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 |
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Abstract | 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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AbstractList | 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. IntroductionCervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial.PurposeTo identify clinical and molecular factors associated with control of cervical disease with EBRT.MethodsRetrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed.ResultsEighty 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).ConclusionYounger 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. Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial. To identify clinical and molecular factors associated with control of cervical disease with EBRT. Retrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed. 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). 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. Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial.INTRODUCTIONCervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are controversial.To identify clinical and molecular factors associated with control of cervical disease with EBRT.PURPOSETo identify clinical and molecular factors associated with control of cervical disease with EBRT.Retrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed.METHODSRetrospective evaluation and molecular analysis of the primary tumor DTC patients who underwent cervical EBRT between 1995 and 2022 was performed.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).RESULTSEighty 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).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.CONCLUSIONYounger 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. |
Author | Andrade, Fernanda Accioly Alves Junior, Paulo Alonso Garcia Brito, Tarcisio Fontenele De Corbo, Rossana Ferreira, Elisa Napolitano Pane, Attilio Vaisman, Fernanda Treistman, Natalia Gonzalez, Fabiola Maria Teresa Torres Bulzico, Daniel Alves Erlich, Felipe Cavalcante, Lara Bessa Campelo Pinheiro Fernandes, Pollyanna Iemini Weyll |
Author_xml | – sequence: 1 givenname: Lara Bessa Campelo Pinheiro surname: Cavalcante fullname: Cavalcante, Lara Bessa Campelo Pinheiro organization: Universidade Federal do Rio de Janeiro – sequence: 2 givenname: Natalia surname: Treistman fullname: Treistman, Natalia organization: Universidade Federal do Rio de Janeiro – sequence: 3 givenname: Fabiola Maria Teresa Torres surname: Gonzalez fullname: Gonzalez, Fabiola Maria Teresa Torres organization: Instituto Nacional de Câncer – sequence: 4 givenname: Pollyanna Iemini Weyll surname: Fernandes fullname: Fernandes, Pollyanna Iemini Weyll organization: Instituto Nacional de Câncer – sequence: 5 givenname: Paulo Alonso Garcia surname: Alves Junior fullname: Alves Junior, Paulo Alonso Garcia organization: Instituto Nacional de Câncer – sequence: 6 givenname: Fernanda Accioly surname: Andrade fullname: Andrade, Fernanda Accioly organization: Instituto Nacional de Câncer – sequence: 7 givenname: Elisa Napolitano surname: Ferreira fullname: Ferreira, Elisa Napolitano organization: Grupo Fleury – sequence: 8 givenname: Tarcisio Fontenele De surname: Brito fullname: Brito, Tarcisio Fontenele De organization: Universidade Federal do Rio de Janeiro – sequence: 9 givenname: Attilio surname: Pane fullname: Pane, Attilio organization: Universidade Federal do Rio de Janeiro – sequence: 10 givenname: Rossana surname: Corbo fullname: Corbo, Rossana organization: Instituto Nacional de Câncer – sequence: 11 givenname: Felipe surname: Erlich fullname: Erlich, Felipe organization: Instituto Nacional de Câncer – sequence: 12 givenname: Daniel Alves surname: Bulzico fullname: Bulzico, Daniel Alves organization: Instituto Nacional de Câncer – sequence: 13 givenname: Fernanda orcidid: 0000-0002-6835-7108 surname: Vaisman fullname: Vaisman, Fernanda email: vaismanfe@gmail.com organization: Instituto Nacional de Câncer |
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Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT)... Cervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are... IntroductionCervical disease control might be challenging in advanced thyroid cancer (DTC). Indications for cervical external beam radiation therapy (EBRT) are... |
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SubjectTerms | 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 |
Title | 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? |
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