Namık Kemal Tıp Dergisi (Dec 2022)

Systemic Treatment Outcomes of Progressive Medullary Thyroid Carcinoma from the Registries of a Tertiary Cancer Center

  • Ferhat FERHATOĞLU,
  • Nail PAKSOY,
  • Mert BAŞARAN

DOI
https://doi.org/10.4274/nkmj.galenos.2022.78942
Journal volume & issue
Vol. 10, no. 4
pp. 350 – 356

Abstract

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Aim:Medullary thyroid carcinoma (MTC) originating from parafollicular C cells is a sporadic endocrine tumor. A unique aspect of the disease is that it is 25% familial and component of multiple endocrine neoplasia 2 syndromes. Surgical resection has curative potential in the early stages. Systemic treatment options are available for unresectable or advanced disease. Due to the rare and limited treatment options for the disease, we found it appropriate to share the results of our patients in our center.Materials and Methods:We enrolled 47 progressive MTC patients in the study between June 2000 and June 2019. Demographic and clinical characteristics of the patients, as well as treatment outcomes, were evaluated. Statistical analyses were performed to identify risk factors associated with survival.Results:The median age was 46 years, and the male to female ratio was 32/15. All patients’ Eastern Cooperative Oncology Group - Performance Status (ECOG-PS) was 0 (66.7%) or 1 (33.3%). While 73% of the patients had lymph node metastasis, 22% had distant organ metastasis at initial diagnosis. Local recurrence was found to be the most common progression type (80.9%). The most frequent distant metastatic sites at progression were the bone (68.1%) and lung (23.4%). From the start of systemic therapy, the median progression-free survival and median overall survival (OS) were 51.7 months and 55.6 months, respectively. Vandetanib was associated with a better OS than systemic treatments (84.7 months vs. 37.1 months, respectively; p=0.047). Patients whose ECOG-PS was 0 had better OS than those with ECOG-PS 1 (77.2 months vs. 34.4 months, respectively; p=0.002). Also, ECOG-PS was determined as an independent prognostic factor [hazard ratio (HR): 14.7; 95% confidence interval (CI): 1.7-124.7; p=0.013].Conclusion:Although the patients with progressive MTC have relatively long survival, systemic treatment options are limited. The ECOG-PS needs to be evaluated in absolute terms in patient management. In addition to tyrosine kinase inhibitors, chemotherapy and 177Lu-octreotate may be effective in selected patients.

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