc
Subjects:
Adult
Aged
cervical disease
Disease control
ErbB-2 protein
external beam radiation
Female
Humans
Iodine Radioisotopes - therapeutic use
Lymph nodes
Male
Metastases
Middle Aged
Mutation
Neoplasm Recurrence, Local
Neoplasm, Residual
Patients
Radiation therapy
Retrospective Studies
Surgery
Survival
Thyroid cancer
Thyroid Neoplasms - mortality
Thyroid Neoplasms - pathology
Thyroid Neoplasms - radiotherapy
Thyroidectomy
Thyroxine
Time Factors
external beam radiation
thyroid cancer
radiation therapy
cervical disease
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Summary:Introduction Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial. Purpose To identify clinical and molecular factors associated with control of cervical disease with EBRT. Methods Retrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed. Results Eighty adults, median age of 61 years, were included. T4 disease was present in 43.7%, lymph node involvement in 42.5%, and distant metastasis in 47.5%. Those with cervical progression were older (62.5 vs. 57.3, p = 0.04) with more nodes affected (12.1 vs. 2.8, p = 0.04) and had EBRT performed later following surgery (76.6 vs. 64 months, p = 0.05). EBRT associated with multikinase inhibitors showed longer overall survival than EBRT alone (64.3 vs. 37.9, p = 0.018) and better local disease control. Performing EBRT before radioiodine (RAI) was associated with longer cervical progression‐free survival (CPFS) than was RAI before (67.5 vs. 34.5, p < 0.01). EBRT ≥2 years after surgery was associated with worse CPFS (4.9 vs. 34, p = 0.04). The most common molecular alterations were ERBB2, BRAF, FAT1, RET and ROS1 and TERT mutation was predictive of worse disease control after EBRT (p = 0.04). Conclusion Younger patients, with fewer affected nodes and treated earlier after surgery had better cervical disease control. Combination of EBRT with MKI improved OS. TERT mutation might indicate worse responders to EBRT; however, further studies are necessary to clarify the role of molecular testing in selecting candidates for cervical EBRT.
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ISSN:1043-3074
1097-0347
1097-0347
DOI:10.1002/hed.27702